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Evaluation and management of proteinuria and nephrotic syndrome in children: recommendations from a pediatric nephrology panel established at the National Kidney Foundation conference on proteinuria, albuminuria, risk, assessment, detection, and elimination (PARADE).

OBJECTIVE: The development of this review article evolved from a National Kidney Foundation consensus conference on recent advances in the importance of evaluating and treating proteinuria. From this conference, a series of recommendations for the evaluation of adults with proteinuria was published. Because specific pediatric aspects of the problem were outside the scope of the original National Kidney Foundation publication, an ad hoc committee of 6 pediatric nephrologists who were active participants in the National Kidney Foundation conference was established to provide primary care physicians with a concise, up-to-date reference on this subject. METHODS: The recommendations that are given represent the consensus opinions of the authors. These are based on data from controlled studies in children when available, but many of the opinions are, by necessity, based on uncontrolled series in children or controlled trials performed in adults, because controlled trials in children have not been performed to evaluate many of the treatments described. RESULTS AND CONCLUSIONS: These recommendations are intended to provide primary care physicians with a useful reference when they are faced with a young child or teenager who presents with proteinuria, whether this is mild and asymptomatic or more severe, leading to nephrotic syndrome.

Child↗

Effect of fluvastatin and dipyridamole on proteinuria and renal function in childhood IgA nephropathy with mild histological findings and moderate proteinuria.

AIM: In recent reports, some kinds of HMG-CoA reductase inhibitors were able to decrease proteinuria and to improve renal function. Here we aimed to clarify the effect of fluvastatin (an HMG-CoA reductase inhibitor) on proteinuria and renal function in children with mild IgA nephropathy. PATIENTS AND METHODS: We conducted a prospective controlled study of 30 children who had been recently diagnosed with normocholesterolemic IgA nephropathy following the detection of a minor lesion or of focal mesangial proliferation and moderate proteinuria. The 30 patients were randomly assigned to receive both of 20 mg of fluvastatin and 5 mg/kg of dipyridamole (group 1), or 5 mg/kg of dipyridamole only (group 2) for 1 year. RESULTS: By the end of the trial, urinary protein, hematuria, BUN and serum creatinine levels had significantly decreased in the patients of group 1 as compared to baseline. Serum total cholesterol, triglyceride and LDL cholesterol levels had significantly decreased, while serum total protein and albumin, and creatinine clearance had significantly increased in group 1 as compared to baseline and group 2. The urinary protein level had significantly decreased in the group 2 patients as compared to baseline, but only slightly. CONCLUSIONS: The results of this study suggest that fluvastatin and dipyridamole treatment yields an antiproteinuric effect and leads to the amelioration of renal function in moderately proteinuric patients with mild histological IgA nephropathy.

Adolescent↗

[A study of proteinuria. (12) The incidence of the patients with proteinuria, microscopic hematuria and glycosuria in Fukuoka Dental College students in 1987 and 1988].

An investigation was made on the incidence of patients with proteinuria, microscopic hematuria and glycosuria in 757 (in 1987) and in 681 (in 1988) students of Fukuoka Dental College; and the results were as follows. 1) The incidence of patients with proteinuria was 6.3% (48/757) in 1987, and 6.9% (47/681) in 1988. 2) The incidence of patients with microscopic hematuria was 4.0% (30/757) in 1987, and 5.0% (34/681) in 1988. 3) The incidence of patients with glycosuria was 0.5% (4/757) in 1987, and 0.1% (1/681) in 1988. 4) Further medical examinations were made on 33 students in 1987, and 37 students in 1988. a) 27 students in 1987 and 34 students in 1988 were diagnosed as normal respectively. b) In three cases, clinical diagnoses could not be established without long-term observation and two cases were diagnosed as urinary tract infection and a case was diagnosed as possible chronic glomerulonephritis in 1987. c) In 1988, a case was diagnosed as urinary tract infection, a case was urethritis and a case should be needed a longterm observation.

Adult↗

[Studies of enzymuria and proteinuria: Report 2; Relationship between glomerular filtration rate and urinary enzymuria and proteinuria].

Urinary splitting enzymes and proteins including N-acetyl-b-D-glucosanimidase (NAG), beta 2 microglobulin (beta 2MG), and alpha 1 microglobulin: (alpha 1MG), which are established to be useful in the evaluation of renal dysfunction, especially renal tubular impairment, were measured to determine the extent of renal tubular impairment in relation to the degree of glomerular dysfunction in patients with renal deterioration. In healthy volunteers, urinary NAG, alpha 1MG and beta 2MG levels were 3.5 +/- 1.4 (mean +/- SD) U/g creatinine, 2.5 +/- 2.0 mg/l and 88 +/- 75 micrograms/l, respectively. While serum beta 2MG level (SBMG; microgram/ml) was between 2.0 and 2.9, among the patients with renal dysfunction, NAG, alpha 1MG and BMG levels showed 8.6 +/- 5.5, 9.8 +/- 5.8 and 785 +/- 1,264, respectively, and further elevated to 10.1 +/- 5.0, 16.5 +/- 0.7 and 525 +/- 440, respectively with a SBMG level over 3.0. Thus glomerular function was deteriorated, urinary alpha 1MG level elevated to significantly higher with a parallel to renal dysfunction. In patients with more severe renal dysfunction, the corresponding urinary NAG and alpha 1MG levels became significantly higher. However, urinary beta 2MG level was significantly higher in patients with moderate renal dysfunction compared to healthy volunteers only when SBMG level was more than 2.0. Therefore, it was more valuable to measure urinary alpha 1MG with NAG or beta 2MG at SBMG level of less than 1.9 and to determine urinary NAG and alpha 1MG at greater than 2.0. These results indicated that the measurement of the levels of urinary splitting enzymes and proteins is valuable in the evaluation of proximal tubular impairment, even when the degree of glomerular impairment is minimal.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetylglucosaminidase↗