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PubMed2006

Proteinuria with and without renal glomerular podocyte effacement.

Renal biopsies of patients with proteinuria and kidney disease most often are associated with podocyte foot process effacement. For several decades, nephrologists have wondered whether proteinuria is a result of podocyte foot process effacement or the cause of it. In the past few years, the author's laboratory has addressed this issue using different mouse models of proteinuria. Although in most cases, podocyte effacement is associated with proteinuria and glomerular disease, in three different mouse models, it was demonstrated that proteinuria can be observed without podocyte foot process effacement. The first model is generated by injection of antibodies to vascular endothelial growth factor or soluble vascular endothelial growth factor receptor 1. The second model is a mouse with deletion of type IV collagen alpha3 chain in the glomerular basement membrane. The third model was generated by genetic deletion of a slit diaphragm protein known as nephrin. Collectively, these experiments and the supporting evidence from several human studies demonstrate that severe defects in either the glomerular basement membrane or the glomerular endothelium can lead to proteinuria without foot process effacement.

Adult↗
PubMed1997

Danaparoid sodium lowers proteinuria in diabetic nephropathy.

Diabetic nephropathy is a progressive renal disease with thickening of the glomerular basement membrane and mesangial expansion and proliferation as histological hallmarks. The presence of the glycosaminoglycan side chains of heparan sulfate proteoglycan, an important constituent of the glomerular basement membrane, is decreased in diabetic nephropathy proportionally to the degree of proteinuria. Danaparoid sodium is a mixture of sulfated glycosaminoglycans consisting mainly of heparan sulfate. The study presented here involved performing a randomized placebo-controlled crossover study with danaparoid sodium in diabetic patients with overt proteinuria. The aim of the study was to evaluate the effect on proteinuria and safety/tolerability. Nine patients completed the study, without major side effects; the crossover study consisted of two 6-wk periods of treatment with 750 anti-Xa units danaparoid sodium subcutaneously once-daily or placebo. Following danaparoid sodium, significant declines of both albuminuria and proteinuria were found. After danaparoid sodium, the albumin excretion ratio standardized for urinary creatinine reduced with 17% in comparison with an increase of 23% after placebo (95% confidence interval of the difference,-75.9-3.9%; P = 0.03). The percentage change of the urinary protein excretion corrected for urinary creatinine differed at 8 wk significantly between both treatment arms (P = 0.001). Additional parameters for safety as hematological, hemostasis, biochemical parameters, and fundusphotography did not show any clinically significant difference for both groups. Only two patients had minor skin hematomas at the injection site while using danaparoid sodium. In conclusion, the supplementation was found to be feasible and was not associated with side effects. A significant decline of proteinuria was found. More prospective dose-finding and long-term studies must be performed to see whether danaparoid sodium could not only induce a reduction of proteinuria but also halt the progression of renal disease.

Adult↗
PubMed1997

Contrasting effects of calcium channel blockade versus converting enzyme inhibition on proteinuria in African Americans with non-insulin-dependent diabetes mellitus and nephropathy.

Hypertension is a common finding in non-insulin-dependent diabetes mellitus (NIDDM) nephropathy. African Americans have a high prevalence of NIDDM and hypertension, and are relatively resistant to the antihypertensive effects of converting enzyme inhibitors (CEI) but respond well to calcium channel blockers (CCB). In the long-term study presented here, the effects of isradipine, a dihydropyridine calcium antagonist, on the course of the nephropathy were investigated and compared with the effects of captopril in 31 African Americans with NIDDM and proteinuria (> or = 500 mg/day). The patients were stratified by levels of GFR and proteinuria, and they were randomized to receive isradipine (N = 16) or captopril (N = 15); doses were adjusted to maintain similar BP levels (< 140/90). At 6 months, mean arterial pressure was similar (102 +/- 3 and 104 +/- 3 mm Hg in the isradipine and captopril groups, respectively) and GFR was unchanged (delta = -4 +/- 3 and +1 +/- 3 ml/min/1.73 in the isradipine and captopril groups, respectively; P = NS). However, proteinuria in the isradipine group increased by approximately 50% (2.01 +/- 0.40 versus 3.04 +/- 0.70 mg/mg creatinine at baseline versus 6 months, respectively, P < 0.05), whereas captopril reduced proteinuria by 30% after 6 months (2.85 +/- 0.70 at baseline versus 2.30 +/- 0.70 mg/mg creatinine, P < 0.05). Dietary protein, sodium intake, and HbA1C levels were similar in both groups and did not differ from baseline. It was concluded that over 6 months, captopril reduces and isradipine increases proteinuria in African Americans with NIDDM and nephropathy. Whether this contrasting effect on proteinuria will result in different rates of progression is not known, but dihydropyridine CCB should be used cautiously in African Americans with diabetic nephropathy.

Adult↗
PubMed1998

Effects of the angiotensin II antagonist valsartan on blood pressure, proteinuria, and renal hemodynamics in patients with chronic renal failure and hypertension.

Angiotensin II receptor antagonists have become clinically available for the treatment of arterial hypertension. Presently, there is little information about their effects on BP, proteinuria, and renal function in patients with moderate or advanced renal failure. This study examines the effects of the angiotensin II antagonist Valsartan (80 mg/d) on proteinuria and glomerular permselectivity in patients with chronic renal failure during a 6-mo treatment, using a double-blind, randomized, placebo-controlled study (treatment group [V-group]: n = 5, age 57 +/- 7 yr, serum creatinine 365 +/- 122 micromol/L; placebo group [P-group]: n = 4, age 62 +/- 11 yr, serum creatinine 346 +/- 61 micromol/L). Study parameters included BP, 24-h proteinuria, GFR, and effective renal plasma flow (ERPF) as determined by inulin and para-aminohippurate clearance. Changes in glomerular permselectivity were assessed by measuring the fractional clearances of neutral dextrans by HPLC gel-permeation chromatography. Valsartan lowered the mean arterial pressure on average by 13 +/- 7 mmHg during the 6-mo treatment (P < 0.05). GFR and ERPF remained almost unchanged. However, after 6 mo of Valsartan treatment, proteinuria was reduced by 396 +/- 323 mg/24 h (26 +/- 18%) and albuminuria by 531 +/- 499 mg/24 h (41 +/- 21%) with regard to baseline values (P < 0.05). In the P-group, both proteinuria and albuminuria increased slightly with time (by 30 +/- 43% and 30 +/- 54%, respectively, NS). The fractional clearances of high molecular weight dextrans >66 A were significantly reduced after 6 mo of Valsartan treatment (P < 0.05), indicating a reduction of the glomerular shunt volume by 54 +/- 20% (P < 0.05) according to the model of Deen et al. (Am J Physiol 249: 347-389, 1985). The mean pore size radius of the glomerular membrane remained unchanged. This effect was independent of glomerular hemodynamic changes. Valsartan persistently lowered proteinuria in patients with chronic renal failure. Although GFR and ERPF remained nearly stable, this effect could be attributed to an improvement in glomerular permselectivity.

Aged↗
PubMed1987

Declining incidence of persistent proteinuria in type I (insulin-dependent) diabetic patients in Denmark.

The decreasing relative mortality among type I (insulin-dependent) diabetic patients during the last 50 years might be related to the incidence of clinical diabetic nephropathy. We therefore followed 2890 type I diabetic patients (1607 males and 1283 females) diagnosed between 1933 and 1972 and before the age of 31, from admission to death, emigration, or January 1, 1984. All patients had been admitted to the Steno Memorial Hospital. Information on development of proteinuria was obtained in 2658 patients (92%). Five hundred twenty-five patients developed proteinuria due to diabetes and 49 developed nondiabetic proteinuria. When comparing patients diagnosed between 1933 and 1942 with those diagnosed between 1953 and 1962, the incidence of proteinuria decreased by 30% (P less than .03). This might explain the decrease of relative mortality in type I diabetic patients. The incidence decreased with increasing age at onset but was always highest in males. Insulin dose (U/kg) and diabetes duration at admission did not influence the incidence of proteinuria. The incidence peaked after 15-17 yr of diabetes duration independent of sex, age at diagnosis, or calendar year of diagnosis. However, the majority of patients did not develop proteinuria during 40 yr of diabetes. This suggests individual renal susceptibility to the deleterious effect of hyperglycemia.

Denmark↗
PubMed1993

Incidence of gross proteinuria in older-onset diabetes. A population-based perspective.

A few population-based studies describe the incidence of gross proteinuria in people with diabetes. We performed a population-based study in southern Wisconsin of diabetic individuals diagnosed at > or = 30 yr of age either taking insulin (n = 398) or not taking insulin (n = 441). The presence of gross proteinuria (> or = 0.3 g/L) was determined by means of a reagent strip. The incidence of proteinuria in the 4-yr interval was 17.3% (95% CI 13.6-21.0) in those taking insulin and 10.7% (95% CI 7.8-13.6) in those not taking insulin. The relative risk of developing proteinuria for those in the highest level of total pack-yr smoked compared with those who had never smoked was 2.0 (95% CI 1.2-3.3) for those taking insulin and 2.5 (95% CI 1.3-4.5) for those not taking insulin. After controlling for other risk variables, the incidence of gross proteinuria was also associated with higher GHb. These data suggest that smoking and glycemic control, both potentially modifiable factors, are significant risk factors for the development of gross proteinuria.

Adult↗
PubMed2004

The effect of trandolapril and its fixed-dose combination with verapamil on proteinuria in normotensive adults with type 2 diabetes.

OBJECTIVE: To compare the effect of fixed-dose trandolapril-verapamil (FDTV) with that of trandolapril on proteinuria in normotensive, type 2 diabetic patients. RESEARCH DESIGN AND METHODS: A total of 60 normotensive, type 2 diabetic patients with 24-h proteinuria >300 mg were randomly assigned to two groups for open-label treatment. One group received 2 mg trandolapril/180 mg verapamil FDTV once daily; the other group received 2 mg trandolapril once daily. Study drugs were administered for 6 months in both groups. Creatinine clearance and 24-h urinary protein excretion were measured at the beginning and the end of the study. Patients were evaluated monthly for blood pressure, fasting blood glucose level, heart rate, and adverse events. Statistical analysis was performed using ANOVA. RESULTS: Both groups experienced a statistically significant (P < 0.005) mean decrease in mean proteinuria from baseline: FDTV ([mean +/- SD] 1200 +/- 200 to 540 +/- 79 mg; P < 0.001) and trandolapril (1,105 +/- 212 to 750.9 +/- 134 mg; P < 0.005). A significantly greater reduction from baseline in proteinuria was observed in the FDTV group compared with the trandolapril group. Patients who received trandolapril experienced a statistically significant (P < 0.05) decrease in mean creatinine clearance (91.1 +/- 3.4 to 75.3 +/- 3 ml/min; P < 0.05) compared with patients who received FDTV (88.3 +/- 3.6 to 82.9 +/- 3.5 ml/min; P > 0.05). Final fasting blood glucose was significantly lower in the FDTV group (139 +/- 19) compared with the trandolapril group (154 +/- 22; P < 0.001). No significant differences were observed between the two groups in mean baseline or final measurements of blood pressure, mean heart rate, or frequency of adverse events. CONCLUSIONS: Our results suggest that FDTV is more effective than trandolapril in reducing proteinuria in normotensive, type 2 diabetic patients. This effect on proteinuria is not related with blood pressure reduction.

Angiotensin-Converting Enzyme Inhibitors↗
PubMedDate not supplied

Significance of proteinuria in type 2 diabetic patients treated at a primary health care center in Abha City, Saudi Arabia.

The aim of the present study is to describe the prevalence of proteinuria in a series of type 2 diabetic patients registered and followed up in the diabetes clinic of a primary health care center (PHCC) in Abha city, southern Saudi Arabia and to relate the proteinuria to some clinical manifestations. The study involved the files of 208 diabetic patients (118 females and 90 males). They were chosen from 475 files of diabetic patients receiving care in the PHC center of Shamasan in Abha City. The selection for this study was based on the fulfillment of certain criteria: type 2 diabetic patients, registered for at least 12 months and visited the clinic for at least once during that period. For each patient the age, sex, family history, diabetes duration, body mass index, the last readings of fasting blood sugar, total cholesterol level, systolic and diastolic blood pressure were used. Proteinuria was considered whenever the last and any of the preceding 3 urine analysis revealed it by the dipstick test provided the patient was not suffering on the day of the test from fever, urinary tract infections, other renal diseases or congestive heart failure. Further, the last recorded subjective evaluation of the treating physician concerning diet, drug and appointment compliance as poor or good was used. The mean age is 56.2+/-8.8 years. The mean duration of diabetes was 9.6+/-4.7 years, while the fasting blood sugar shows a considerably high mean of 218.0+/-72.0 mg/dl. The total cholesterol level on the other hand showed a slight high average of 233.7+/-55.2 mg/dl. The mean systolic and diastolic blood pressure were within normal ranges (136.4+/-18.9mmHg and 87.5+/-10.8mmHg) respectively. The results of the three different types of compliance as scored by the treating physician. The poor scores dominate with 74%, 82.7% and 78.4% of patients' diet, drug and appointment compliances. Proteinuria is present in more than half of the patients (54.3%). The outcome of the logistic regression model for proteinuria showed that the significant factors were the poor glycemic control with an odds ratio (OR) of 3.13, diabetes duration (OR= 1.08 for every year) and diastolic blood pressure (OR= 6.11). The overall model prediction was 72.12%. Diabetic patients treated in the PHC level should be regularly monitored for microalbuminuria and not gross proteinuria to prevent progression to overt nephropathy which will eventually lead to ESRD. The risk increases with poorly controlled and hypertensive patients.

Diabetes Mellitus, Type 2↗
PubMed2005

[The use of a simple algorithm to improve proteinuria diagnosis in clinical laboratories].

BACKGROUND AND OBJECTIVE: When proteinuria appears, a differential diagnosis must determine its origin. The object of this work has been to evaluate the results after the laboratory implantation of an algorithm for the screening and diagnosis of proteinuria. MATERIAL AND METHODS: From a total of 30,718 processed urines, a 30 mg/dl or higher protein concentration was obtained in 639, recommending a new sample to confirm and differentiate proteinuria. We received 207, to which total protein, creatinine, albumin and alpha-1-microglobulin were quantified, together with pseudoperoxidase and leukocyte esterase from dipstick. The results were introduced in an expert system (UPES and its application Protis), allowing differentiate hematuria, leukocyturia and proteinuria and suggesting the assessment of other parameters, like IgG, alpha-2-macroglobulin, light chain kappa/lambda, when necessary. RESULTS: From 207 urinalysis assayed for selective proteinuria, 39 were normal, 96 were classified as primary glomerulopathy, 26 as secondary glomerulopathy and 5 as tubulo-interstitial nephropathy. A differential diagnosis of hematuria was made in 58 of these urines. Besides, kappa light chains were detected in a sample from a patient with a normal serum protein graph, which were confirmed by immune fixation. CONCLUSION: With the proposed algorithm, the information obtained from a urine sample increases substantially, allowing detection and differentiation of proteinuria and providing suggestions for the clinical evaluation of the patient.

Algorithms↗
PubMedDate not supplied

Quantification of proteinuria with urinary protein to osmolality ratios in children with and without renal insufficiency.

BACKGROUND: Spot urine is recommended as an accurate method to determine proteinuria in children and adults. However, urinary excretion of creatinine may vary in newborns and spot urine may be influenced by the hydration-dehydration condition of patients. The study was done to assess the validity of the urine protein to osmolality ratio versus the urine protein to creatinine ratio in health and disease conditions. METHODS: We studied the correlation of the urine protein-osmolality ratio (Uprot/Uosm) and the urine protein to creatinine ratio (Up/Ucr) and compared results with the 24-hour urinary protein excretion. Three groups were compared: children with normal renal function and without proteinuria (group 1, n=53), children with normal renal function and with proteinuria (group 2, n=52) and patients with renal insufficiency (group 3, n=45). Early morning urine samples and 24-hour urine specimens were collected for protein, creatinine, and osmolality. RESULTS: The optimal cutoff value of the Uprot/Uosm ratio was determined to be 0.33 mg/L/mosm/kg H2O for abnormal proteinuria and 1.75 mg/L/mosm/kg H2O for nephrotic range proteinuria. In comparing ROC curves, we found no differences between the Uprot/Uosm and Up/Ucr ratios in detecting abnormal proteinuria or nephrotic syndrome in children with normal or decreased renal function (P>0.05). CONCLUSION: Both the Uprot/Uosm and Up/Ucr ratios from random urine specimens are good predictors of 24-hour urinary total protein excretion in children with and without renal insufficiency.

Child↗
PubMed2005

The link between circulating markers of endothelial function and proteinuria in patients with primary glomerulonephritis.

INTRODUCTION: It is well established that there is an increase in the incidence of cardiovascular mortality in patients with proteinuric renal disease. The magnitude of the increase in risk is unlikely to be explained by traditional risk factors for cardiovascular disease alone. Proteinuria itself may constitute an additional risk factor, and proteinuric patients are known to have a degree of endothelial dysfunction. The nature of this relationship between proteinuria and endothelial function is the subject of intense investigation. AIM: The aim of this study was to examine the relationship between proteinuria and endothelial dysfunction, as reflected by serum von Willebrand factor (vWF), and the soluble cell adhesion molecules VCAM and ICAM, in patients with primary glomerulonephritis (GN). A secondary aim was to discern whether any relationship could be explained by renal function, lipid profile, inflammation or blood pressure. METHODS: A cross-sectional study was undertaken in consecutive patients attending a general nephrology clinic with biopsy-proven primary GN. Patients with end-stage renal disease (ESRD), those on immunosuppressive drugs, or with intercurrent infective illnesses were excluded. Blood pressure and body mass index were recorded. Routine lab assays were undertaken for serum creatinine, lipid profile, and 24-hour urinary protein (U(Prot)). Additional serum samples were stored at -80 degrees C for subsequent measurement of vWF, VCAM, ICAM and sensitive C reactive protein (sCRP). RESULTS: Data were collected from 129 (86 male) patients. Mean (standard deviation) estimated creatinine clearance was 64 (32) ml/min, and median (interquartile range) 24-hour proteinuria was 1.1 (0.22-2.9) g. Mean vWF was 173 (68) IU/dl, median VCAM, ICAM and sCRP were 594 (410-708) ng/ml, 235 (208-286) ng/ml, and 2.33 (0.83-5.68) mg/l, respectively. There was a significant positive correlation between vWF and U(Prot) (Spearman rank correlation, r = 0.41, p < 0.001). When split into tertiles, according to U(Prot) (0-500 mg, 500-2000 mg, and > 2000 mg), there was a significant, stepwise increase in mean vWF (p < 0.001), log VCAM (p < 0.001), and log ICAM (p = 0.002). On multivariate analysis with vWF as the continuous dependent variable, U(Prot), age, total cholesterol and sCRP were the only significantly independent correlates (model-adjusted R2 = 33%). CONCLUSION: In patients with primary GN, there is a significant association between endothelial activation as reflected by vWF, VCAM, or ICAM and increasing proteinuria. Elevations in vWF, as well as being related to classical risk factors, are associated with increases in total proteinuria and low-grade inflammation. Thus, future prospective studies should examine the extent to which vWF and other circulating markers of endothelial activation predict coronary heart disease risk in patients with proteinuric renal disease.

Adult↗
PubMed1984

Proteinuria in gold-treated rheumatoid arthritis.

Treatment records of 1800 patients with rheumatoid arthritis who were included in the clinical trials of auranofin in the United States were examined for data on development of proteinuria. Three percent (41) of 1283 auranofin-treated patients had an abnormal 24-hour urine protein level: 15 had mild (0.15 to 1 g/d), 17 had moderate (1 to 3.5 g/d), and 9 had heavy (greater than 3.5 g/d) proteinuria. Permanent renal impairment did not occur, and proteinuria did not persist beyond 12 months in most patients. Seven of eight patients who were rechallenged when the proteinuria had cleared were able to continue treatment without relapse. No clinically discernible risk factors were found. Biopsy specimens from 4 patients showed membranous glomerulonephritis, which indicates an underlying immunopathologic mechanism. In similar groups of patients, the risk of developing proteinuria with auranofin therapy is significantly less than that with parenteral gold therapy (p less than 0.05) and similar to that with background therapy with nonsteroidal antiinflammatory drugs (p = 0.92). The lower incidence and relatively benign nature of proteinuria seen in this review support previous findings that auranofin is better tolerated than injectable gold.

Adult↗
PubMed2002

Nutcracker syndrome in children with orthostatic proteinuria: diagnosis on the basis of Doppler sonography.

OBJECTIVE: To evaluate the Doppler sonographic findings of the left renal vein in children with orthostatic proteinuria in comparison with healthy children and to propose more reliable sonographic criteria for diagnosing nutcracker syndrome in children. METHODS: Doppler sonographic findings in 47 children with orthostatic proteinuria and in 27 healthy control subjects were compared. The diagnosis of orthostatic proteinuria was made on the basis of clinical and laboratory findings. The peak velocity and anteroposterior diameter were measured at the hilar and aortomesenteric portions of the left renal vein. The means +/- 2 SD of the anteroposterior diameter ratio and peak velocity ratio between the 2 portions were calculated for control subjects and used as the cutoff levels for nutcracker syndrome. RESULTS: The peak velocity ratios between aortomesenteric and hilar portions were 5.21+/-2.55 in the patient group and 2.57+/-0.70 in the control group. The anteroposterior diameter ratios between the 2 portions were 5.31+/-2.65 in the patient group and 2.77+/-0.69 in the control group. We set the cutoff level of anteroposterior diameter and peak velocity ratios for the diagnosis of nutcracker syndrome at mean +/- 2 SD of the value for the control group (3.98 for the peak velocity ratio and 4.16 for the anteroposterior diameter ratio). When these cutoff levels were applied, the patients with orthostatic proteinuria had abnormal levels of anteroposterior diameter in 27 (57.4%) of 47, peak velocity in 30 (63.8%) of 47, and both in 23 (48.9%) of 47. CONCLUSIONS: Nutcracker syndrome may be an important cause of orthostatic proteinuria in children. Doppler sonography of the left renal vein may be a useful screening tool in patients with suspected orthostatic proteinuria to evaluate whether the cause is nutcracker syndrome.

Adolescent↗
PubMed1999

High levels of tissue factor pathway inhibitor in patients with nephrotic proteinuria.

Acquired deficiency of naturally occurring anticoagulant proteins, due to loss in the urine, has been proposed as one of the major thrombogenic alterations in nephrotic proteinuria. The aim of this study was to investigate if proteinuria may induce deficiency of tissue factor pathway inhibitor (TFPI). TFPI, protein C (PC) and antithrombin (AT) were measured in 31 patients with nephrotic proteinuria, compared with 62 age- and sex-matched controls. Plasma levels of TFPI activity, total TFPI antigen and free TFPI antigen were significantly higher in patients with nephrotic proteinuria than in controls, and none of the patients had TFPI deficiency. Intravenous injection of 7500 IU unfractionated heparin induced a significant further increase of TFPI in two patients with high pre-heparin levels. Also plasma levels of PC were significantly higher in patients than in controls. Mean AT antigen levels were not significantly different between patients and controls, and AT activity was only marginally increased with borderline significance. Three out of 31 patients had substantial acquired AT deficiency. In conclusion, proteinuria is not associated with TFPI deficiency, but with a marked increase of this anticoagulant protein. The acquired thrombophilic diathesis of patients with nephrotic proteinuria can therefore not be attributed to TFPI deficiency.

Adult↗
PubMed1999

Enalapril treatment of proteinuria in normotensive children.

A retrospective study was performed in 48 normotensive proteinuric children to evaluate the effect of enalapril (n = 17), a combination of enalapril and prednisone (n = 11) and prednisone alone (n = 20) on urinary protein excretion and systemic blood pressure. Enalapril treatment was associated with significant and persistent diminution of proteinuria from 1.32 +/- 0.23 to 0.53 +/- 0.11 and 0.44 +/- 0.07 g/day on the 4th and 8th week of treatment, respectively. Combined therapy with enalapril and prednisone resulted in a comparable significant reduction of proteinuria from a pre-treatment value of 2.06 +/- 0.42 to 0.63 +/- 0.22 and 0.52 +/- 0.17 g/day on the 4th and 8th week of treatment, respectively. In contrast to this, in the group treated with prednisone alone, proteinuria decreased significantly only from the 6th week of therapy (p < 0.02). Consequently, these children had significantly higher urinary protein losses at the 4th week of treatment as compared to patients on enalapril treatment (given either alone or combined with prednisone) (p < 0.01 and p < 0.05, respectively). Importantly, the enalapril-induced reduction of proteinuria was unrelated to variations in arterial blood pressure and no significant changes in this parameter were observed. The results indicate that enalapril can be used safety and effectively for symptomatic treatment of proteinuria in normotensive children with preserved renal function. ACE inhibitor provides additive antiproteinuric effect to corticosteroids by accelerating the rate of diminution of proteinuria. Its combination with prednisone may be of particular importance in those cases, where the degree of hypoproteinemia is a concern. (Tab. 2, Fig. 1, Ref. 29.)

Adolescent↗
PubMed2000

[Proteinuria in children: practical approach].

Significant proteinuria is not an unfinding in children. Its causes are variable. When detected by dipstick examination of urine, the proteinuria must be assessed quantitatively by measuring the urinary protein/creatinine ratio in a spot sample. Orthostatic proteinuria is the most common cause of intermittent proteinuria. Persistent glomerular or tubular proteinuria are the consequences of various glomerulopathies or tubulopathies, the prognosis of which is variable. Whether glomerular or tubular, persistent proteinuria must be fully investigated, including by renal biopsy.

Adolescent↗
PubMed2001

Prevalence of persistent asymptomatic proteinuria in HIV-infected outpatients and lack of correlation with viral load.

AIM: Human immunodeficiency virus-associated nephropathy (HIVAN) is projected to be a leading cause of end-stage renal disease (ESRD) in young African American men in the new millennium. Little is known about the early natural history of the disease, including the prevalence of asymptomatic nephropathy. The primary aim of this study was to define the prevalence of persistent asymptomatic proteinuria in a contemporary, ambulatory human immunodeficiency virus- (HIV) infected population. The secondary aim was to correlate the presence of persistent proteinuria with measures of HIV disease. METHODS: Using a readily available screening tool, the urine dipstick, we determined the prevalence of persistent asymptomatic proteinuria in the outpatient VA Connecticut (VA CT) Healthcare System West Haven HIV Clinic population. We compared the presence of persistent proteinuria with measures of HIV viral disease. RESULTS: The prevalence of persistent asymptomatic proteinuria was 14% (7 of 49 patients). The presence of persistent proteinuria was not correlated with viral load. CONCLUSIONS: A significant prevalence of occult renal disease exists in the asymptomatic HIV-seropositive outpatient population and is not correlated with viral load.

AIDS-Associated Nephropathy↗
PubMedDate not supplied

[Diabetic nephropathy: an epidemiological study based on proteinuria in a population of black African diabetics in Cotonou, Benin].

We evaluated proteinuria to determine the frequency of diabetic nephropathy and to study epidemiological aspects of this disease. We measured 24-hour urinary protein excretion in 152 diabetic patients. We recorded the age and sex of each patient, the duration of diabetes and blood glucose concentration. Proteinuria was diagnosed in 28% of the diabetic patients. The frequency of proteinuria was higher in men (33%) than in women (19%). The highest frequency (37.5%) was observed in subjects aged 70 years or over. In these patients, the higher frequency of proteinuria was associated with a longer duration of diabetes. However, proteinuria was detected in 28% of patients with diabetes diagnosed less than one year previously, suggesting a long period of undiagnosed diabetes in these subjects. Finally, proteinuria was more frequent in patients treated with insulin (42%) than in those treated orally (25%). Thus, diabetic nephropathy is a frequent complication in black diabetic patients in Cotonou. As hemodialysis and kidney transplantation are very expensive and access to these treatments is limited in developing countries, preventive measures based on optimizing patient management and the early diagnosis of diabetes and its complications are required.

Adult↗