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Query: UMLS:C0033687 (proteinuria)
 24,015 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The risk to the transplanted kidney of vesicoureteric reflux was evaluated in 150 consecutive first cadaveric renal allografts surviving for over three months. Of the 119 (79 per cent) allografts studied by micturating cystography 29 (24 per cent) were shown to reflux. The presence of reflux was associated with urine leakage and reoperation, and with ureteric insertion involving a short intramural tunnel. Graft failure (graft nephrectomy or death from renal failure) occurred in 14 of 29 refluxing grafts as compared to 14 failures in 90 nonrefluxing grafts (P less than 0.01). Graft failure in the refluxing group was typically slow, and commonly associated with proteinuria, microscopic hematuria, hypertension and a biopsy appearance of mesangiocapillary glomerular change. Urinary infection, though frequent (69 per cent), was not more common in the group with than in that without reflux. Vesicoureteric reflux is an important cause of late renal-graft failure.
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PMID:Risks of vesicoureteric reflux in the transplanted kidney. 32 32

Antireflux surgery was performed in five patients with vesicoureteral reflux at a time when renal insufficiency was present. Notable proteinuria was present in four of the patients, and a kidney biopsy specimen showed glomerular lesions in one. Despite the eradication of reflux and of infection, all five patients continued to have progressive renal insufficiency culminating in renal failure. Vesicoureteral reflux nephropathy may include a glomerulopathy leading to progressive glomerular sclerosis. Antireflux surgery would not alter this ongoing process and therefore would not halt progressive renal failure.
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PMID:Irreversible renal failure following vesicoureteral reflux. 75 14

Radiological findings of segmental renal hypoplasia are reported, based on the observation of 6 children aged between 8 and 14. The leading clinical symptom is arterial hypertension. Urinary tract infection and proteinuria are additional common findings. Cases with bilateral disease often have renal failure. The intravenous urogram shows unilateral or bilateral small kidneys with segmental renal scarring and transverse lobulation. In the pathological areas the calyces are ectatic or clubbed and their infundibulum is elongated. Vesico-ureteral reflux is frequent. In angiography the lobulated segments appear hypovascular. Diagnosis was verified by histological examination.
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PMID:Segmental renal hypoplasia in childhood. 101 4

Vesicoureteral reflux and chronic pyelonephritis are usually associated with proteinuria of less than 1 gm. per 24 hours. When there is massive proteinuria an associated glomerulopathy is usually present. We describe a patient who had nephrotic syndrome with radiological evidence of ureterovesical reflux and histological evidence of chronic pyelonephritis without associated glomerulonephritis.
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PMID:Nephrotic syndrome secondary to chronic pyelonephritis and ureterovesical reflux. 124 1

This study was designed to evaluate the occurrence and the type of proteinuria in 82 children with vesico-ureteric reflux (VUR) with or without renal scars. The urinary excretion of the high molecular weight protein albumin was taken as an index of glomerular alterations and the excretion of retinol-binding protein (RBP), beta 2-microglobulin and brush border antigens (BBA) (measured by monoclonal antibody-based enzyme-linked immunosorbent assay) was taken as an index of tubular alterations. All such markers were increased in children with VUR and were related to the degree of renal function. Patients showing reduced creatinine clearance had very high levels of albuminuria, microproteinuria and BBA, with all these variables reciprocally correlated. In children with normal renal function however, only microproteins (not albumin or BBA) were slightly increased, thus indicating an isolated tubular defect without involvement of the proximal segment of the tubule. However, microprotein excretion did not correlate with the grade of scarring (99mtechnetium-dimercaptosuccinic acid scan), both RBP and beta 2-microglobulin excretion being normal in 75% of children with radioisotopic signs of renal lesions but increased in 17% of children without scars. Therefore, tubular proteinuria identifies different groups of children with VUR but is not related to renal scarring. Prospective studies will define the usefulness of proteinuria as a reliable indicator of renal outcome.
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PMID:Urinary excretion of brush border antigens and other proteins in children with vesico-ureteric reflux. 131 Nov 86

To clarify the mechanism for reflux nephropathy to progress to irreversible or marginal renal damages, this study was conducted. We studied 57 cases of VUR in children followed-up more than 3 years after anti-reflux operation and investigated the correlation between changes of urinary protein excretion and clinical data. In general, proteinuria is the most important feature heralding a poor outcome in patients with reflux nephropathy. 9 cases (15.8%) in our series were positive of proteinuria postoperatively. In this positive group, scarring grade had been higher and renal size had been smaller significantly before operation than in other group. From these facts, it would appear that prognosis of refluxing kidney was determined by volume of remnant kidney, and glomerular hyperfiltration of remnant nephron would affect the progression of reflux nephropathy. According to the relationship between changes of urinary protein excretion and scarring grade or renal size, poor prognosis (proteinuria will worsen) would be more than 5 of scarring grade score (cumulation of bilateral scarring grades, Smellie's a = 1, b = 2, c = 3, d = 4) and less than -4S.D. in cumulative renal ratio preoperatively. Then border to progression in reflux nephropathy was between 2 and 4 of scarring grade score, and between -2S.D, and -4S.D. in cumulative renal ratio. In this marginal progression urinary protein excretion and GFR were found to be 100-300 mg/day and 60-75 ml/min, respectively.
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PMID:[The progression of renal damage in reflux nephropathy--clinical analysis of proteinuria in children with vesicoureteral reflux]. 147 59

Although hypoalbuminemia is a fundamental characteristic of nephrotic syndrome (NS), there are many patients with massive proteinuria that do not develop hypoalbuminemia. We have studied the clinical and biochemical characteristics of 19 patients with persistent massive proteinuria (greater than 5 g/d) and normal serum albumin (group I) in comparison with 16 patients with similar proteinuria excretion, but persistent hypoalbuminemia (group II). Most of group I patients had diagnoses suggesting glomerular hyperfiltration (focal glomerulosclerosis [FGS] associated with vesicoureteral reflux [VUR], reduction of renal mass, proteinuria associated with obesity, sclerotic phase of idiopathic crescentic glomerulonephritis [GN] in contrast with those of group II, in which membranous GN was the most frequent diagnosis. We prospectively investigated differences in the antiproteinuric effect of captopril, an antiotensin-converting enzyme inhibitor (ACEI); after 6 months of treatment, proteinuria decreased clearly in group I (7.1 +/- 1.7 to 3.7 +/- 1.7 g/d; P less than 0.001), whereas no significant changes were observed in group II (8.1 +/- 2.4 to 8.8 +/- 4 g/d). Serum creatinine (Scr) remained stable during captopril treatment in group I, whereas three patients in group II showed a worsening of renal function.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Nephrotic proteinuria without hypoalbuminemia: clinical characteristics and response to angiotensin-converting enzyme inhibition. 199 78

Renal biopsies were performed on 25 patients with reflux nephropathy to clarify the relationship between the pathological findings and clinical parameters. Biopsy specimens were obtained at anti-reflux operation by open renal biopsy. Glomerular lesions were classified as focal, diffuse, segmental and global sclerosis. Tubulo-interstitial changes were defined according to the principle advocated by Cotran and expressed as the percentage of the lesions. The clinical parameters consisted of the grades of VUR, the grades of renal scarring, renal function and the daily urinary protein excretion. A significant relationship was noted between the grades of VUR and those of renal scarring. The percentage of global sclerosis in the kidney revealed a close relationship with the grades of VUR and the percentage of tubulo-interstitial changes but not with the renal function or the daily urinary protein excretion. Focal segmental hyalinosis and/or sclerosis (FSHS) lesions were presented in 3 of 25 cases (12%). The pathological findings of the FSHS lesions had a close relationship with the renal function and the daily urinary protein excretion and the prognosis of the kidney. The other patients without FSHS lesions displayed an unchanged renal function. Based on these observations, it is clear that the prognosis of the patients with vesico-ureteral reflux could be predicted from the histopathological findings; the presence of FSHS lesions suggests a poor prognosis for the kidney. The degree of daily proteinuria represents a useful parameter for evaluating the progression of the reflux nephropathy.
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PMID:Studies on reflux nephropathy--clinical investigation of renal lesions. 235 59

Vesicoureteral reflux (VUR) is mainly a primary phenomenon due to incompetence of the ureterovesical junction, mostly affecting a pediatric population. During micturition cystourethrography (MCU) reflux into the kidney--intrarenal reflux (IRR)--is occasionally seen. In areas with IRR the kidney surface may subsequently be depressed and the papillae retracted (reflux nephropathy (RN]. VUR may lead to hypertension and/or end-stage renal failure. Most commonly, VUR is discovered during evaluation for urinary tract infection, but it may also be present in patients with hypertension, toxemia of pregnancy, chronic renal failure and proteinuria, and it may be found in siblings of patients with VUR. For the time being VUR is demonstrated at radiographic MCU, whereas RN is diagnosed by demonstration of focal scars and of abnormal parenchymal thickness at urography. In children with VUR and no abnormalities of calyces or parenchymal defects standardized measurement of the parenchymal thickness at three sites may identify kidneys which are likely to develop focal scars. Quantitation of focal scarring should be performed in connection with a measure of the overall kidney size. The occurrence of IRR is dependent of the papillary morphology, intrapelvic pressure and urine flow. There may be an important relationship between renal ischemia and IRR in producing a 'vicious circle of deleterious effects' which, combined with parenchymal extravasation, may lead to RN. Treatment of VUR includes medical and surgical management. Since renal scarring may occur in infancy, prevention should focus on infants and young children. Infants and young children with severe VUR may have normal urograms. Therefore a MCU should also be performed, preferably with the recommended standardized technique.
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PMID:Vesicoureteral reflux and reflux nephropathy. 388 98

Chronic pyelonephritis is secondary to urinary tract infection associated with vesico-ureteric reflux or obstructive uropathy. Pyelonephritis scarring almost always occurs in early childhood and is linked to the concomitant presence of urinary tract infection and renal papillae allowing intrarenal reflux. When bilateral, pyelonephritis scarring may lead to end-stage renal disease. Destruction of the renal parenchyma occurs over years and is often accompanied by arterial hypertension and proteinuria. Surgical correction of vesico-ureteric reflux does not prevent further renal scarring. Since sterile reflux does not appear to be harmful, it is important to diagnose vesico-ureteric reflux early and prevent urinary tract infection by administering chemoprophylaxis during the first seven years of life.
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PMID:[Importance of vesico-ureteral reflux in the pathogenesis of chronic pyelonephritis]. 634 Jan 86


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