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

Vesicoureteric reflux (VUR) into transplanted kidneys has been cited as an often disregarded but frequent complication of transplantation which is associated with a glomerular lesion that resembles membranoproliferative glomerulonephritis, marked proteinuria, and graft failure. To determine the prevalence of this complication in our transplant population, all of our 23 patients with marked proteinuria and 27 controls without proteinuria had voiding cystourethrograms performed approximately two years after transplantation. In our population, VUR was infrequent (8%). Moreover, in the three of the four cases detected renal function has not deteriorated and three of the four do not have marked proteinuria. We cannot confirm the suggestion that VUR is a frequent cause of late renal allograft failure.
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PMID:Does vesicoureteric reflux result in renal allograft failure? 699 80

Gross vesico-ureteric reflux is the essential pathogenetic factor in the etiology of the small, scarred kidney of non-obstructive, chronic pyelonephritis (reflux nephropathy). 18 (12.5%) of 144 patients entering a dialysis-transplant programme had end-stage reflux nephropathy. The majority of patients initially presented with severely impaired renal function, hypertension and significant proteinuria. Documented urinary tract infections had only occurred in one-third of the patients. 8 of the 12 women presented during a pregnancy, usually with a presentation resembling toxaemia of pregnancy. Reflux nephropathy is a significant cause of end-stage chronic renal failure.
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PMID:End-stage reflux nephropathy. 726 18

Urinary tract infections are among the most frequently encountered health problems in patients of family physicians. The diagnosis requires the demonstration of more than 100,000 bacterial colonies per milliliter in a freshly voided urine specimen. Dysuria, proteinuria, and pyuria are unreliable diagnostic criteria. The pathogenesis is uncertain although vaginal colonization with enteric bacteria, voluntary avoidance of urination, and sexual intercourse are contributing causes. Vesicoureteral reflux is related to recurrent infection but a causal relationship has not been established. Urinary tract infection in children is related to decreased renal growth and kidney scars, but therapy of the infections does not prevent kidney damage. Infections disappear spontaneously in up to 40 percent of adult women. Bacteriuria in pregnancy, however, is related to low birth weight in infants and increased perinatal mortality. Asymptomatic bacteriuria need not be diagnosed or treated except in pregnant women. For symptomatic infections, short-term antibiotic therapy is as effective as long-term therapy. Prophylactic antibiotics and therapy by modification of behavior using a multifaceted regimen can reduce the frequency of recurrent infection.
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PMID:The spectrum of urinary tract infections in family practice. 741 Oct 63

Reflux nephropathy is an important cause of chronic renal failure in children. After the parenchymal scar, the progression is thought to be mediated by glomerular hypertension in remnant nephrons resulting in modifications in permselectivity to macromolecules. Proteinuria correlates with a progressive course. The glomerular permselectivity to macromolecules in basal conditions and after acute hemodynamic stress was investigated in 28 children whose bilateral vesico-ureteric reflux (VUR) had been previously surgically corrected (meanly 5.6 years before) and with normal creatinine clearance (CrCl). Bilateral renal scarring (0 to 8 scale for both kidneys) was 4.3 +/- 1.6. Albuminuria (UAE) was evaluated in basal conditions and under acute hyperfiltration induced by amino acid (Aa) infusion. After isotonic saline at 310 ml/hour/1.73 m2, 6 mg/kg/min of Aa were infused for 2 hrs. UAE was significantly higher than controls in basal conditions (p < 0.01), and further increased after Aa infusion (p < 0.02). Microalbuminuria was detectable in 53.5% of the children in basal conditions and in 64.3% after Aa. Also urinary beta 2 microglobulin significantly increased at the end of the test (p < 0.001). CrCl significantly increased at the first hour (p < 0.05). Children with severe renal parenchymal scarring had greater UAE (p < 0.01) and beta 2M (p < 0.02) values after provocative test than those with mild renal damage. In 8 children GFR and ERPF were measured by means of inulin and p-hippurate clearance respectively. The variations in UAE during Aa infusion were significantly correlated with GFR dynamics (p < 0.05) while they were not influenced by ERPF modifications.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Glomerular permselectivity to macromolecules in reflux nephropathy: microalbuminuria during acute hyperfiltration due to aminoacid infusion. 829 36

Vesicoureteral reflux can lead to chronic pyelonephritis, renal scarring, and renal failure. We present a case of renal scarring masquerading as bilateral, complex renal masses. A 35-year old woman who was diagnosed with vesicoureteral reflux as a child presented for evaluation of recently developed hypertension and an abnormal renal ultrasound. Her serum creatinine level was 2.5 mg/dL and she had subnephrotic-range proteinuria. A renal sonogram showed small, echogenic kidneys and bilateral complex renal masses of 3.8 (right) and 4.4 (left) cm in greatest dimensions. CT scan of the kidneys revealed slightly contrast-enhancing masses with irregular walls. Renal angiogram showed decreased blood supply to the areas coinciding with the masses consistent with renal scarring. There was no increased vascularity. This case demonstrates that renal scarring may masquerade as renal masses. A step-wise, comprehensive approach is necessary to rule out potentially malignant lesions in these patients.
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PMID:Renal scars masquerading as complex masses in a patient with vesicoureteral reflux nephropathy. 1141 54

Renal damage in children has been found to be more congenital in origin than was previously thought. Congenital anomalies of the kidney and urinary tract (CAKUT) involve renal dysplasia, renal hypoplasia, urinary tract obstruction and vesicoureteral reflux. CAKUT are sometimes bilateral and different types often coexist. Depending on their types and severity, children with CAKUT often have varying degrees of a reduced number of nephrons at birth. CAKUTare now the leading cause of renal failure in children. Children with renal dysplasia or obstructive uropathy may have abnormal renal tubules, and tend to lose essential water and sodium in urine. This can lead to poor body growth unless they are supplemented with water and sodium. Children with severe ureteric reflux often develop urinary infection and renal scarring. Renal scarring can further increase the risk of renal failure in children who already have other CAKUTand fewer nephrons than normal. Hypertension and proteinuria may develop in children with renal dysplasia and further aggravate renal function unless they are treated. Recent advances in the understanding and management of CAKUT make it possible for children with CAKUT to grow normally, have fewer complications such as urinary infection, have longer renal survival, and survive even with end-stage renal diseases through renal replacement therapy.
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PMID:Medical management of congenital anomalies of the kidney and urinary tract. 1452 48

Posterior urethral valves are the most common cause of congenital obstructive uropathy, resulting in renal failure in childhood. Nowadays, in most cases, diagnosis is suggested by antenatal ultrasound. However, antenatal intervention has not resulted in a significantly improved outcome. Endoscopic valve ablation is the initial treatment in most of these neonates, but others procedures, like vesicostomy or ureterostomy, can also be justified in some particular cases in order to improve renal function prognosis. Different factors like bladder dysfunction, VUR, polyuria and proteinuria, can be responsible for the slow and progressive deterioration in renal function that some of these patients show over the years. By treating them all, we may prevent or delay the onset of end stage renal disease.
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PMID:Initial and long-term management of posterior urethral valves. 1555 86

Urinary tract infection (UTI) is one of the most common childhood bacterial infections, after upper respiratory tract and middle ear infections. The current goal of management is to prevent detrimental effects of UTI by early detection and treatment. Recommendations for the imaging of children depend upon age at presentation and sex. All children aged <5 years who have had a febrile UTI require a radiologic evaluation to identify any underlying genitourinary pathology. Older children can undergo a more tailored work-up depending on whether there is a febrile UTI or cystitis-type symptoms. Dysfunctional voiding and urge syndrome significantly increase the risk of developing UTIs in children. Vesicoureteral reflux can increase the risk of pyelonephritis and renal scarring in children with UTIs. For the most part, pyelonephritis can be diagnosed on clinical grounds in the majority of patients and a subsequent (99m)Tc-dimercaptosuccinic acid scan can be reserved to identify post-nephritic renal scarring. When renal scarring is identified, the child and parents need to be educated regarding the possibility of hypertension, proteinuria, progressive nephropathy, and the risk of complications in future pregnancies. Treatment of UTI is started in the unwell child before the culture results are available and subsequently changed to culture-specific antimicrobial therapy. A short course of treatment is required for acute uncomplicated UTIs. A child with acute pyelonephritis requires 10-14 days of antibacterial treatment. The oral route in young children often causes vomiting, which implies therapeutic delay, a well known risk factor for scarring.
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PMID:Controversies in the diagnosis and management of urinary tract infections in children. 1635 21

Fifty-six children (35 boys and 21 girls) below the age of 12 years with primary Vesicoureteric reflux (VUR) detected by voiding cystourethrogram after an initial episode of documented urinary tract infection (UTI), were studied prospectively for a period of 6-12 years (Mean 8 years) with reference to scarring, grade of reflux, break-through infections, adverse effects to prophylactic drugs and clinical and laboratory evidence of renal failure. The mean age at presentation was 1.95 years. Grade I-V reflux occurred in 7.1%, 28.6%, 48.2%, 12.5%, 3.6% respectively. Thirty-one (55.3%) had detectable renal scars on dimercaptosuccinic acid (DMSA) scan. All of them were treated with low dose prophylactic antibiotics until the age of 5 years. None had any major adverse effects to the prophylactic antibiotics. Ten (17.9%) had breakthrough UTI while on prophylaxis and 3 (5.4%) had UTI after discontinuing prophylaxis at 5 years of age. Two patients underwent ureteric reimplantation. Clinical and laboratory evidence of renal failure was not observed during the follow up period. Systolic blood pressure of all patients was below the 90th percentile for age. One had significant proteinuria. Majority of this cohort of patients with varying degrees of reflux nephropathy were managed conservatively with regular monitoring and low-dose prophylactic antibiotic therapy.
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PMID:Long-term clinical follow up of children with primary vesicoureteric reflux. 1652 6

Vesicoureteral reflux (VUR) in children is associated with increased risk of urinary tract infection (UTI). Recurrent UTI in the presence of the VUR is believed to cause renal scarring, which carries a risk of subsequent hypertension, toxemia of pregnancy, and significant renal damage, including end-stage renal disease. The natural history of VUR is to improve or resolve completely with time in most of the patients. The traditional management consists of prompt treatment of UTI, long-term anti-microbial prophylaxis until the VUR resolves, or surgical intervention in those with persistent high grade VUR, recurrent UTI in spite of prophylaxis with anti-microbial agent, allergy to anti-microbial agents, and patient/parent non-compliance with the medical management. Voiding dysfunction and constipation play an important role, and their diagnosis and appropriate management helps reduce the frequency of UTI and promote the resolution of the VUR. Patients with renal scarring need to be monitored for potential complications such as hypertension, proteinuria, and progression of the renal damage. In patients with hypertension and/or proteinuria, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) are the drugs of choice, because of their reno-protective properties. Recent studies have revealed that there is no convincing evidence that UTI in the presence of VUR predicts renal injury or that the use of long-term anti-microbial prophylaxis or surgical intervention prevents renal scarring or its progression. However, until proven otherwise by a prospective, placebo-controlled, randomized study, it is advisable to err on the side of caution and consider VUR and UTI risk factors for renal scarring and treat each patient on individual basis.
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PMID:Medical management of vesicoureteral reflux--quiz within the article. Don't overlook placebos. 1748 66


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