Electrophoretic analysis (sds-page) of canine urinary proteins according to the stage of chronic kidney disease / [Análise eletroforética (SDS-PAGE) de proteínas urinárias de cães de acordo com o estágio da doença renal crônica]

Glomerular proteinuria is characterized by the loss of high-molecular-weight proteins (HMWPs), while tubulointerstitial proteinuria is characterized by the loss of low-molecular-weight proteins (LMWPs). The objective was to assess the molecular weight of urinary proteins (MWUP) in dogs with naturally acquired CKD and determine the proportion of HMWPs and LMWPs according to CKD stage. Twenty-eight dogs with CKD were recruited and divided into 4 groups based on serum creatinine (Cr) levels (group1: Cr<1,4, n=8; group2: 1,45,0, n=5). The control group consisted of 5 healthy dogs. The MWUP was determined by SDS-PAGE. The urinary protein-to-creatinine ratio (UP/C) was used to quantitatively assess proteinuria. The electrophoresis pattern revealed a proportionally greater loss of HMWPthan of LMWP in all groups with CKD and an increased loss of LMWP in group 4 (P<0.05). These results suggest a predominance of glomerular injuries throughout all stages of CKD in these dogs and an increase in tubulointerstitial injury towards the end-stage of the disease. The results of the present study support the recommendation of SDS-PAGE as an effective technique for the qualitative assessment of proteinuria, as well as a method for assessing the severity and location of renal injury.(AU)

A proteinúria glomerular é caracterizada pela perda de proteínas de alto peso molecular (PAPM), enquanto a proteinúria tubulointersticial se caracteriza pela perda de proteínas de baixo peso molecular (PBPM). O objetivo do trabalho foi determinar o peso molecular das proteínas urinárias (PMPU) de cães com DRC naturalmente adquirida e a proporção de PAPM e PBPM de acordo com o estágio da DRC. Foram utilizados 28 cães com DRC, divididos em quatro grupos, de acordo com o nível sérico de creatinina (cr) (grupo 1: cr<1,4, n=8; grupo 2: 1,45,0, n=5). O grupo controle era composto por cinco cães saudáveis. O PMPU foi determinado por SDS-PAGE. A relação proteína:creatinina urinária (RPCU) foi utilizada como um método quantitativo de proteinúria. A eletroforese revelou uma perda proporcionalmente maior de PAPM, quando comparada às PBPM, em todos os grupos de DRC, bem como uma perda crescente de PBPM no grupo 4 (P<0,05). Esses resultados sugerem uma predominância de lesão glomerular em todos os estágios de DRC nesses cães e uma progressão crescente na lesão túbulo-intersticial no estágio terminal da doença. Os resultados deste estudo reafirmam a recomendação de que a eletroforese de proteínas urinárias é uma técnica qualitativa efetiva de avaliação da proteinúria, bem como um método que permite avaliar a extensão e a localização da lesão renal.(AU)

Renal transplant patients with preformed anti-HLA antibodies: early biopsy findings and clinical outcomes / Pacientes transplantados renais com anticorpos anti-HLA pré-formados: achados precoces de biópsia e desfechos clínicos

Abstract Introduction: Renal fibrosis is the end point of a process that begins at transplant, with ischemia reperfusion and early inflammation, and progresses over time with immunological and non-immunological phenomena. Early identification of morphological markers and intervention could improve graft function and survival. Objective: to evaluate the correlation between intensity and specificity of pre-transplant anti-HLA antibodies and kidney allograft pathology in order to identify early risk factors or markers of allograft dysfunction. Methods: A retrospective cohort of kidney transplant recipients with pre-transplant anti-HLA antibodies who underwent graft biopsy within the first two years post-transplant was divided into two groups according to the specificity of anti-HLA antibodies: nonspecific (non-DSA, n = 29) and specific (DSA+, n = 16). Kidney graft pathology, renal function, and proteinuria were analyzed. Results: general characteristics were similar in both groups, except for the higher dose of thymoglobulin in DSA+ group (p < 0.05). The non-DSA group had higher scores for glomerulosclerosis, interstitial inflammation (i) and interstitial fibrosis (ci) (p < 0.05) and higher incidence of cell-mediated acute rejection. No statistical difference in incidence of antibody-mediated rejection, renal function, and proteinuria was observed during follow up. Discussion and conclusions: the difference in inflammation scores and interstitial fibrosis may be associated to the higher incidence of acute cell-mediated rejection and polyomavirus nephropathy in the Non-DSA group. We also should take into account the protective effect of higher doses of thymoglobulin, reducing ischemia reperfusion injury in the DSA+ group. The short follow-up might have been insufficient to detect long-term changes in allograft tissue, renal function, and proteinuria.

Resumo Introdução: A fibrose renal é o desfecho de um processo iniciado no transplante, com reperfusão, isquemia e inflamação precoce, que progride ao longo do tempo com fenômenos imunológicos e não imunológicos. A identificação de marcadores morfológicos e a intervenção precoce poderiam melhorar a função e a sobrevida do enxerto. Objetivo: Avaliar a correlação entre intensidade e especificidade de anticorpos anti-HLA pré-transplante alterações histológicas do enxerto renal, de forma a identificar fatores de risco ou marcadores de disfunção precoces do aloenxerto. Métodos: O presente estudo incluiu uma coorte retrospectiva de receptores de transplante renal sensibilizados com anticorpos anti-HLA no pré-transplante submetidos a biópsia de enxerto nos primeiros dois anos após o transplante. Os grupos foram divididos em função da especificidade dos anticorpos anti-HLA: sem anticorpos doador-específicos (não-DSA, n = 29) e com anticorpos doador-específicos (DSA+, n = 16). Alterações histológicas do enxerto renal, função renal e proteinúria foram analisados. Resultados: Os dois grupos tinham características gerais semelhantes, exceto pela dose mais elevada de timoglobulina administrada nos indivíduos do grupo DSA+ (p < 0,05). O grupo não-DSA teve escores mais elevados de glomeruloesclerose, inflamação intersticial (i) e fibrose intersticial (ci) (p < 0,05), além de maior incidência de rejeição celular aguda (RCA). Não foi observada diferença estatística na incidência de rejeição mediada por anticorpos, função renal ou proteinúria durante o seguimento. Discussão e Conclusões: A diferença nos escores de inflamação e fibrose intersticial pode estar associada à maior incidência de RCA e nefropatia por poliomavírus no grupo não-DSA. Devemos considerar ainda o efeito protetor das doses mais elevadas de timoglobulina na redução da lesão por isquemia-reperfusão no grupo DSA+. O curto período de seguimento pode ter sido insuficiente para detectar alterações de longo prazo no tecido do aloenxerto, função renal e proteinúria.

Proteinuria en habitantes de una aldea costera de Santa Rosa, Guatemala / Proteinuria in inhabitants of a coastal village of Santa Rosa, Guatemala

Objetivo: determinar la presencia de proteinuria en habitantes de una aldea de la región costera de Santa Rosa, Guatemala, julio del año 2019. Material y métodos: estudio descriptivo y transversal, en una muestra de 575 habitantes de la aldea Casas Viejas, captada por durante cuatro jornadas médicas. Las muestras de orina fueron analizadas con tiras reactivas. Resultados: de los habitantes que participaron, 55.48 % (319) fueron de sexo femenino, la mediana de edad fue de 24 años, el 39.820% (229) estudiante y el 85.2 % (490) sin antecedentes patológicos. De los factores predisponentes de enfermedad renal, el 56.170% (323) consume antiinflamatorios no esteroideo -AINES-, el 82.26 % (473) bebidas carbonatadas, el 13.570% (78) bebidas alcohólicas; la mediana de consumo de agua fue de 6 vasos diarios y 13.22 % (76) han estado expuestos a agroquímicos. Proteinuria se documentó en 8.87 % (51) de los habitantes. Conclusiones: más de la mitad de los sujeto de estudio son de sexo femenino y sin antecedentes patológicos; de los factores predisponentes a enfermedad renal los más frecuentes son el consumo de -AINES-, bebidas carbonatadas y la hidratación inadecuada. Nueve de cada cien sujetos de estudio presentan proteinuria.

Objetive: to establish urine protein presence in inhabitants of a small village of the coastal region in Santa Rosa, Guatemala. July 2019. Material y methods: Descriptive and transversal study performed on 575 persons from Casas Viejas village, using a nonprobabilistic sampling. Proteinuria was determined by urine test strips. Results: Of the persons studied, 55.48% (319) were female, mean age was 24 years old, 39.82% (229) were students and 85.25% had no pathological background. Predisposing factors of kidney disease were noted, 56.17% (323) consumed Non-steroidal Anti-inflammatory Drugs (NSAIDs), 82.26% (473) consumed carbonated drinks, 13.57% (78) alcoholic beverages, the mean water consumption was 6 glasses per day, and 13.22% (76), were exposed to agrochemical pesticides. Proteinuria was found in 8.87% (51) of the sample. Conclutions: more than half of population were female and didn´t showed pathological signs. Predisposing factors to kidney disease were, frequent NSAIDs use, carbonated drinks consumption a no adequate hydration. Nine of each one hundred people studied presented urine protein.

Daño hepatocelular, proteinuria y autoinmunidad: ¿enfermedad multisistémica o coincidencia de enfermedades? Caso clínico / Hepatocellular damage, proteinuria and autoimmunity: multisystemic disorder or coexistence of diseases?

We report a 19 years old male presenting with knee pain, elevated liver enzymes and proteinuria. Further investigation found positive antinuclear and anti-smooth muscle antibodies and a liver biopsy revealed the presence of an autoimmune hepatitis. Treatment with corticosteroids and azathioprine was started, resulting in normalization of liver enzymes but proteinuria persisted and a kidney biopsy disclosed a focal segmental glomerulosclerosis. The use of lisinopril resulted in a significative reduction of proteinuria and, after 30 months of follow up, he continues with azathioprine, lisinopril and a low prednisone dose without evidence of liver or kidney disease activity.

Proteinuria en gammapatías monoclonales / Proteinuria in monoclonal gammopathies

La presencia de proteínas en la orina se denomina proteinuria, en adultos se define clínicamente por una excreción urinaria de proteínas superior a 150 mg en 24 horas y se produce por una alteración en la barrera de filtración glomerular, que permite el escape de las proteínas en la orina. La proteinuria es frecuente en diferentes enfermedades, particularmente en las gammapatías monoclonales. Los criterios para el diagnóstico de estas entidades incluyen la presencia de células plasmáticas anormales en la médula ósea, una proteína monoclonal en suero aumentada, una proteína monoclonal en orina o lesiones osteolíticas. Para el diagnóstico, evaluación y monitoreo del tratamiento de las gammapatías monoclonales se realizan los estudios electroforéticos de proteínas plasmáticas o proteinogramas séricos y urinarios, técnica que permite la separación de proteínas en función de su migración diferencial al ser sometidas a un campo eléctrico(AU)

The presence of protein in urine is called proteinuria in adults is clinically defined by a urinary excretion of more than 150 mg in 24 hours and proteins occurs by a change in the glomerular filtration barrier, which allows the escape of proteins in urine. Proteinuria is common in various diseases, particularly monoclonal gammopathies. The criteria for diagnosis of these entities include the presence of abnormal plasma cells in the bone marrow, a monoclonal protein increased serum, a monoclonal protein in urine or osteolytic lesions. For diagnosis, evaluation and treatment monitoring of monoclonal gammopathies, electrophoretic studies proteins plasma or serum and urinary proteinograms technique that allows separation of proteins based on their differential migration when subjected to an electric field is performed(AU)

The Natural Course of Biopsy-Proven Isolated Microscopic Hematuria: a Single Center Experience of 350 Patients

The increasing interest in healthcare and health screening events is revealing additional cases of asymptomatic isolated microscopic hematuria (IMH). However, a consensus of the evaluation and explanation of the IMH prognosis is controversial among physicians. Here, we present the natural course of IMH together with the pathological diagnosis and features to provide supportive data when approaching patients with IMH. We retrospectively evaluated 350 patients with IMH who underwent a renal biopsy between 2002 and 2011, and the pathological diagnosis and chronic histopathological features (glomerulosclerosis, interstitial fibrosis, and tubular atrophy) were reviewed. Deterioration of renal function was examined during follow up. The patients with IMH were evaluated for a mean of 86 months. IgA nephropathy was the most common diagnosis in 164 patients (46.9%). Chronic histopathological changes were observed in 166 (47.4%) but was not correlated with proteinuria or a decline in renal function. Ten patients developed proteinuria, and all of them had IgA nephropathy. Three patients progressed to chronic kidney disease with an estimated glomerular filtration rate < 60 mL/min/1.73 m2 but none progressed to end stage renal disease. In conclusion, IMH had a generally benign course during 7-years of observation, although IgA nephropathy should be monitored if it progresses to proteinuria. Future prospective randomized studies may help conclude the long-term prognosis and lead to a consensus for managing IMH.

Effect of low-dose valsartan on proteinuria in normotensive immunoglobulin A nephropathy with minimal proteinuria: a randomized trial

BACKGROUND/AIMS: Immunoglobulin A nephropathy (IgAN) is a generally progressive disease, even in patients with favorable prognostic features. In this study, we aimed to investigate the antiproteinuric effect and tolerability of low-dose valsartan (an angiotensin II receptor blocker) therapy in normotensive IgAN patients with minimal proteinuria of less than 0.5 to 1.0 g/day. METHODS: Normotensive IgAN patients, who had persistent proteinuria with a spot urine protein-to-creatinine ratio of 0.3 to 1.0 mg/mg creatinine, were recruited from five hospitals and randomly assigned to either 40 mg of valsartan as the low-dose group or 80 mg of valsartan as the regular-dose group. Clinical and laboratory data were collected at baseline, and at 4, 8, 12, and 24 weeks after valsartan therapy. RESULTS: Forty-three patients (low-dose group, n = 23; regular-dose group, n = 20) were enrolled in the study. Proteinuria decreased significantly not only in the regular-dose group but also in the low-dose group. The change in urine protein-to-creatinine ratio at week 24 was -41.3% +/- 26.1% (p < 0.001) in the regular-dose group and -21.1% +/- 45.1% (p = 0.005) in the low-dose group. In the low-dose group, blood pressure was constant throughout the study period, and there was no symptomatic hypotension. In the regular-dose group, blood pressure decreased at weeks 8 and 12. No significant change in glomerular filtration rate, serum creatinine level, or serum potassium level was observed during the study period. CONCLUSIONS: Our results suggest that low-dose valsartan can significantly reduce proteinuria without causing any intolerability in normotensive IgAN patients with minimal proteinuria.

Prediction of Cortical Defect Using C-Reactive Protein and Urine Sodium to Potassium Ratio in Infants with Febrile Urinary Tract Infection

PURPOSE: We investigated whether C-reactive protein (CRP) levels, urine protein-creatinine ratio (uProt/Cr), and urine electrolytes can be useful for discriminating acute pyelonephritis (APN) from other febrile illnesses or the presence of a cortical defect on 99mTc dimercaptosuccinic acid (DMSA) scanning (true APN) from its absence in infants with febrile urinary tract infection (UTI). MATERIALS AND METHODS: We examined 150 infants experiencing their first febrile UTI and 100 controls with other febrile illnesses consecutively admitted to our hospital from January 2010 to December 2012. Blood (CRP, electrolytes, Cr) and urine tests [uProt/Cr, electrolytes, and sodium-potassium ratio (uNa/K)] were performed upon admission. All infants with UTI underwent DMSA scans during admission. All data were compared between infants with UTI and controls and between infants with or without a cortical defect on DMSA scans. Using multiple logistic regression analysis, the ability of the parameters to predict true APN was analyzed. RESULTS: CRP levels and uProt/Cr were significantly higher in infants with true APN than in controls. uNa levels and uNa/K were significantly lower in infants with true APN than in controls. CRP levels and uNa/K were relevant factors for predicting true APN. The method using CRP levels, u-Prot/Cr, u-Na levels, and uNa/K had a sensitivity of 94%, specificity of 65%, positive predictive value of 60%, and negative predictive value of 95% for predicting true APN. CONCLUSION: We conclude that these parameters are useful for discriminating APN from other febrile illnesses or discriminating true APN in infants with febrile UTI.

Doença de lesões mínimas e glomeruloesclerose segmentar e focal em adultos: resposta a corticoide e risco de insuficiência renal / Minimal change disease and focal segmental glomerulosclerosis in adults: response to steroids and risk of renal failure

Resumo Introdução: O perfil clínico de pacientes brasileiros adultos com síndrome nefrótica por doença de lesões mínimas (LM) e glomeruloesclerose segmentar e focal (GESF) é pouco conhecido. Objetivo: Avaliamos as características clínico-laboratoriais e resposta a tratamento em pacientes adultos com síndrome nefrótica e diagnósticos histológicos de LM ou GESF. Métodos: Fez-se a análise retrospectiva de 50 pacientes adultos com LM e 120 com GESF. Todos os pacientes foram inicialmente tratados com corticosteroide. Os desfechos do estudo foram: resposta a corticosteroide, prevalência de remissão total, progressão para doença renal crônica estágio 5 (DRC5) e necessidade de terapia de substituição renal por DRC5. Resultados: Níveis iniciais de creatinina sérica foram 24% mais elevados entre pacientes com GESF (p = 0,02) e os de proteinúria foram 36% mais altos em LM (p < 0,001). Pacientes com LM foram córtico-sensíveis em 80% dos casos, com remissão total em 74%, e os pacientes com GESF em 58% (p = 0,01), com remissão total em 30% (p = 0,002). A prevalência de insuficiência renal aguda em pacientes com GESF foi de 39% (vs. 12%, p = 0,013) e DRC5 de 10% (vs. 0%, p < 0,001). Remissão completa ou parcial com o uso de corticosteroide reduziu em 83% o risco de DRC5 (p < 0,001) e remissão total associou-se a redução no risco de DRC5 de 89% (p < 0,001). Conclusão: A resposta positiva à corticoterapia foi o fator mais importante relacionado à preservação da função renal ao longo de mais de uma década de seguimento, e GESF relacionou-se a menor índice de resposta a corticosteroide.

Abstract Introduction: There is scarce data on the clinical profile of adult Brazilian patients with nephrotic syndrome caused by minimal change disease (MCD) and focal segmental glomerulosclerosis. Objective: We evaluated the clinical characteristics and response to treatment in adult patients with nephrotic syndrome having a histological diagnosis of MCD or FSGS. Methods: This is a retrospective analysis of 50 patients with MCD and 120 with FSGS. All patients were initially treated with steroids. The study outcomes were: steroid responsiveness, prevalence of total remission, progression to chronic renal failure and need of renal replacement therapy due to end-stage renal disease (ESRD). Results: Initial serum creatinine level was 24% higher among patients with FSGS (p = 0.02), and proteinuria levels were 36% higher in MCD (p < 0.001). Patients with MCD were sensitive to steroid therapy in 80% of the cases, with total remission in 74%, while patients with FSGS were sensitive in 58% (p = 0.01), with total remission in 30% (p = 0.002). Patients with FSGS had an acute renal failure prevalence of 39% (vs. 12%, p = 0.013) and ESRD of 10% (vs. 0%, p < 0.001). Steroid responsiveness reduced in 83% the risk of ESRD (p < 0.001), while total remission was associated to a reduction in risk of 89% (p < 0.001). Conclusion: A positive response to steroid therapy was the most important factor related with preservation of renal function and FSGS was related with less steroid responsiveness.

Comparison of Urinary Protein Creatinine Index (uPCI) and Dipsticks for the Prediction of Renal Dysfunction in Chronic Cigarette Smokers.

Background: Proteinuria is recognized as one of the earliest sign of renal function deterioration in chronic smokers. Proteinuria occurs due to alteration in glomerular permeability and later due to failure of reabsorption of filtered protein by the tubular cells. Normally, most healthy adults excrete 20 – 150 mg of protein in urine over 24 hours. However, it is difficult to collect 24 hrs urine samples. Objectives: To advocate the use of PCI (protein creatinine index) in assessment of proteinuria and to compare dipstick result with PCI in the assessment of proteinuria in chronic cigarette smokers. Material & Methods: A total of 30 cigarette smokers and 40 age and sex matched controls were included for the study. A random specimen of urine collected from each cigarette smoker and non- smoker was tested quantitatively by manual sulfosalicylic acid colorimetric method for the estimation of protein concentration. Creatinine concentration in each specimen was measured by modified Jaffe’s method and the urinary PCI was calculated. Results: Normal range of PCI which has been established in this study is 50 to 259. Significantly higher amounts of protein were found to be excreted in urine in chronic smokers (9.313 ± 4.003 mg/dl) as compared to healthy non smokers (7.738 ± 2.05 mg/dl). On comparison of PCI between healthy non smoker and chronic smoker subjects, PCI has been found to be significantly elevated in chronic smokers (healthy non smoker- 118.32 ± 56.86, chronic smoker- 180.1 ± 88.23) (p=0.001). Conclusion: PCI of random urine sample can provide a very useful, simple and convenient method for the quantitative assessment of proteinuria to confirm the advent of kidney damage, avoiding the drawbacks of 24 hrs urine collection.

Isolated Proteinuria in Hepatitis A Versus E Virus (HAV vs HEV) Infected Patients: A Hospital Based Observational Study.

Introduction: Viral hepatitis, either acute or chronic, may lead to nephropathies as one of its multiple extrahepatic complications which often remain clinically silent for a long period and are overlooked. Proteinuria can be a useful tool for early detection of the underlying renal impairment. This study was undertaken to detect the presence of proteinuria and to assess and compare the level of proteinuria in HAV and HEV- infected cases; the two most common causes of acute hepatitis in Bangladesh. Method: For this 100 diagnosed patients of HAV & HEV (50 each) hepatitis were screened for isolated proteinuria in a random spot urine sample during their 3rd to 4th post-ecteric follow ups. Result: 43% HAV and 45% HEV patients had high spot urinary protein with maximum incidence (54 %) occurring in 3rd decades of life. The pattern of isolated proteinuria was significantly different in HAV vs HEV cases. The mean ± SD value of spot urinary protein of HEV females was significantly higher than that of HAV where highest rate (64%) of mild proteinuria was observed in HAV and maximum number (46%) of moderate proteinuria in HEV patients. Conclusion: Spot urinary protein concentration should be checked quantitatively in every HEV as well as HAV- hepatitis patient even when clinically improved.

Crystals in a patient with asymptomatic proteinuria

No abstract available.

Efectividad del ácido sulfosalicílico en comparación con la tira reactiva para la detección de proteinuria en gestantes con trastorno hipertensivo en el Instituto Nacional Materno Perinatal - Julio 2013 / Effectiveness of the sulfosalicylic acid compared with the strip test for the detection of proteinuria in pregnant women with hypertensive disorder at the National Institute Materno Perinatal - July 2013

Objetivo: Determinar la eficacia del ácido sulfosalicílico en comparación con la tira reactiva para la detección de proteinuria en el diagnóstico de preeclampsia en gestantes con trastorno hipertensivo en el Instituto Nacional Materno Perinatal - julio 2013. Material y métodos: Tipo de Observacional, transversal, analítico comparativo. Se comparó 300 gestantes con prueba de tira reactiva con 300 gestantes a quienes se les realizó la prueba de turbidez en orina mediante el ácido sulfosalicílico. Resultados: Un total de 600 gestantes cumplieron los criterios de inclusión. El 36,5 por ciento (n=219) de pacientes estudiadas presentó criterios de severidad. El análisis de curva ROC del ácido acetilsalicílico tuvo una capacidad de detección de proteinuria estadísticamente significativa (área bajo la curva=0,66; lC 95 por ciento: 0,61 - 0,70), mientras que la tira reactiva también tuvo una capacidad de detección de proteinuria estadísticamente significativa (un área bajo la curva=0,75; lC 95 por ciento: 0,71 - 0,79). Los índices diagnósticos del ácido acetil salicílico para la detección de proteinuria en las gestantes con trastornos hipertensivos del embarazo fueron 63,1 por ciento, 68,6 por ciento, 76,9 por ciento, 52,9 por ciento, 1,58 y 0,54; respectivamente, mientras que para la tira reactiva los mismos índices fueron 78,1 por ciento, 71,7 por ciento, 82 por ciento, 66,4 por ciento, 2,69 y 0,31; respectivamente. Conclusiones: Las pruebas del ácido sulfosalicílico y la tira reactiva para la determinación de proteinuria en pacientes con trastornos hipertensivos del embarazo, tienen índices diagnósticos aceptables, recomendándose especialmente su utilidad en los casos de emergencia.

Objective: To determine the effectiveness of sulfosalicylic acid compared with the test strip for the detection of proteinuria in the diagnosis of preeclampsia in pregnant women with hypertensive disorder in the National Maternal Perinatal Institute - July 2013. Methods: Observational, cross comparative analytical study. We compared 300 pregnant women with dipstick test with 300 pregnant women who underwent the test of turbidity in urine by sulfosalicylic acid. Results: A total of 600 pregnant women met the inclusion criteria. The 36.5 per cent (n=219) of patients studied had severe criteria. ROC curve analysis of aspirin had an ability to detect statistically significant proteinuria (AUC=0.66, 95 per cent Cl: 0.61 to 0.70), while the test strip also had a capacity of detecting statistically significant proteinuria (an area under the curve=0.75, 95 per cent Cl: 0.71 to 0.79). Diagnostic indices of aspirin for the detection of proteinuria in pregnant women with hypertensive disorders of pregnancy were 63.1 per cent, 68.6 per cent, 76.9 per cent, 52.9 per cent, 1.58 and 0.54, respectively, while for the same indices strip were 78.1 per cent, 71.7 per cent, 82 per cent, 66.4 per cent, 2.69 and 0.31, respectively. Conclusions: Sulfosalicylic acid tests and test strip for the determination of proteinuria in patients with hypertensive disorders of pregnancy are acceptable diagnostic indices, recommending especially useful in emergency cases.

Survey of predictive value of 4-hour urine collection for diagnosis of proteinuria in preeclampsia

Measuring the 24-hour urine protein >/= 300 mg is the standard threshold value for diagnosis of preeclampsia. This study was intended to determine if a patient's 4-hour urine protein correlate with the 24-hour value for diagnosis of preeclampsia. This was a cross sectional study performed on 84 women with suspected preeclampsia due to positive urinary test strip with minimum protein content of 1+ and BP >/= 140/90 at Al-zahra Educational Hospital in Rasht [Iran] from May 2007 to January 2008. Urine samples were collected within 24 hours in successive periods: The first 4-hour and the next 20-hours urine, in separate containers. The protein contents of 4-hour and 24-hour urine samples were calculated. Data were analyzed by intra-class correlation coefficient, and Receiver Operating Characteristic [ROC] curve. The ROC curve showed the cut-off point of 55.5 for 4-hour urine protein. The correlation between 4- and 24-hour urine protein excretions identified that most women [about 85.1%] with protein excretion rate of 300 mg/24h or more [with preeclampsia] had the same amount of protein of 55.5 or more in their 4-hour urine excretion [p<0.001]. Also, most of them [about 83.7%] with a total urinary protein excretion of less than 300 mg/24h [no preeclampsia] had a protein excretion rate of less than 55.5 mg/4h. This study showed 4-hour protein collection can be used as acceptable substitute for assessing the protein content of 24-hour urine samples as a more convenient, faster, and cheaper method for diagnosis of preeclampsia and the cut-off point for 4-hour urine protein is 55.5 mg

Indice proteína/creatinina en la detección de proteinuria significativa en gestantes con preeclampsia. Hospital Nacional Dos de Mayo: agosto 2011 a mayo 2012 / Index protein/creatinine in the detection of significant proteinuria in pregnant women with preeclampsia. National Hospital Dos de Mayo. August 2011 to May 2012

Objetivos: Determinar la sensibilidad, especificidad y el valor predictivo del índice proteína/creatinina en muestra aislada de orina en la detección de proteinuria significativa en gestantes >=34 semanas con diagnóstico de preeclampsia. Material y métodos: Se realizó un estudio observacional, descriptivo, prospectivo de casos y controles. Se revisaron 50 casos (gestantes en quienes se haya diagnosticado preeclampsia con proteinuria significativa) y 50 controles (gestantes que no tuvieron patología hipertensiva asociada ni proteinuria significativa) en el periodo que correspondió al estudio. Resultados: Hubo una mayor frecuencia de pacientes primíparas en un 52 por ciento del total de gestantes. Hubo un periodo internatal prolongado en el 19 por ciento del total de gestantes. El 9 por ciento del total de gestantes tuvo el antecedente de preeclampsia. El 24 por ciento de total de gestantes tuvieron un IMC mayor de 30. El 78 por ciento de gestantes tuvieron más de 04 controles prenatales. El 95 por ciento de gestantes tuvieron un índice proteína/creatinina >/=0.1. El 85 por ciento de gestantes tuvieron un índice proteína/creatinina >/=0.15. El 68 por ciento de gestantes tuvieron un índice proteína/creatinina >/=0.20. El 51 por ciento de gestantes tuvieron un índice proteína/creatinina >/=0.25.EI 39 por ciento de gestantes tuvieron un índice proteína/creatinina >/=0.30. El 29 por ciento de gestantes tuvieron un índice proteína/creatinina >/=0.35. El 14 por ciento de gestantes tuvieron un índice proteína/creatinina >/=0.40. Hubo una mayor frecuencia de partos cesáreas en un 65 por ciento. Conclusiones: Existe una correlación estadísticamente significativa entre el índice proteína/creatinina urinaria con la colección urinaria de 24 horas para el diagnóstico de preeclampsia. Para un punto de corte de 0.30 del índice proteína/creatinina, la sensibilidad fue del 78 por ciento, la especificidad del 100 por ciento y el valor predictivo positivo del 100 por ciento.

Proteinuria predicts relapse in adolescent and adult minimal change disease

OBJECTIVE: This study sought to outline the clinical and laboratory characteristics of minimal change disease in adolescents and adults and establish the clinical and laboratory characteristics of relapsing and non-relapsing patients. METHODS: We retrospectively evaluated patients with confirmed diagnoses of minimal change disease by renal biopsy from 1979 to 2009; the patients were aged >13 years and had minimum 1-year follow-ups. RESULTS: Sixty-three patients with a median age (at diagnosis) of 34 (23-49) years were studied, including 23 males and 40 females. At diagnosis, eight (12.7%) patients presented with microscopic hematuria, 17 (27%) with hypertension and 17 (27%) with acute kidney injury. After the initial treatment, 55 (87.3%) patients showed complete remission, six (9.5%) showed partial remission and two (3.1%) were nonresponders. Disease relapse was observed in 34 (54%) patients who were initial responders (n = 61). In a comparison between the relapsing patients (n = 34) and the non-relapsing patients (n = 27), only proteinuria at diagnosis showed any significant difference (8.8 (7.1-12.0) vs. 6.0 (3.6-7.3) g/day, respectively, p = 0.001). Proteinuria greater than 7 g/day at the initial screening was associated with relapsing disease. CONCLUSIONS: In conclusion, minimal change disease in adults may sometimes present concurrently with hematuria, hypertension, and acute kidney injury. The relapsing pattern in our patients was associated with basal proteinuria over 7 g/day.

Significado de la Proteinuria en el niño y adolescente / The meaning of proteinuria in children and adolescents

Introducción: la proteinuria persistente en niños y adolescentes es indicador de enfermedad renal crónica, es factor de progresión de la misma y factor de riesgo cardiovascular, igual que en adultos. Pero niños y adolescentes pueden tener proteinurias transitorias condicionadas por alteraciones benignas que hay que diferenciar y otras etiologías que hay que descartar. Objetivos: enfoque diagnóstico de la proteinuria en niños y adolescentes y análisis de la aplicabilidad de las conclusiones del consenso de proteinurias a este grupo etario. Material y Método: se realiza búsqueda, evaluación y síntesis de evidencia bibliográfica existente en relación a la fisiopatología y detección de proteinuria en niños y adolescentes. Se presenta un algoritmo diagnóstico. Resultados y Conclusiones: el significado de proteinuria en niños y adolescentes es igual que en adultos pero existen diferencias en su etiología. Adecuando las unidades de expresión de resultados, las recomendaciones del consenso de proteinurias resultan válidas para esta población

Short-term effects of soy protein diet in patients with proteinuric glomerulopathies / Efeitos a curto prazo da dieta com proteína da soja em pacientes com glomerulopatias proteinúricas

INTRODUCTION: It has been suggested that soy protein can slow renal disease progression by decreasing plasma cholesterol and proteinuria in patients with nephropathies. This study was designed to evaluate the effect of soy protein on proteinuria and dyslipidemia, in patients with proteinuric glomerulopathies. PATIENTS AND METHODS: Patients were divided into three groups: Control Group (n = 9) received diet with 0.8 g/kg/day of animal protein; Study Group 1 (n = 9), 0.8 g/kg/day of soy protein; and Group 2 (n = 9), 0.8 g/kg/day of soy protein plus fibers. The study period corresponded to eight weeks. During the baseline period and by the end of the study, patients were submitted to laboratorial and anthropometric evaluation. RESULTS: There was no statistically significant difference between baseline and post-diet periods among the three groups in anthropometric parameters or body composition, neither in proteinuria levels (Control: 0.7 ± 0.6 versus 0.8 ± 0.6; Group 1: 2.0 ± 1.7 versus 1.9 ± 1.8; Group 2: 2.0 ± 1.4 versus 2.1 ± 2.0). However, a slight decrease in triglycerides (244.8 ± 275.9 versus 200.5 ± 34.0), total (234.0 ± 59.4 versus 181.2 ± 110.3) and LDL (136.0 ± 59.1 versus 104.1 ± 39.4) cholesterol in Group 1 was observed, although not significant. CONCLUSION: We have not observed beneficial effects when using soy protein instead of animal protein with the aim of attenuating proteinuria and hyperlipidemia, but we have shown that soy protein has not caused deleterious changes in body composition, ensuring an adequate nutritional state.

INTRODUÇÃO: Há indícios de que a proteína da soja poderia contribuir para reduzir a velocidade de progressão da doença renal, diminuindo colesterol sérico e proteinúria em pacientes com nefropatias. Este estudo foi desenvolvido para avaliar o efeito da die>ta com proteína da soja sobre proteinúria e dislipidemia, em pacientes com glomerulopatias proteinúricas. PACIENTES E MÉTODOS: Os pacientes foram divididos em três grupos: o Grupo Controle (n = 9) recebeu dieta com 0,8 g/kg/dia de proteína animal; o Grupo de Estudo 1 (n = 9) recebeu dieta com 0,8 g/kg/dia de proteína da soja e o Grupo 2 (n = 9), dieta com 0,8 g/kg/dia de proteína da soja mais fibras. O período de estudo foi de oito semanas. Durante o período basal e no final do estudo, os pacientes foram submetidos à avaliação laboratorial e antropométrica. RESULTADOS: Não foram observadas diferenças estatisticamente significantes entre os períodos pré e pós-intervenção em nenhum dos grupos estudados, nos parâmetros antropométricos ou na composição corporal entre os três grupos, nem nos níveis de proteinúria (Controle: 0.7 ± 0.6 versus 0.8 ± 0.6; Grupo 1: 2.0 ± 1.7 versus 1.9 ± 1.8; Grupo 2: 2.0 ± 1.4 versus 2.1 ± 2.0). No entanto, observou-se discreta diminuição nos níveis triglicérides (244.8+-275.9 versus 200.5+-34.0), colesterol total (234.0+-59.4 versus 181.2+-110.3) e LDL (136.0+-59.1 versus 104.1+-39.4) no Grupo 1, embora sem atingir significância estatística. CONCLUSÃO: Não foram detectados efeitos benéficos com a substituição da proteína animal pela proteína da soja em relação aos objetivos de reduzir proteinúria e hiperlipidemia; porém, constatou-se que a dieta de proteína da soja não causou alterações deletérias na composição corporal, mantendo um estado nutricional adequado.

Doença renal crônica: importância do diagnóstico precoce, encaminhamento imediato e abordagem interdisciplinar estruturada para melhora do desfecho em pacientes ainda não submetidos à diálise / Chronic kidney disease: importance of early diagnosis, immediate referral and structured interdisciplinary approach to improve outcomes in patients not yet on dialysis

Atualmente, é amplamente aceita a definição da doença renal crônica (DRC) que se baseia em alterações na taxa de filtração glomerular e/ou presença de lesão parenquimatosa mantidas por pelo menos três meses. Embora os critérios para diagnóstico de DRC estejam agora bem mais claros, a proporção de pacientes com DRC em estágio avançado vista pela primeira vez por nefrologista imediatamente antes do início de tratamento dialítico ainda é inaceitável. O diagnóstico precoce e o encaminhamento imediato para o nefrologista são etapas essenciais no manuseio desses pacientes, pois possibilitam a educação pré-diálise e a implementação de medidas preventivas que retardam ou mesmo interrompem a progressão para os estágios mais avançados da DRC, assim como diminuem morbidade e mortalidade iniciais. Nesta revisão, discutimos a complexidade da DRC, a multiplicidade de intervenções atualmente recomendadas na sua prevenção secundária e diferentes modelos de prestação de cuidados à saúde, além de examinarmos o racional do atendimento interdisciplinar e a evolução dos pacientes seguidos em clínicas que já adotaram esse modelo.

At present, chronic kidney disease (CKD) is broadly defined on the basis of changes in the glomerular filtration rate and/or the presence of parenchymal damage present for at least 3 months. Although the diagnosis of CKD is now quite straightforward, the proportion of patients with end-stage renal disease seen by a nephrologist for the first time immediately before the initiation of dialysis is still unacceptable. Early diagnosis and immediate nephrology referral are key steps in management because enable predialysis education, allow implementation of preventive measures that delay or even halt progression of CKD to end stage renal disease, as well as decrease initial morbidity and mortality. In this review, we discuss the complexity of CKD and the multiplicity of interventions currently recommended in its secondary prevention, different models of healthcare delivery, and examine the rational and outcomes of patients followed in interdisciplinary care clinics.

Cómo se logra la protección renal en pacientes con factores de riesgo para enfermedad renal / How do we achieve renal protection in patients at risk for kidney disease?

Las acciones que se realicen sobre el sistema renina-angiontensina-aldosterona, la tensión arterial, la proteinuria, el metabolismo de lípidos y glucosa, se encuentran entre las más destacadas de un esquema claramente beneficioso para el paciente con enfermedad renal.