Prevalencia de compromiso renal en pacientes pediátricos internados con enfermedad por coronavirus 2019: estudio multicéntrico / Prevalence of renal involvement among pediatric patients hospitalized due to coronavirus disease 2019: A multicenter study

Introducción. El compromiso renal (CR) en niñosinternados con enfermedad por coronavirus2019 (COVID-19, por su sigla en inglés) varía entre el 1,2 % y el 44 %. Dado que existe limitada información local, el objetivo primario de este estudio fue estimar la prevalencia de CR en nuestro medio. Población y métodos. Estudio transversalrealizado en 13 centros de Argentina entre marzo y diciembre de 2020. Se incluyeron pacientes internados con COVID-19, de 1 mes a 18 años y que tuvieran al menos una determinación de creatinina sérica y/o de orina completa.Se excluyeron aquellos con enfermedad renal conocida. Se consideró CR la presencia de lesión renal aguda (LRA), proteinuria, hematuria, leucocituria y/o hipertensión arterial (HTA). Resultados. De 528 historias clínicas elegibles, seincluyeron las de 423 pacientes (el 55,0 % de sexo masculino, mediana de edad 5,3 años). El cuadro clínico fue asintomático en el 31 %, leve en el 39,7 %, moderado en el 23,9 %, grave en el 1,2 %, crítico en el 0,7 %, y el 3,5 % presentó síndrome inflamatorio multisistémico pediátrico (SIMP). Dos pacientes (0,47 %) fallecieron. La prevalencia de CR fue del 10,8 % (intervalo de confianza 95% 8,2-14,2), expresada por leucocituria (16,9 %), proteinuria (16,0 %), hematuria (13,2 %), HTA (3,7 %) y LRA (2,3 %). Ninguno requirió diálisis. Presentar CR se asoció (p <0,0001) con formas graves de enfermedad. Conclusión. La prevalencia de CR en pacientes pediátricos internados con COVID-19 en 13 centros de nuestro país fue del 10,8 % y predominó en las formas clínicas graves.

Introduction. Renal involvement among pediatric patients with coronavirus disease 2019 (COVID-19) ranges between 1.2% and 44%. Given the limited information available locally, the primary objective of this study was to estimate the prevalence of renal involvement in our setting. Population and methods. Cross-sectional study conducted in 13 Argentine sites between March and December 2020. Patients aged 1 month to 18 years hospitalized due to COVID-19 and with at least one measurement of serum creatinine and/or a urinalysis were included. Those with a known kidney disease were excluded. Renal involvement was defined as the presence of acute kidney injury (AKI), proteinuria, hematuria, leukocyturia and/or arterial hypertension (HTN). Results. Among 528 eligible medical records, 423 patients were included (55.0% were males; median age: 5.3 years). The clinical presentation was asymptomatic in 31%; mild, in 39.7%; moderate, in 23.9%; severe, in 1.2%; critical, in 0.7%; and 3.5% had multisystem inflammatory syndrome in children (MIS-C). Two patients (0.47%) died. The prevalence of renal involvement was 10.8% (95% confidence interval: 8.2­14.2); it was described as leukocyturia (16.9%), proteinuria (16.0%), hematuria (13.2%), HTN (3.7%), and AKI (2.3%). No patient required dialysis. Renal involvement was associated with severe forms of disease (p < 0.0001). Conclusion. The prevalence of renal involvement among pediatric patients hospitalized due to COVID-19 in 13 Argentine sites was 10.8%; severe forms of disease prevailed.

The first appointment with a nephrologist: Brazilian patients' demographic and kidney function characteristics. A retrospective study

ABSTRACT BACKGROUND: The number of nephrologists has risen slowly, compared with the prevalence of chronic kidney disease (CKD) in Brazil. Data on patients referred to nephrology outpatient clinics remains scarce. OBJECTIVE: To determine the demographic and kidney function characteristics of patients at their first appointment with a nephrologist. DESIGN AND SETTING: Retrospective study conducted at three nephrology outpatient clinics (public and private services), in São Paulo, Brazil. METHODS: From December 2019 to February 2020, we collected patient data regarding demographics, kidney function parameters and comorbidities. We then analyzed data on 394 patients who met a nephrologist for their first appointment. RESULTS: The main comorbidities were hypertension (63.7%), diabetes (33.5%) and nephrolithiasis (22.3%). Regarding CKD stages, 24.1%, 9.1%, 13.7%, 15.2%, 15.2% and 2.3% of the patients were in stages 1, 2, 3a, 3b, 4 and 5, respectively. Proteinuria was absent or mild, moderate and high in 17.3%, 15.2% and 11.7%, respectively; and 16.2% had not undergone previous investigation of serum creatinine or proteinuria (55.8%). For 17.5%, referral to a nephrologist occurred late. Patients in public services were older than those in private services (59 years versus 51 years, respectively; P = 0.001), more frequently hypertensive (69.7% versus 57.5%; P = 0.01) and reached a nephrologist later (22.4% versus 12.4%; P = 0.009). CONCLUSION: Referrals to a nephrologist were not being made using any guidelines for CKD risk and many cases could have been managed within primary care. Late referral to a nephrologist happened in one-fifth of the cases and more frequently in the public service.

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.

The natural history of solitary post-nephrectomy kidney in a pediatric population

ABSTRACT Introduction: Children with a solitary post-nephrectomy kidney (SNK) are at potential risk of developing kidney disease later in life. In response to the global decline in the number of nephrons, adaptive mechanisms lead to renal injury. The aim of this study was to determine the prevalence and time of onset of high blood pressure (HBP), proteinuria, glomerular filtration rate (GFR) disruption and renal tubular acidosis (RTA) in children with SNK. Materials and methods: After obtaining the approval from our institution's ethics committee, we reviewed the medical records of patients under 18 years of age who underwent unilateral nephrectomy between January 2005 and December 2015 in three university hospitals. Results: We identified 43 patients, 35 (81.4%) cases of unilateral nephrectomy (UNP) were due to a non-oncologic pathology and Wilm's tumor was identified in 8 (18.6%) cases. In patients with non-oncologic disease, 9.3% developed de novo hypertension, with an average time of onset of 7.1 years, 25% developed proteinuria de novo, with an average time of onset of 2.2 years. For GFR, 21.8% presented deterioration of the GFR in an average time of 3.4 years. Ten (43.5%) patients developed some type of de novo renal injury after UNP. Patients with oncologic disease developed the conditions slowly and none of them developed proteinuria. Conclusions: Taking into account the high rate of long term postoperative renal injury, it can be considered that nephrectomy does not prevent this disease. The follow-up of children with SNK requires a multidisciplinary approach and long-term surveillance to detect renal injury.

Association Between Hepatitis B Virus and Chronic Kidney Disease: a Systematic Review and Meta-analysis

Abstract: Background. Hepatitis B virus infection and chronic kidney disease are prevalent and remain a major public health problem worldwide. It remains unclear how infection with hepatitis B virus impacts on the development and progression of chronic kidney disease. Aim. To evaluate the effect of infection with HBV on the risk of chronic kidney disease in the general population. Material and methods. We conducted a systematic review of the published medical literature to determine if hepatitis B infection is associated with increased likelihood of chronic kidney disease. We used the random effects model of DerSimonian and Laird to generate a summary estimate of the relative risk for chronic kidney disease (defined by reduced glomerular filtration rate and/or detectable proteinuria) with hepatitis B virus across the published studies. Meta-regression and stratified analysis were also conducted. Results. We identified 16 studies (n = 394,664 patients) and separate meta-analyses were performed according to the outcome. The subset of longitudinal studies addressing ESRD (n = 2; n = 91,656) gave a pooled aHR 3.87 (95% CI, 1.48; 6.25, P < 0.0001) among HBV-infected patients and no heterogeneity was recorded. In meta-regression, we noted the impact of male (P = 0.006) and duration of follow-up (P = 0.007) upon the adjusted hazard ratio of incidence of chronic kidney disease (including end-stage renal disease). No relationship occurred between HBV positive status and prevalent chronic disease (n = 7, n = 109,889 unique patients); adjusted odds ratio, were 1.07 (95% CI, 0.89; 1.25) and 0.93 (95% CI, 0.76; 1.10), respectively. Conclusions. HBV infection is possibly associated with a risk of developing reduced glomerular filtration rate in the general population; no link between HBV sero-positive status and frequency of chronic kidney disease or proteinuria was noted in cross-sectional surveys.

Proteinuria is common among HIV patients: what are we missing?

OBJECTIVES:HIV-related renal diseases are the leading causes of chronic kidney diseases worldwide. The present study aimed to investigate the prevalence of pathological proteinuria and its risk factors among HIV patients.METHODS:A review of the medical records of 666 HIV-infected individuals aged 18 years or older in an urban HIV/AIDS clinic based in Porto Alegre in southern Brazil. Overt proteinuria was defined as a protein-to-creatinine ratio greater than 150 mg/g according to Kidney Disease: Improving Global Outcomes.RESULTS:The prevalence of pathological proteinuria in the present study cohort was 20%. Characteristics associated with pathological proteinuria after univariate analysis included alcohol abuse, hepatitis C virus coinfection, the occurrence of diabetes and therapy including tenofovir. Adjusted residuals analysis indicated an association between pathological proteinuria and both a CD4 lymphocyte count below 200 cells/mm3 and a viral load higher than 1000 copies/mL. Additionally, an absence of pathological proteinuria was associated with a CD4 lymphocyte count higher than 500 cells/mm3. After adjustment for variables with p<0.2 in the univariate analysis using a Poisson regression model, tenofovir-containing regimens and a CD4 lymphocyte count below 200 cells/mm3 were significantly associated with pathological proteinuria.CONCLUSION:The risk of chronic kidney diseases in this large contemporary cohort of HIV-infected individuals appeared to be attributable to a combination of HIV-related risk factors. In addition to the traditional risk factors cited in the literature, both regimens containing tenofovir and HIV disease severity seem to be associated with chronic kidney diseases in patients with HIV. Assessment of proteinuria constitutes a novel method for chronic kidney disease staging in HIV-infected individuals and may be effectively used to stratify the risk of progression to end-stage renal disease.

Función renal en pacientes pediátricos con trasplante alogénico de progenitores hematopoyéticos / Renal function in pediatric patients with allogeneic hematopoietic progenitor cell transplantation

Patients with hematopoietic stem cell transplantation can develop some degree of renal failure. The aim of this descriptive study is to evaluate markers of kidney injury in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation between 1991 and 2011. Patients and Method: A descriptive study of pediatric patients with allogeneic transplant of hematopoietic precursors between 1991 and 2011. The patients were between 1 month and 18 years of age at the time of the study and had at least 6 months of follow up. Clinical and nutritional history, continuous blood pressure monitoring (ABPM), urine tests, proteinuria, creatinine and renal and bladder ultrasonography imaging were evaluated. Results: During this period 65 patients were transplanted, of which 13 patients were included. 46% (n = 6) showed diverse degrees of renal compromise defined by altered renal parenchymal echogenicity, clinic or masked hypertension and/or microalbuminuria. Conclusion: In this clinical group, almost half of the patients patients had some degree of renal injury in their evolution. We consider essential to assess the renal function in the follow-up of these patients.

Introducción: Los pacientes con trasplante de progenitores hematopoyéticos pueden evolucionar con algún grado de compromiso renal. El objetivo de este estudio descriptivo fue evaluar marcadores de injuria renal en pacientes pediátricos sometidos a trasplante alogénico de progenitores hematopoyéticos entre 1991 y 2011. Pacientes y Método: Estudio descriptivo en pacientes pediátricos con Trasplante alogénico de Precursores Hematopoyéticos entre los años 1991 y 2011 con edad entre 1 mes y 18 años al momento de realizar el estudio y que tuviesen al menos 6 meses de seguimiento. Se evaluaron antecedentes clínicos, nutricionales, presión arterial por monitoreo continuo (MAPA), exámenes de orina, proteinuria, creatininuria y estudio de imágenes por ecotomografía renal y vesical. Resultados: Durante este período se trasplantaron 65 pacientes, de los cuales se incluyeron 13 pacientes. Un 46% (n = 6) presentó compromiso renal de grado variable definido por alteración en la ecogenicidad del parénquima renal, hipertensión arterial clínica o enmascarada y/o microalbuminuria. Conclusión: En la serie clínica estudiada con el 50% de los pacientes presentó algún grado de injuria renal en su evolución. Consideramos importante evaluar función renal en el seguimiento de este grupo de pacientes.

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.

Prevalence of urinary tract infection in diabetic patients and identification of the causal microorganisms

Urinary tract infection [UTI] is a condition in which the urinary tract is infected with a pathogen causing inflammation. One of the predisposing factors for UTIs is diabetes mellitus [DM], spillage of glucose into the urine provide a good culture medium for bacteria. The objectives of this study were to evaluate the distribution of UTIs among diabetic patients of both genders with studying the effect of some relative factors, and identifying types of the causal microorganisms. Diabetic patients [type1 and 2], from both genders were included in this study. All patients were interviewed. Uncontaminated urine samples were collected for micro-scopic and macroscopic analysis. Isolations and identifications of bacteria were done by standard methods. Out of 150 diabetic patients, 53 [35.33%] have UTI. Gender, middle age and high level of proteinuria were risk factors, while type and duration of DM with its type of treatment, body mass index [BMI], and hypertension were non significant. The isolated types of pathogens were Escherichia coli [45.3%], Klebsiella pneumoniae [15.1%], Staphylococcus saprophyticus [15.1%], Citrobacter diversus [11.3%], Candida albicans [7.5%] and Staphylococcus aureus [5.7%]. This study revealed that diabetic females were most susceptible to get UTIs than diabetic males. In both genders the most reliable age for UTI were between 31-40 years. The results showed that the level of proteinuria was higher in patients suffering from UTIs associated with DM, which considered as a risk factor. Certain types of microorganisms were isolated; the most common types were Escherichia coli, Klebsiella pneumoniae and Staphylococcus saprophyticus

Risk factors associated with the development of overt nephropathy in type 2 diabetes patients: A 12 years observational study.

Background & objectives: Diabetic nephropathy (DN) is the leading cause of chronic kidney disease and end-stage renal disease in developing countries. Early detection and risk reduction measures can prevent DN. The aim of the study was to determine the risk factors for the development of proteinuria over a period of 12 years of follow up in normoalbuminuric type 2 diabetes patients attending a specialized centre. Methods: Of the 2630 type 2 diabetes subjects newly registered in 1996, 152 (M:F;92:60) normoalbuminuric subjects had baseline and subsequent measurements of anthropometric, haemodynamic and biochemical details spanning 12 years. The subjects were divided into 2 groups based on the renal status during follow up visits. Group 1 (non-progressors) had persistent normoalbuminuria and group 2 (progressors) had persistent proteinuria. Presence of other diabetic complications during follow up and details on antidiabetic and antihypertensive agents were noted. Results: During median follow up of 11 years in subjects with normal renal function at baseline, 44.1 per cent developed proteinuria at follow up. Glucose levels, HbA1c, systolic blood pressure (SBP), triglycerides, and urea levels were significantly higher at baseline among progressors than non-progressors. Progressors had a longer duration of diabetes and significant fall in estimated glomerular filtration rate (eGFR) levels at follow up. In Cox's regression analysis, baseline age, duration of diabetes, baseline HbA1c and mean values of HbA1c, triglycerides, SBP and presence of retinopathy showed significant association with the development of macroalbuminuria. Interpretation & conclusions: Type 2 diabetes patients with uncontrolled diabetes and increase in blood pressure are at high risk of developing nephropathy. Age, long duration of diabetes, elevated BP, poor glycaemic control and presence of retinopathy were significantly associated with the progression of diabetic nephropathy.

Factors affecting the progression of diabetic nephropathy and its complications: a single-center experience in Saudi Arabia

One out of five Saudi diabetics develops end-stage renal disease [ESRD]. Factors associated with progressive loss of renal function have not been extensively studied and reported in our community. We sought to evaluate the pattern and progression in glomerular filtration rate [GFR] and investigate the potential risk factors associated with progression to diabetic nephropathy [DN] among Saudi patients. Hospital-based retrospective analysis of type 2 diabetic patients seen between January 1989 and January 2004 at Security Forces Hospital and King Saud University in Riyadh, Saudi Arabia. DN was defined as persistent proteinuria assessed by urine dipstick [at least twice for at least two consecutive years and/or serum creatinine >130 micromol/L; and/or GFR <60 mL/min/1.73m[2]. Of 1952 files reviewed, 621 [31.8%] met the criteria for DN, and 294 [47%] were males. The mean [SD] age of the patients at baseline was 66.9 [11.4] years, and mean duration of diabetes was 15.4 [7.5] years. GFR deteriorated from a baseline value of 78.3 [30.3] mL/min/1.73m[2] to 45.1 [24.1] mL/min/1.73m[2] at the last visit, with a mean rate of decline in GFR of 3.3 mL/min/year. Progression of nephropathy was observed in 455 [73.3%] patients, with 250 [40.3%] patients doubling their first-hospital-visit serum creatinine level in a mean of 10.0 [6.0] years. At the end of the study, 1 6.5% of the cohort developed ESRD and were dialyzed. GFR >90 mL/min/1.73m[2] at the first hospital visit; duration of diabetes >10 years; persistent proteinuria; systolic blood pressure >130 mm Hg; and presence of retinopathy were significant markers associated with progression of nephropathy. Diabetic nephropathy tends to be progressive among Saudis, with GFR deteriorating at a rate of 3.3 mL/year and with a doubling of serum creatinine level in 40.3% of patients in 9.9 years

Raising awareness of chronic kidney disease in a Brazilian urban population

The incidence and prevalence of chronic kidney disease have been increasing in recent years in developing countries. The aim of this study was to report the results of a general chronic kidney disease awareness program applied to an urban population in a large Brazilian city. From January 2002 to January 2005 a total of 8883 individuals in the city of Curitiba (PR, Brazil) were screened for hypertension, body mass index, hematuria, and proteinuria. A family history and previous medical diagnosis of hypertension and diabetes mellitus (DM) were also recorded. Of the 8883 individuals assessed, 56% were women, subject median age was 47 years (range: 17-93 years) and more than 90% were Caucasian. Thirty percent had signs of hematuria, 6% had proteinuria, and 3% had hematuria and proteinuria. The median of mean arterial pressure values was 93 mmHg (range: 71- 135 mmHg) and 16% of the population screened had a history of hypertension. A significant positive family history of both hypertension or DM was present in 42% (P < 0.0001; chi-square = 83.18) and 7% (P < 0.0001; chi-square = 161.31) of thehypertensive group, respectively. Finally, the prevalence of hypertension and DM was significantly higher in older individuals with proteinuria. In the present study, a higher prevalence of hematuria and proteinuria was found in older individuals with hypertension and diabetes compared to the general population. These data confirm the need for public awareness of renal disease in high-risk individuals.

Prevalence of hematuria and proteinuria in healthy 4 to 6 year children in daycare centers of Rasht [northern Iran]

Screening of kidney diseases by urinalysis in preschool children was approved in many parts of the world with inexpensive tools such as urinary dipsticks. In this study the researchers investigate the prevalence of hematuria and proteniuria in 4 to 6-year-old children in daycare centers of Rasht [Iran]. The researchers examined proteinuria and hematuria in 1520 healthy children in daycare centers of Rasht. Urine strips were employed to examine the urine which was already collected from the subjects. Another urine sample was collected from those children with abnormal findings in the first samples with dipstick of the same brand a month later. If any positive result was found again, the urine was analyzed with dipstick and microscope concurrently. In the first dipstick samples, the prevalence was 3.2% for hematuria, 5.8% for proteinuria, and 0.13% for a mixture of proteinuria and hematuria. In the second urinalysis in patients with positive findings, hematuria, proteinuria as well as mixed proteinuria and hematuria were 20.4%, 52.0%, and 2.0% correspondingly. In the third analysis of samples, the abnormal findings in all patients were 13 [0.85%] isolated hematuria, 24 [1.57%] isolated proteinuria and one [0.06%] mixed hematuria and proteiuria. This study showed that the prevalence of proteinuria and hematuria during pre-school period [4 to 6 year-olds] may reveal relatively similar frequencies of some other studies

Prevalence of proteinuria in rural adult population in Tamil Nadu.

BACKGROUND & OBJECTIVES: Presence of proteinuria is considered as an early marker of an increased risk of progressive kidney disease. Angiotensin converting enzyme (ACE) inhibitors (ACEi) and angiotensin II receptor blockers (ARB) treatment to persons with proteinuria and chronic kidney disease has been shown to decrease the progression to endstage renal disease. As the exact prevalence of proteinuria is not known in the general population, we undertook this study to estimate the same in a rural adult population in Vellore district, Tamil Nadu. METHODS: A convenient sample of 5,043 adults was included. All individuals were tested for albuminuria by albumin dipstick examination in an untimed urine sample. Individuals who tested positive for albuminuria underwent a second dipstick examination after a gap of one week. Individuals with persistent albuminuria on the second dipstick examination underwent further evaluation which included medical history, physical examination, 24 h urine protein estimation, total serum protein and albumin estimation. Ultrasound of the abdomen was done in patients with renal failure and renal biopsy was performed in selected patients. RESULTS: Of the total 5,043 individuals screened, 63.1 per cent were females. Mean age of the study population was 50.94 +/- 11.2 yr. First dipstick test identified 594 individuals positive for albuminuria. Repeat dipstick could be done in only 576, of whom 212 showed persistent albuminuria. Significant proteinuria was detected in 24 individuals of the 208 who had 24 h urine protein measured. Of these 24 patients, 3 were found to have chronic renal failure, 12 were presumed to have diabetic nephropathy clinically, one each had focal segmental glomerulosclerosis and biopsy proven diabetic nephropathy, and 7 patients had proteinuria of unknown aetiology. INTERPRETATION & CONCLUSION: The prevalence of proteinuria in this adult rural population was 0.47 per cent (0.30-0.67%). The detection and treatment of chronic kidney disease in 24 individuals is bound to reduce the rate of decline of renal functions. Screening programme for proteinuria in different parts of country may be an effective measure to bring a decline in rate of progression of chronic kidney disease in general population.

Non-diabetic renal disease in patients with type 2 diabetes mellitus.

OBJECTIVES: A wide spectrum of non-diabetic renal diseases (NDRD) are reported to occur in patients with type 2 diabetes mellitus. However, the prevalence and nature of NDRD in type 2 diabetics is not widely documented in our country. Therefore, the objectives of this study were to analyse prevalence and spectrum of non-diabetic renal disease in type 2 diabetic patients. METHODS: Two hundred sixty type 2 diabetic with clinical renal diseases were screened for evidence of NDRD, between April 1997 to March 1999. Renal disease other than diabetic nephropathy was found in 32 (12.3%) patients. Their (male 23; female 9) age ranged between 35-72 (mean 54.15+/-10.3) years. The duration of diabetes was < 5 years in 14 (43.7%), between 5-9 years in 8 (25%) and > 10 years in 10 (31.2%) patients. RESULTS: The presenting clinical syndromes were : chronic renal failure 15 (47%), acute nephritic syndrome 6 (18.7%), nephrotic syndrome 5 (15.6%), acute renal failure 4 (12.5%) and rapidly progressive glomerulonephritis (RPGN) in 2 (6.2%) cases. Overall, incidence of glomerular (46.8%) and tubulo-interstitial lesions (53.2%) were almost equal in type 2 diabetes patients. The spectrum of non-diabetic renal diseases includes : primary isolated glomerulopathy 12 (37.5%); mesangioproliferative GN superimposed on diabetic glomerulosclerosis (DGS) in 3 (9.3%); acute tubulo-interstitial nephropathy (TIN) 4 (12.5%); chronic TIN 10 (31.25%) and three patients had chronic pyelonephritis. Diabetic retinopathy was absent in 22 (69%) cases where 10 (31%) patients had background diabetic retinopathy. None of the patients with non-diabetic glomerular disease had diabetic retinopathy, except two who had DGS in addition to mesangioproliferative GN on renal biopsy. The background diabetic retinopathy was seen in 47% of patients with TIN without clinical evidence of diabetic nephropathy. The recovery of renal function or clinical improvement was observed in 47% of patients with NDRD with institution of appropriate treatment. CONCLUSION: The prevalence of NDRD was 12.3% in our type 2 diabetic patients. Both non-diabetic glomerulopathy (47%) and tubulo-interstitial nephropathy (53%) can occur with nearly equal frequency in such patients. It is also gratifying to diagnose and treat NDRD in type 2 diabetics in selected cases.

Etude de la prevalence de la proteinure chez les femmes gestantes a Abidjan

La recherche systematique d'une proteinurie au cours du bilan prenatal; permet de detecter precocement les anomalies de la fonction renale. Dans le but de souligner l'importance de cet examen nous avons realise une etude prospective transversale sur une periode de 6 mois; (1er Fevrier au 31 juillet 2000) dans 6 maternites peripheriques d'Abidjan. L'objectif de ce travail etait de determiner la prevalence de la proteinurie chez les femmes gestantes afin d'evaluer le risque de developpement d'une nephropathie dans cette population. Dans notre etude nous avons trouver une prevalence de 6;15 pour cent; soit 544 cas de proteinurie sur 8836 gestantes recues en consultation prenatales. Nous avons etudie les caracteres epidemiologiques cliniques; biologiques et les antecedents pathologiques des gestantes proteinuriques. Nos resultats etaient les suivants : les gestantes proteinuriques etaient pour la plupart des paucipares (75;73 pour cent) avec un niveau socio economique bas (54;77 pour cent sans emploi) ; 55;88 pour cent des gestantes avaient un age inferieur ou egal a 25 ans ; la majorite des proteinuries a ete detectee au 2e trimestre (50 pour cent) et au 3e trimestre (36;06 pour cent) de la grossesse ; 8 1;80 pour cent des gestantes etaient supposees sans antecedent ; 57;37 pour cent des gestantes ne presentaient aucun signe clinique (HTA-OMI). La fonction renale a ete appreciee par le dosage de la creatinine. Sur 119 dosages demandes; seulement 24 dosages ont ete effectues. Les taux etaient eleves chez 3 gestante. (?14 mg par l). Devant ces resultats; il apparait essentiel de : souligner le caractere pronostic de la proteinurie d'autant plus qu'elle est retrouve a une frequence elevee dans les syndromes vasculo-renaux de la grossesse ; souligner son importance chez toute femme gestante meme apparemment saines ; l'explorer correctement afin de reduire le risque renal a court et a long terme dans cette population de femmes gestantes

Diabetes mellitus; incidence of proteinuria, micro-albuminuria and transferrinuria

Diabetic nephropathy is a common microvascular complication of diabetes mellitus and reflects serious renal disease specific to diabetes. It is one of the common causes of end stage renal disease. A cross sectional study was carried out to find the incidence of proteinuria, microalbuminuria and transferrinuria in know diabetics of Rawalpindi. One hundred and forty six consecutive diabetics were included in the study [68 men and 78 women] for detection of diabetic nephropathy. Thirty age and sex matched, healthy controls were also included in the study. Urine protein, microalbumin and transferrin concentration were analysed in the 24 hours urine samples submitted by all diabetics and healthy controls. The screening of protein in urine was done by dipstick method using Uristix Ames [UK]. Quantitative urine total protein was estimated by Biuret method; the dipstick negative samples were analysed for microalbuminuria by using Pyrogallol-molybdate test technique and urinary transferrin was estimated by immunoturbidimetry method. The transferrin excretion in diabetic subjects significantly [P<0.01] exceeded that in healthy subject. The 65% of diabetics had an abnormally high urinary transferrin excretion and 40% had high urinary protein excretion [proteinuria: 14%: microalbuminuria: 26%]. It is concluded that microalbuminuria proteinuria and transferrinuria is common in our diabetics reflecting poor metabolic control

Incidencia, etiologia y pronostico de la proteinuria persistente significativa en el transplante renal / Incidence, etiology and prognostic value of persistent significant proteinuria in kidney transplants

Se investigo la incidência, etiología y valor pronóstico de la PPS en el injerto renal. Se revisaron retrospectivamente las historias clínicas de 273 pacientes (288 injertos), seleccionándose 236 injertos (l78 DV, 58 DC) que funcionaron más de 4 meses (230 pacientes, 148 hombres y 82 mujeres). También se revieron histológicamente 226 trasplantes y 35 riñones nativos. Se detectó PPS en 67 injertos (28.4 por ciento); de éstos 43 tuvieron diagnóstico histológico (Glomerulopatía del Trasplante (GPTTx) 19, Glomerulopatías (GP) idiopáticas 13 y rechazo crónico ll). Las GP idiopáticas debutaron habitualmente con sindrome nefrótico (65 por ciento), mientras que los pacientes con rechazo crónico rara vez lo hicieron. La aparición de proteinuria coexistió habitualmente con deterioro funcional en los injertos con rechazo crónico y con GPTTx; en las GP idiopáticas se asoció habitualmente a función renal normal. En los injertos con PPS, no pudieron establecerse diferencias estadísticamente significativas en la sobrevida actuarial (SA) en relación al momento de aparición o la magnitud de la PPS, la presencia o no de Hipertensión arterial (HA), el tratamiento inmunosupresor inicial recibido, y el diagnóstico histológico. La diferencia resultó altamente significativa (p