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[Pathological analysis of renal diseases with mild proteinuria]
Ryota Ikee1, Noriaki Hemmi, Takamitsu Saigusa
1Second Department of Internal Medicine, National Defense Medical College, Saitama.
Abstract:
Proteinuria is an important predictor of renal outcome in a variety of renal diseases. Proteinuria exceeding 0.5 g/day is often considered to be a major indication of renal biopsy. In this study, we analyzed the clinical and histopathological data of 58 patients with mild proteinuria of less than or equal to 0.5 g/day. The histopathological diagnosis included 45 cases(77.6%) of mesangial proliferative glomerulonephritis, 4 cases(6.9%) of lupus nephritis, one case of membranoproliferative glomerulonephritis and only 6 cases(10.3%) of minor glomerular abnormality. The percent sclerotic glomeruli exceeded 10% in 17 cases(29.3%) and reached 71.4% in 2 cases. There were no significant differences in histopathological parameters(percent sclerotic glomeruli, tubulointerstitial change, arterio-arterio sclerotic change) between the groups with or without microhematuria. There was a positive correlation between age and percent sclerotic glomeruli. Percent sclerotic glomeruli in our cases were higher than in the healthy population reported by Kaplan et al. and the influence of glomerulonephropathy was obvious. During the follow-up period(mean 19.7 months), one patient progressed to chronic renal failure and 2 patients had increased urinary protein excretion, but the others did not. These results suggest the importance of clarifying the prognosis by renal biopsy even in cases with mild proteinuria.
Insights
Even mild proteinuria (≤0.5 g/day) can indicate significant kidney disease. Renal biopsy is crucial for prognosis, revealing glomerulonephritis in most patients and higher glomerulosclerosis than in healthy populations.
Area of Science:
- Nephrology
- Pathology
- Internal Medicine
Context:
- Proteinuria is a key indicator of kidney disease progression.
- A threshold of 0.5 g/day often prompts renal biopsy.
- Mild proteinuria cases require further investigation for accurate diagnosis.
Purpose:
- To analyze clinical and histopathological data of patients with mild proteinuria (≤0.5 g/day).
- To evaluate the diagnostic yield and prognostic value of renal biopsy in mild proteinuria.
- To correlate histopathological findings with clinical parameters like microhematuria and age.
Summary:
- This study examined 58 patients with mild proteinuria, finding mesangial proliferative glomerulonephritis in 77.6%.
- Glomerulosclerosis was prevalent, exceeding 10% in 29.3% of cases and higher than in healthy controls.
- Despite mild proteinuria, some patients showed progression, underscoring the need for biopsy.
Impact:
- Highlights the diagnostic importance of renal biopsy even with minimal proteinuria.
- Provides insights into the prevalence of specific glomerulonephritis types in mild proteinuria.
- Suggests that age correlates with glomerulosclerosis, impacting renal outcome prediction.