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Asymptomatic constant isolated proteinuria in children
N Yoshikawa1, K Kitagawa, K Ohta
1Department of Pediatrics, Kobe University Hospital, Japan.
Insights
Nearly half of children with asymptomatic proteinuria have significant kidney disease, with boys being more affected. Renal biopsy is recommended due to the risk of chronic kidney impairment.
Area of Science:
- Pediatric Nephrology
- Renal Pathology
- Clinical Medicine
Background:
- Asymptomatic constant isolated proteinuria is a common finding in children.
- The underlying renal pathology and long-term prognosis are often unknown without invasive procedures.
Purpose of the Study:
- To determine the prevalence of renal pathologic abnormalities in children with asymptomatic constant isolated proteinuria.
- To identify clinical predictors of renal abnormalities.
- To assess the clinical course and risk of chronic renal impairment.
Main Methods:
- Retrospective study of 53 children with asymptomatic constant isolated proteinuria.
- Analysis of clinical features, renal biopsy findings (light, immunofluorescence, and electron microscopy), and clinical course.
- Follow-up assessment for chronic renal impairment.
Main Results:
- 47% of children had significant glomerular changes, including focal segmental glomerulosclerosis, IgA nephropathy, and membranous glomerulonephritis.
- No significant clinical or laboratory differences were found between groups with significant versus minimal glomerular changes, except for a male predominance in the significant changes group.
- Seven patients with significant glomerular changes developed chronic renal impairment, while none with minimal changes did.
Conclusions:
- A high incidence of significant glomerular changes exists in children with asymptomatic constant isolated proteinuria.
- The risk of progression to chronic renal impairment necessitates renal biopsy in these children.
- Renal biopsy is indicated for accurate diagnosis and prognosis assessment.
Abstract:
The clinical features, renal biopsy findings, and subsequent course in 53 children with asymptomatic constant isolated proteinuria were studied retrospectively (1) to determine the prevalence of renal pathologic abnormalities among these children, (2) to identify those clinical characteristics that may enable recognition of children with an increased likelihood of having renal pathologic abnormalities, and (3) to assess the clinical course. All biopsy specimens were examined by light, immunofluorescence, and electron microscopy. Twenty-five patients (47%) had significant glomerular changes (15 had focal segmental glomerulosclerosis, 4 IgA nephropathy, 3 diffuse mesangial proliferative glomerulonephritis without IgA deposition, and 3 membranous glomerulonephritis), and 28 had minimal glomerular changes. There were no differences between the patients with significant glomerular changes and those with minimal glomerular changes with regard to clinical and laboratory findings except for a predominance of boys in the former group. At the latest follow-up, seven patients with significant glomerular changes, but none with minimal glomerular changes, had chronic renal impairment. Because of the high incidence of significant glomerular changes and the high rate of progression to chronic renal impairment, we believe that a renal biopsy is indicated for a child with asymptomatic constant isolated proteinuria.