Related Experiment Videos
The glomerular changes in children with reflux nephropathy
M Morita1, S Yoshiara, R H White
1Department of Nephrology, Children's Hospital, Birmingham, U.K.
Insights
Early glomerular changes in reflux nephropathy, including focal segmental glomerulosclerosis (FSGS), correlate with proteinuria. Microproteinuria is an early indicator of FSGS in pediatric patients with reflux nephropathy.
Area of Science:
- Pediatric Nephrology
- Renal Pathology
- Glomerular Diseases
Background:
- Heavy proteinuria and focal segmental glomerulosclerosis (FSGS) are known in adult reflux nephropathy.
- Early glomerular changes in pediatric reflux nephropathy are not well understood.
Purpose of the Study:
- To investigate early glomerular and vascular changes in pediatric patients with reflux nephropathy.
- To correlate these changes with proteinuria levels.
Main Methods:
- Analysis of renal biopsy specimens from 24 pediatric patients (aged 5.2-18.8 years).
- Measurement of urinary protein excretion using urine protein-to-creatinine ratios.
- Examination of glomerular and hilar arteriolar morphology.
Main Results:
- Segmental sclerotic lesions (FSGS) were found in 8 biopsies, originating from the glomerulus hilum.
- A strong positive correlation existed between glomerular involvement extent and proteinuria (P < 0.0001).
- Parahilar hyaline deposits and enlarged, thickened hilar arterioles with subendothelial hyaline deposits were common.
Conclusions:
- Glomerular and vascular changes in pediatric reflux nephropathy may represent stages of hyperfiltration.
- Microproteinuria is the earliest clinical sign of FSGS and should be routinely screened for in patients with reflux nephropathy.
Abstract:
While heavy proteinuria and focal segmental glomerulosclerosis (FSGS) are well-recognized features of progressive reflux nephropathy in adults, little is known of their early evolution. We have studied the glomerular changes in renal biopsy specimens obtained from 24 patients aged 5.2-18.8 years, in whom urinary protein excretion was measured as early morning urine protein creatinine ratios, using the Coomassie blue dye-binding method. Segmental sclerotic lesions were found in eight biopsies and traced through serial sections to a hilar origin in every instance. There was a strong positive correlation between the extent of glomerular involvement and the amount of proteinuria (P less than 0.0001). Parahilar hyaline deposits were observed in 16 biopsies, including five of the eight showing FSGS. All unsclerosed glomeruli were enlarged, and the hilar arterioles showed both enlargement and thickening, their walls frequently containing subendothelial hyaline deposits. Since in most patients renal function was comparatively well preserved, despite extensive loss of renal substances, we believe that these glomerular and vascular changes represent the stages in the evolution of hyperfiltration. Microproteinuria is the earliest clinical manifestation of FSGS, and should be sought routinely in all patients with reflux nephropathy.