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The glomerular changes in children with reflux nephropathy.

M Morita¹, S Yoshiara, R H White

¹Department of Nephrology, Children's Hospital, Birmingham, U.K.

The Journal of Pathology

|November 1, 1990

Summary

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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:

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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.