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A large retrospective review of persistent proteinuria in children
Chingying Chang-Chien1, Gwo-Tsann Chuang1, I-Jung Tsai1
1Department of Pediatrics, National Taiwan University Children's Hospital, College of Medicine, National Taiwan University, No. 8 Chung-Shan South Rd., Taipei, 10061, Taiwan.
Insights
Persistent proteinuria in children can signal underlying renal diseases. Acute kidney injury and congenital anomalies were leading causes in moderate to severe cases, highlighting the need for assessment.
Area of Science:
- Pediatric Nephrology
- Clinical Diagnostics
- Renal Medicine
Background:
- Proteinuria is a common pediatric finding, potentially indicating early renal injury.
- 35% of children with persistent proteinuria have levels >100 mg/dl, often linked to renal diseases.
- Identifying the cause and prognosis of pediatric proteinuria is crucial.
Purpose of the Study:
- To determine the causes and outcomes of persistent proteinuria in children.
- To analyze the relationship between proteinuria severity and underlying renal conditions.
Main Methods:
- Retrospective analysis of urinalysis data from 37,645 children (2011-2016).
- Identification of persistent proteinuria in 2.3% of cases.
- Categorization into mild, moderate, and severe proteinuria groups based on levels.
Main Results:
- Mild proteinuria causes were often unidentifiable.
- Acute kidney injury, lupus erythematosus, nephrotic syndrome, and congenital anomalies were key in moderate/severe groups.
- Chronic renal insufficiency rates differed significantly across groups; prematurity was a risk factor.
Conclusions:
- Persistent proteinuria in children necessitates evaluation due to varied associated diseases and mortality risks.
- Severity grading aids in identifying potential underlying renal pathologies.
- Early detection and management are vital for pediatric renal health.
Background:
Proteinuria is a common finding in children. It may be due to a benign cause, but it can also represent early renal injury. Of children with persistent proteinuria noted in mass urine screening programs, 35% have a urine protein level greater than 100 mg/dl and many of them are associated with many underlying renal diseases. The aim of this study was to identify the etiology and prognosis of persistent proteinuria in children.
Methods:
We collected data on urine protein from January 2011 to December 2016 in a tertiary medical center. During this 6-year period, 37,645 children received urinalysis, and 2.3% were found to have persistent proteinuria. We reviewed their medical charts for clinical diagnoses and renal function. According to the level of persistent proteinuria, we divided the children into three groups (mild, moderate, and severe).
Results:
Most clinical diagnoses in the mild persistent proteinuria group were not readily identifiable. In the moderate and severe groups, acute kidney injury was the leading cause of significant proteinuria, followed by systemic lupus erythematosus, steroid-sensitive nephrotic syndrome, and congenital urogenital tract anomalies. There were significant differences in the rate of chronic renal insufficiency among the three groups. Prematurity with extremely low birth weight was also a major factor associated with pediatric chronic renal insufficiency.
Conclusion:
Assessing persistent proteinuria in children is important due to the diverse range of associated diseases or mortality.
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