Kidney Function and Protein Excretion in Relation to Pathomorphology of Glomerular Diseases

2015 ◽  
pp. 128-135 ◽  
Author(s):  
I. J�ckle ◽  
W. G�nther ◽  
H. von Gise ◽  
J. M. Alt ◽  
A. Bohle ◽  
...  
Keyword(s):  
Kidney Function ◽  
Glomerular Diseases ◽  
Protein Excretion

Approach to the Patient with Glomerular Disease

2018 ◽  
Author(s):  
Richard J. Glassock ◽  
An S De Vriese ◽  
Fernando C. Fervenza
Keyword(s):  
Nephrotic Syndrome ◽  
Renal Biopsy ◽  
Rapidly Progressive Glomerulonephritis ◽  
Chronic Glomerulonephritis ◽  
Glomerular Diseases ◽  
Diagnosis And Prognosis ◽  
Protein Excretion ◽  
Clinical Syndromes ◽  
Organ Systems ◽  
Therapeutic Decision Making

Glomerular diseases of the kidneys are associated with a limited array of clinical syndromes, including asymptomatic hematuria and/or proteinuria, acute nephritis, nephrotic syndrome, rapidly progressive glomerulonephritis, and chronic glomerulonephritis. The specific diseases that underlie these syndromes are numerous and heterogeneous. Broadly, they may be divided into primary and secondary disorders depending on whether the kidneys are the sole organs affected or whether other organ systems are also involved in the disease processes. A systematic approach involving a careful history, physical examination, assessment of renal function, and urinalysis (composition and microscopy) and protein excretion, combined with biochemical and serologic testing, can provide important clues to diagnosis and prognosis. Renal biopsy is often required for a complete and accurate diagnosis as well as a prognosis and therapeutic decision making. This review contains 4 figures, 6 tables and 92 references Key words: glomerular filtration rate, glomerulonephritis, hematuria, nephrotic syndrome, proteinuria, renal biopsy, serum complement

scholarly journals Long distance run induced hydration and kidney function changes in marathoners

2015 ◽  
Vol 21 (3) ◽  
pp. 299-304
Author(s):  
Luiz Guilherme Cruz Gonçalves ◽  
Rodrigo Leal de Queiroz Thomaz de Aquino ◽  
Enrico Fuini Puggina
Keyword(s):  
Kidney Function ◽  
Physical Exertion ◽  
Hydration Status ◽  
Urine Ph ◽  
Long Distance ◽  
Membrane Selectivity ◽  
Marathon Race ◽  
Protein Excretion ◽  
Bradford Assay ◽  
In The Beginning

AbstractThe aim of the study was to verify the hydration status and the kidney function in marathoners during the training season and after a marathon race. Nine male runners were investigated during 12 weeks of training. Urine was collected in four moments; in the beginning (C1) and during (C2) the training program, before (C3) and after (C4) the competition. Urine pH was measured using reagent tapes, urine density with a refractometer, protein excretion by Bradford assay and erythrocytes and leucocytes by microscopy. Changes were observed when C-4 was compared to the other collection times for all variables investigated. It is possible to conclude that physical exertion induced important changes in the hydration status and glomerular membrane selectivity to macromolecules, modifying the kidney function of the marathoners in C4.

scholarly journals MO267HIGHER FRACTIONAL EXCRETION OF TOTAL PROTEIN IS  A PREDICTOR OF PROGRESSION IN IDIOPATHIC MEMBRANOUS NEPHROPATHY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Hideaki Kuno ◽  
Go Kanzaki ◽  
Rina Oba ◽  
Saeko Hatanaka ◽  
Takaya Sasaki ◽  
...  
Keyword(s):  
Glomerular Filtration ◽  
Total Protein ◽  
Membranous Nephropathy ◽  
Proportional Hazards ◽  
Fractional Excretion ◽  
Cox Proportional Hazards ◽  
Urinary Protein Excretion ◽  
Glomerular Diseases ◽  
Protein Excretion ◽  
Clinicopathological Findings

Abstract Background and Aims Lower estimated glomerular filtration rate (eGFR) and higher proteinuria are the most sensitive predictor of the development of progressive renal insufficiency in various glomerular diseases. On the other hand, the onset of idiopathic membranous nephropathy (iMN) shows insidious progression, and the prognosis varies significantly. Therefore, it is difficult to predict the renal outcome in MN, using only the severity of proteinuria. Fractional excretion of total protein (FETP), which was protein clearance divided by creatinine clearance (Ccr), may be a better indicator of protein leak per functioning nephron. A recent study has also reported that FETP accurately predicted transplant failure and was more sensitive and specific than protein creatine ratio (PCR). Few studies, however, have analyzed the FETP to evaluate their relationship with renal function and histologic lesions in glomerular diseases. Thus, this study aims to assess the relationship between FETP and the clinicopathological findings and whether FETP predicts outcome in iMN. Method This study included patients with iMN that underwent kidney biopsies during the period from 2002 to 2020. We analyzed 24-h urinary protein excretion, FETP, and other clinicopathological findings at the kidney biopsy. The FETP was determined by the standard clearance technique based on 24-h urine collection: FETP = (urinary total protein / serum total protein) / (urinary creatinine / serum creatinine) × 100. A 30% decrease in eGFR or the occurrence of ESRD were the endpoints. The multivariate factors affecting the prognosis were analyzed with the Cox proportional-hazards model, and the cumulative risk of risk factors was analyzed by Kaplan‑Meier curve. Results A total of 153 subjects with MN were identified and were followed up for a median of 5.4 years. (age 64.9±13.6 [mean ± SD] years, male 73.2 %, hypertension 42.5 %, diabetes 10.5 %, nephrotic Syndrome 67.3 %, chronic kidney disease [CKD: eGFR<60ml/min/1.73m2] 51.9 %, eGFR 61.6±22.6 mL/min/1.73m2, urinary protein excretion [u-TP] 4.3±3.6 g/day, PCR 5.4±4.5 g/gCr, FETP 0.12±0.18 %, Selectivity Index [S.I] 0.23±0.39, fractional excretion of IgG [FEIgG] 0.065±0.170 %, glomerulosclerosis [GS] 13.9±13.7 %, interstitial fibrosis and tubular atrophy [IFTA] 12.2±10.0 %). FETP was more significantly associated with clinical parameters than PCR and FEIgG (Table.1). The high FETP group had a significantly worse renal prognosis during the follow-up periods than the low FETP group (Figure.1). Using Cox proportional hazards models, with FETP entered, and age, sex, eGFR,u-TP as covariates, FETP predict the primary endpoint with a hazards ratio of 0.343 (P<0.05). Conclusion These results suggest that FETP would be superior to PCR, the standard measure of proteinuria, in predicting outcome in patients with iMN. FETP could indicate the increased glomerular protein permeability and decreased glomerular filtration function in iMN.

Pregnancy Outcomes in Patients with Glomerular Disease Attending a Single Academic Center in North Carolina

2017 ◽  
Vol 45 (5) ◽  
pp. 442-451 ◽  
Author(s):  
Michelle M. O'Shaughnessy ◽  
Meghan A. Jobson ◽  
Katy Sims ◽  
Abigail L. Liberty ◽  
Patrick H. Nachman ◽  
...  
Keyword(s):  
North Carolina ◽  
Kidney Function ◽  
Pregnancy Outcomes ◽  
Perinatal Death ◽  
Obstetric Care ◽  
Glomerular Disease ◽  
Primary Study ◽  
Glomerular Diseases ◽  
Disease Subtypes ◽  
Primary Glomerular Disease

Background: Contemporary data regarding pregnancy outcomes in US patients with primary glomerular diseases are lacking. We aimed to report fetal and maternal outcomes among women with biopsy-proven primary glomerular disease who received obstetric care at a single large academic US center. Methods: All women with a biopsy-confirmed primary glomerular disease diagnosis and without end-stage kidney disease who received obstetric care at the University of North Carolina (UNC) Hospitals (1996-2015) were identified using the Glomerular Disease Collaborative Network registry and the UNC Hospitals Perinatal Database. The primary study outcome was perinatal death (stillbirth at >20 weeks or neonatal death). Secondary outcomes included premature birth (<37 weeks), birth weight, preeclampsia, and kidney function changes (postpartum vs. baseline). Demographics, clinical characteristics, and outcomes were compared across glomerular disease subtypes. Results: Among 48 pregnancies in 43 women (IgA nephropathy n = 17, focal segmental glomerulosclerosis [FSGS] n = 16, membranous nephropathy n = 6, minimal change disease n = 4), 13% of pregnancies resulted in perinatal death and 48% of babies were born prematurely. From a maternal perspective, 33% of pregnancies were complicated by preeclampsia, 39% by a doubling of urinary protein, and 27% by a ≥50% increase in serum creatinine. Outcome differences across glomerular disease subtypes were not statistically significant, although decline in kidney function appeared most frequent in FSGS. Conclusion: Adverse pregnancy outcomes are frequently observed in women with glomerular disease. The independent influence of glomerular disease subtype on outcomes requires further study. More widespread reporting and analysis of pregnancy outcomes in women with glomerular disease are urgently needed.

scholarly journals Is morning urinary protein-to-creatinine ratio a reliable estimator of 24-hour proteinuria in patients with kidney diseases?

2010 ◽  
Vol 138 (11-12) ◽  
pp. 726-731
Author(s):  
Visnja Lezaic ◽  
Stojanka Ristic ◽  
Violeta Dopsaj ◽  
Jelena Marinkovic
Keyword(s):  
Kidney Function ◽  
Total Protein ◽  
Kidney Diseases ◽  
Intraclass Correlation ◽  
Creatinine Ratio ◽  
Failure Group ◽  
Spot Urine ◽  
Receiver Operating Characteristic Curves ◽  
Protein Excretion ◽  
The Difference

Introduction. Proteinuria is the most frequent marker of kidney damage. Although 24-hour urinary proteinuria is the gold standard, the measurement of proteinuria from albumin urinary creatinine ratio is proposed as much useful metod. Objective. To evaluate the accuracy of urine protein-to-creatinine (P/Cr) ratio in morning urine specimens as compared with 24-hour total protein excretion for the measurement of proteinuria in patients with different kidney diseases and different renal function levels. Methods. Proteinuria in the studied patients was assessed by 24-hour protein excretion (24-hour PRT) and spot urine P/Cr ratio. The analysis of concordance between 24-hour PRT and P/ Cr was carried out using intraclass correlation coefficient (ICC), paired t-test and Bland-Altman plots. The discriminant cutoff values for spot urine P/Cr ratio in predicting 24-hour protein ?threshold? excretion were determined using receiver operating characteristic curves (ROC), as well as sensitivity and specificity. Results. A total of 303 patients were included in the study. The concordance between 24-hour PRT and P/Cr ratio was excellent (ICC 0.931). Systematic overestimation of PRT by urinary P/ Cr ratio was disclosed (mean difference 0.138, p=0.011). The P/ Cr of 0.25 (sensitivity 0.90; specificity 0.96), 0.66 (1.00; 0.91) and 2.55 (1.0; 0.97) g/g reliably predicted 24-hour urine total protein equivalent ?thresholds? at 0.2, 1.0 and 3.5 g/day. The chronic renal failure group independently positively influenced the difference between 24-hour PRT and P/Cr. It means the lower the kidney function the higher is the difference between the two proteinuria measurements. Conclusion. This study supports the recommendation of using spot urine P/Cr ratio in proteinuria screening in patients with different kidney diseases. The obtained results indicated better agreement between morning P/Cr and 24-hour PRT in patients with lower proteinuria and better kidney function.

Approach to the Patient with Glomerular Disease

2018 ◽  
Author(s):  
Richard J. Glassock ◽  
An S De Vriese ◽  
Fernando C. Fervenza
Keyword(s):  
Nephrotic Syndrome ◽  
Renal Biopsy ◽  
Rapidly Progressive Glomerulonephritis ◽  
Chronic Glomerulonephritis ◽  
Glomerular Diseases ◽  
Diagnosis And Prognosis ◽  
Protein Excretion ◽  
Clinical Syndromes ◽  
Organ Systems ◽  
Therapeutic Decision Making

Glomerular diseases of the kidneys are associated with a limited array of clinical syndromes, including asymptomatic hematuria and/or proteinuria, acute nephritis, nephrotic syndrome, rapidly progressive glomerulonephritis, and chronic glomerulonephritis. The specific diseases that underlie these syndromes are numerous and heterogeneous. Broadly, they may be divided into primary and secondary disorders depending on whether the kidneys are the sole organs affected or whether other organ systems are also involved in the disease processes. A systematic approach involving a careful history, physical examination, assessment of renal function, and urinalysis (composition and microscopy) and protein excretion, combined with biochemical and serologic testing, can provide important clues to diagnosis and prognosis. Renal biopsy is often required for a complete and accurate diagnosis as well as a prognosis and therapeutic decision making. This review contains 4 figures, 6 tables and 92 references Key words: glomerular filtration rate, glomerulonephritis, hematuria, nephrotic syndrome, proteinuria, renal biopsy, serum complement

scholarly journals JAK-STAT Activity in Peripheral Blood Cells and Kidney Tissue in IgA Nephropathy

2020 ◽  
Vol 15 (7) ◽  
pp. 973-982
Author(s):  
Jianling Tao ◽  
Laura Mariani ◽  
Sean Eddy ◽  
Holden Maecker ◽  
Neeraja Kambham ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Kidney Function ◽  
Peripheral Blood ◽  
Kidney Tissue ◽  
Janus Kinase ◽  
Signal Transducer ◽  
Blood Monocytes ◽  
Glomerular Diseases ◽  
Kidney Fibrosis ◽  
Cytokine Stimulation

Background and objectivesIgA nephropathy is the most common primary glomerular disease in the world. Marked by mesangial inflammation and proliferation, it generally leads to progressive kidney fibrosis. As the Janus kinase signal transducer and activator of transcription pathway has been implicated as an important mediator of diabetic kidney disease and FSGS, detailed investigation of this pathway in IgA nephropathy was undertaken to establish the basis for targeting this pathway across glomerular diseases.Design, setting, participants, & measurements Well characterized patients with IgA nephropathy and controls were studied, allowing us to compare 77 patients with biopsy-proven IgA nephropathy with 45 healthy subjects. STAT phosphorylation was assessed in peripheral blood monocytes (PBMCs) by phosphoflow before and after cytokine stimulation. Kidney Janus kinase signal transducer and activator of transcription activity was studied by immunofluorescence and by transcriptomic studies. An STAT1 activity score was established using downstream transcriptional targets of pSTAT1 and associated with disease and clinical outcomes.ResultsWe found PBMCs to have upregulated pSTAT production at baseline in patients with IgA nephropathy with a limited reserve to respond to cytokine stimulation compared with controls. Increased staining in glomerular mesangium and endothelium was seen for Jak-2 and pSTAT1 and in the tubulointerstitial for JAK2, pSTAT1, and pSTAT3. Activation of the Janus kinase signal transducer and activator of transcription pathway was further supported by increased pSTAT1 and pSTAT3 scores in glomerular and tubulointerstitial sections of the kidney (glomerular activation Z scores: 7.1 and 4.5, respectively; P values: <0.001 and <0.001, respectively). Clinically, phosphoflow results associated with proteinuria and kidney function, and STAT1 activation associated with proteinuria but was not associated with progression.ConclusionsJanus kinase signal transducer and activator of transcription signaling was activated in patients with IgA nephropathy compared with controls. There were altered responses in peripheral immune cells and increased message and activated proteins in the kidney. These changes variably related to proteinuria and kidney function.

Impact of kidney function and urinary protein excretion on intima–media thickness in Japanese patients with type 2 diabetes

2015 ◽  
Vol 19 (5) ◽  
pp. 909-917 ◽  
Author(s):  
Yusuke Nakade ◽  
Tadashi Toyama ◽  
Kengo Furuichi ◽  
Shinji Kitajima ◽  
Yoshiyasu Miyajima ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Function ◽  
Intima Media Thickness ◽  
Japanese Patients ◽  
Urinary Protein Excretion ◽  
Urinary Protein ◽  
Media Thickness ◽  
Protein Excretion
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