scholarly journals Interpretation of 24-Hour Urinary Protein Level for Diagnosis of Nephrotic Syndrome in Marked Hypoalbuminemia

2021 ◽  
Author(s):  
Raghvendra Narayan ◽  
Shivani Singh
Keyword(s):  
Nephrotic Syndrome ◽  
Serum Albumin ◽  
Protein Level ◽  
Urinary Protein ◽  
Mantoux Test ◽  
Laboratory Methods ◽  
X Ray ◽  
Urinary Protein Level ◽  
Chest X Ray ◽  
Nephrotic Range Proteinuria

Nephrotic syndrome is a common renal problem in childhood and is characterised by generalised oedema, massive proteinuria, hypoalbuminemia and hyperlipidemia. There are various laboratory methods to quantify proteinuria. Among them 24-hour urinary protein estimation is considered a gold standard for diagnosis of nephrotic syndrome. Nephrotic range proteinuria is considered when 24-hour urinary protein is more than 40 mg/m2/hr. There is scarce literature available regarding the changes in quantitative proteinuria when there is marked hypoalbuminemia (serum albumin less than 2.5 gm/dL). This series is about three patients of nephrotic syndrome (6 yers old male, 4 years old male and 5 years old male), having marked hypoalbuminemia and their 24-hour urinary protein level resulted into non-nephrotic range. All the patients underwent relevant physical, clinical examinations and laboratory blood and urine investigations(Haemoglobin, Mantoux test, chest x-ray, urine routine, urine culture and sensitivity, lipid profile, serum albumin and 24 hour urinary protein). All the cases were managed with Prednisolone and diuretics like Furosemide and were followed up till the subside of proteinuria and oedema conditions.

P0504FACTORS ASSOCIATED WITH THE LONG-TERM RENAL OUTCOME OF IDIOPATHIC FOCAL SEGMENTAL GLOMERULOSCLEROSIS WITH NEPHROTIC SYNDROME

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
HIROAKI TANAKA ◽  
Takayuki Fujii ◽  
JUNYA KOSHIZAKA ◽  
NOBUAKI YAMAUCHI ◽  
MAYU MORIMOTO ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Protein Level ◽  
Roc Analysis ◽  
Hazard Analysis ◽  
Urinary Protein ◽  
Renal Outcome ◽  
Urinary Protein Level ◽  
Renal Prognosis ◽  
The Mean

Abstract Background and Aims In the treatment of idiopathic focal segmental glomerulosclerosis (FSGS) with nephrotic syndrome, the remission of proteinuria is considered to be an important goal. The partial remission of proteinuria improves renal survival, whereas it may progressively reduce the renal function. A study searched for a novel partial remission more accurately reflecting the long-term renal outcome. The goal of proteinuria reduction for improving the renal prognosis remains to be clarified. We examined factors associated with the long-term renal outcome of idiopathic FSGS. Method Of 148 patients with FSGS diagnosed based on kidney biopsy between 1981 and 2018, a retrospective cohort study was conducted involving 33 who had undergone immunosuppressive therapy for nephrotic syndrome, and had been followed-up for ≥1 year, excluding those with secondary FSGS. We examined the renal prognosis, regarding a 50% decrease in the estimated glomerular filtration rate (eGFR) as an outcome. We calculated the rate of decrease in the urinary protein level 4 and 8 months after the start of treatment, and estimated the rate of decrease associated with renal hypofunction using ROC analysis. Based on the results of ROC analysis, Cox’s proportional hazard analysis was performed using factors contributing to renal hypofunction as covariates. Results Concerning the background of the 33 patients, the mean follow-up period was 11.4 years, and there were 24 males. The mean age was 49.8 years, and the mean blood pressure was 100.5 mmHg. The mean urinary protein level, albumin (Alb) level, eGFR, and total cholesterol (TCho) level were 7.4 g/day, 2.1 g/dL, 44.3 mL/min/1.73 m2, and 369 mg/dL, respectively. Corticosteroid therapy was selected in 21 patients, whereas it was combined with steroid pulse therapy in 12. The daily dose of prednisolone was 37.3 mg. On ROC analysis, the rate of decrease in the urinary protein level after 4 months was 83.1% (AUC: 0.74, sensitivity: 0.80, specificity: 0.74), and that after 8 months was 85.7% (AUC: 0.78, sensitivity: 0.90, specificity: 0.65). Cox’s proportional hazard analysis, in which the data were adjusted with the sex, blood pressure, urinary protein level at the start of treatment, Alb level, eGFR, and treatment methods, showed that the rate of decrease in the urinary protein level after 4 months was significantly correlated with renal hypofunction: after 4 months: hazard ratio, 0.19 (95%CI: 0.04-0.77); p=0.0202; after 8 months: hazard ratio, 0.34 (95%CI: 0.05-1.37); p=0.1359. Conclusion In the treatment of idiopathic FSGS with nephrotic syndrome, the rate of decrease in the urinary protein level 4 months after the start of treatment was correlated with the long-term renal outcome.

scholarly journals Tubuloglomerular Disease With Cone-Shaped Epiphyses Associated With Hypomorphic Variant and a Novel p.Cys14Arg in the TTC21B Gene: A Case Report

2021 ◽  
Vol 9 ◽  
Author(s):  
Martin Bezdíčka ◽  
Dana Zemková ◽  
Sylva Skálová ◽  
Eva Hovorková ◽  
Miroslav Podhola ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Kidney Development ◽  
Kidney Biopsy ◽  
Intraflagellar Transport ◽  
X Ray ◽  
Heterozygous Variant ◽  
Renal Tubular ◽  
Nephrotic Range Proteinuria ◽  
Generation Sequencing

Monogenic nephrotic syndrome (NS) is associated with a resistance to initial glucocorticoid therapy and causative variants, which may be found in several genes influencing podocyte stability and kidney development. The TTC21B gene, which encodes the retrograde intraflagellar transport protein IFT139, is found mostly in association with ciliopathies in humans. The role of this protein in podocyte cytoskeleton stability was confirmed later and the mutated TTC21B also may be associated with proteinuric diseases, such as nephrotic syndrome. Our patient manifested as an infant with brachydactyly, nephrotic-range proteinuria, and renal tubular acidosis, and a kidney biopsy revealed focal segmental glomerulosclerosis (FSGS). Multiple phalangeal cone-shaped epiphyses of the hand were seen on X-ray. Next-generation sequencing revealed the well-described p.Pro209Leu heterozygous variant and a novel heterozygous p.Cys14Arg variant in the TTC21B gene. Our finding confirmed that the causative variants in the TTC21B gene may contribute to a spectrum of clinical features, such as glomerular proteinuric disease with tubulointerstitial involvement and skeletal abnormalities.

scholarly journals Association between Sarcopenia and Renal Function in Patients with Diabetes: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Satoshi Ida ◽  
Ryutaro Kaneko ◽  
Kanako Imataka ◽  
Kazuya Murata
Keyword(s):  
Renal Function ◽  
Protein Level ◽  
Observational Studies ◽  
Meta Analysis ◽  
Albumin Level ◽  
Urinary Albumin ◽  
Urinary Protein ◽  
Urinary Protein Level ◽  
Patients With Diabetes ◽  
Meta Analyses

Previous studies involving patients with diabetes have indicated that sarcopenia is related to renal function. The objective of the present study was to investigate the association between sarcopenia and urinary albumin level, urinary protein level, and estimated glomerular filtration rate (eGFR) in patients with diabetes. A meta-analysis of observational studies was conducted. A literature search was performed using MEDLINE, Cochrane Controlled Trials Registry, and ClinicalTrials.gov. Data were extracted from studies investigating the association between sarcopenia and urinary albumin level, urinary protein level, and eGFR and by calculating odds ratio (OR) and 95% confidence intervals (CIs). Statistical analysis was performed using a random-effects model to calculate pooled OR and 95% CI. Six studies (2662 patients) that met the criteria were included in the meta-analysis. Sarcopenia was significantly associated with urinary albumin level with a pooled OR of 2.11 (95% CI, 1.55–2.88; P<0.001). The pooled ORs of the associations between sarcopenia and urinary protein level and decreased eGFR were 1.82 (95% CI, 1.13–2.92; P=0.01) and 3.75 (95% CI, 1.24–11.41), respectively. Sarcopenia was significantly associated with urinary albumin level, urinary protein level, and decreased eGFR. However, further investigations are needed, including meta-analyses with a larger number of studies.

scholarly journals Role of gene Xpert test in clinical TB suspect in children

2018 ◽  
Vol 5 (4) ◽  
pp. 1657
Author(s):  
Sheenu Gupta ◽  
Veerana Kotrashetti ◽  
Rizwan Ahmed
Keyword(s):  
Diagnostic Tests ◽  
Clinical Manifestations ◽  
Childhood Tuberculosis ◽  
Mantoux Test ◽  
Gastric Aspirate ◽  
X Ray ◽  
Tb Treatment ◽  
Childhood Tb ◽  
History Of ◽  
Chest X Ray

Background: Tuberculosis (TB) is a major global health problem. Childhood tuberculosis (TB) is common in our community but it is relatively neglected, due to greater challenges in diagnosis. Clinical manifestations of childhood TB differ from adults. The diagnosis in most cases is based on clinical evidence but chest X-ray, Mantoux test, history of Kochs contact, malnutrition and sputum/gastric sample microscopy are important supporting investigations. WHO recommended use of newer diagnostic tests like Gene Xpert in pediatric cases where TB is mostly paucibacillary and identification of TB bacilli is difficult for confirmation of diagnosis.Methods: This prospective study was conducted among admitted and OPD patients in the department of Pediatrics over a period of 1and half year. Clinically suspected cases of TB in the age group 0-12 years who met the diagnostic criteria made the study group. Refusal of consent by parent and children already on TB treatment were excluded from this study. Investigations like chest X-ray, Mantoux test, sputum/gastric aspirate microscopy and Gene Expert were done to confirm the clinical diagnosis.Results: Pulmonary tuberculosis was more common (28%), TB lymphadenitis 22%, TB meningitis 14%, Tubercular Pleural effusion 12 %. and rest were no TB. BCG scar was present in 90%. History of contact was present in 76% and Mantoux test was positive in 76%. Gene Expert was positive only in one case in our study rest 49 cases were negative. The most common symptoms were fever (72%), cough (52%) and weight loss (40%).Conclusions: This study supports that detailed history, clinical evaluation and active investigative workup in addition to newer diagnostic tests like Gene Xpert has a major role in diagnosing childhood tuberculosis.

scholarly journals Henoch-Schönlein Nephritis Manifesting with Purpura 15 years after Diagnosis of IgA Nephropathy

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Hideaki Yamabe ◽  
Mitsuaki Kaizuka ◽  
Satoru Tsunoda ◽  
Tasuku Nagasawa ◽  
Kazuo Nomura ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Iga Nephropathy ◽  
Protein Level ◽  
Immunoglobulin A ◽  
Urinary Protein ◽  
Screening Tests ◽  
Iga Vasculitis ◽  
Protein Levels ◽  
Urinary Protein Level ◽  
Urinary Abnormalities

Henoch-Schönlein nephritis or immunoglobulin A (IgA) vasculitis is characterized by purpura, arthralgia, abdominal pain, and glomerulonephritis with glomerular IgA deposition. Notably, the presence of purpura is essential to diagnose this disease. We report the case of a patient in whom proteinuria and haematuria were detected during screening tests and he was diagnosed with IgA nephropathy at 20 years of age. Corticosteroids were administered for 7 years and were subsequently tapered. At 35 years of age, he noticed purpura on his lower extremities and was diagnosed with anaphylactoid purpura. Following the appearance of purpura, urinalysis revealed an increase in urinary protein levels from 0.7 g/g creatinine (Cr) to 1.4 g/gCr, and his serum Cr levels increased from 1.1 mg/dL to 1.35 mg/dL. Two months later purpura subsided, and his urinary protein level and serum Cr level were restored to the former levels. Although the cause remains unknown, an interval may occasionally be observed between the appearance of purpura and urinary abnormalities. However, to our knowledge to date, a 15-year interval is the longest interval, in such cases, reported in the literature.

scholarly journals GeneXpert: a game changer in the detection and diagnosis of childhood tuberculosis

2017 ◽  
Vol 5 (1) ◽  
pp. 35 ◽  
Author(s):  
Nayantara Rao Gandra ◽  
Jayasri Helen Gali
Keyword(s):  
Pleural Effusion ◽  
Elbow Joint ◽  
Mantoux Test ◽  
Gastric Aspirate ◽  
X Ray ◽  
History Of ◽  
Chest X Ray ◽  
The Government ◽  
Detection And Diagnosis ◽  
Game Changer

Background: Battling against tuberculosis (TB) is still a major challenge in India, despite measures undertaken by the government and medical fraternity. Delay in diagnosing tuberculosis is a challenge, causing hurdle in the prevention of spread of the disease.Methods: This retrospective study analysed the samples by geneXpert assay. Samples (n=403, from 359 children) included pulmonary (sputum and gastric aspirate, 359), extrapulmonary (lymph node aspirate (LNA), 41) cerebrospinal fluid (CSF, 03) pus from the lesion at the elbow joint (01).  Only sputum was analysed for 315 children, both sputum and LNA for 41.Results: Mean age of patients was 9.08±2.85 years, range 3-15 years. There were 221 (61.56%) males and 138 (38.44%) females. Fever (71, 19.78%), fever with cough (87, 24.23%), fever with weight loss (41,11.42%) were the main symptoms.  There were three patients with high fever, headache and seizures with neck rigidity, clinically diagnosed as Tuberculous meningitis. There was history of contact with Tuberculosis in 15 (4.18%) patients. Mean ESR was 112.09mm/1st Hr±56.05 (range 54 -750 mm/1st Hr). Mantoux test was positive in 270 (75.42%). Chest X-ray was normal in 33 (9.19%); consolidation in 189 (52.65%), mild pleural effusion in 94 (26.18%) mild pleural effusion associated with consolidation in 43 (11.98%) were reported. Positive GeneXpert assay (106 samples, 27.39%; sputum (87, 24.23% %), pus (01), CSF (03), LNA (15, 57.69%) was reported in 87 patients.  Results were obtained ≤36 hours, mean 2 hours± 2.34 (range 6- 36 hours).Conclusions: GeneXpert is an effective tool for rapid detection of tuberculosis. Present study supports its inclusion in the battery of routine investigations. It can revolutionise the scenario in prevention and management of tuberculosis. 

scholarly journals SAT-466 Hashimoto’s Glomerulonephritis: A Reality or Just a Coincidence?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Andres Alberto Gomez Noronha ◽  
Isabel Pulgar Sedó
Keyword(s):  
Nephrotic Syndrome ◽  
Serum Albumin ◽  
Membranous Glomerulonephritis ◽  
High Serum ◽  
Pathology Report ◽  
Hashimoto’S Disease ◽  
First Case ◽  
Hashimoto's Disease ◽  
Nephrotic Range Proteinuria ◽  
Low Serum

Abstract Background: Glomerulonephritis is a common health problem surrounding nephrologists, mainly characterized by nephrotic range proteinuria, low serum albumin level and edema. There are several causes such as infections, cancer or autoinmune disorders, like Hashimoto’s thyroiditis. This is a chronic inflammation of the thyroid gland caused by high serum thyroid autoantibodies leading to hypothyroidsm. In the last years, many authors worldwide have found an uncommon association between Hashimoto’s disease and nephrotic syndrome. This may be attributed to cross-reacting antigens, such as thyroglublin, that become deposited in the glomeruli. Clinical Case: A 40-year women was admitted to our hospital with typical symptoms of nephrotic syndrome. The patient has a history of hypothyroidsm two years ago, treated with levothyroxine 200 mcg. Initial tests were congruent with glomerular impairment: low serum albumin 2.8 g/dl (NR &gt; 3.5 g/l), hypercholesterolemia 300 mg/dl, (NR &lt;200 mg/dl) and nephrotic-range proteinuria (9g/24h). Viral infections such as HIV, hepatitis B and C, herpes virus and rubella were discarded. Moreover, autoantibodies such as ANA, ANCAc and ANCAp were studied with no contributory results. Tumor markers were also tested and a complete body CT scan was performed looking for some occult cancer, but nothing contributory was found. Thyroid hormones levels were out of range (TSH: 20.04 mIU/l, NR: 0.27-4.20 mIU/l; FT4: 5 pmol/L, NR: 12-22 pmol/L). ATPO and ATG were performed, which were positive and in several fold higher levels than expected. (ATPO: &gt;600 U/ml, N&lt;34 U/ml; ATG: 195 U/ml, N &lt;115 U/ml) During hospitalization a kidney biopsy was performed. The anatomic pathology report was compatible to membranous glomerulonephritis. Since there was no clear etiology of the nephrotic syndrome, we assumed that Hashimoto’s disease had an important role in this particular case, having already discarded the most common causes. We decided to optimized levothyroxine dose (from 200 mcg qd to 250 mcg qd) and ACE inhibitors (losartan 50 mg qd) were added to the therapeutic plan. During the follow up (one year later), we observed an improvement in thyroid hormone levels (TSH: 0.94 mIU/l, FT4: 14.17 pmol/L) and a decreased in proteinuria (3g/24h); however, ATPO and ATG levels persisted high (ATPO: &gt;600. ATG: 170.6). No immunosuppressive therapy was used at all. Conclusion: This is the first case in our hospital demonstrating the possible association between Hashimoto’s disease and membranous glomerulonephritis. Santoro et al. strongly believe that there is a trully relationship connecting both entities, suggesting that similar imnunological abnormalities ought to be the key point in the pathogenesis of the two conditions. Reference: (1) Santoro, D., Vadalà, C., Siligato, R., Buemi, M., & Benvenga, S. Autoimmune thyroiditis and glomerulopathies. Frontiers in endocrinology, 8, 119. (2017)

scholarly journals Thyroid Dysfunction In Patient With Nephrotic Syndrome

2018 ◽  
Vol 28 (1) ◽  
pp. 40-44
Author(s):  
Ruhul Amin ◽  
Md Nazmul Huda ◽  
Md Nurul Islam ◽  
Sandipon Ghose ◽  
ASM M Rahman ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Thyroid Hormones ◽  
Serum Albumin ◽  
Thyroid Dysfunction ◽  
Albumin Level ◽  
Overt Hypothyroidism ◽  
Thyroid Status ◽  
Healthy Control ◽  
Nephrotic Range Proteinuria ◽  
Serum Tsh

A large amount of protein is lost in urine along with thyroid hormones and hormone binding proteins in nephrotic syndrome (NS). This hormone loss may lead to low T4, T3 and sometimes high TSH level and often to be associated with subclinical or overt hypothyroidism. This study was done to assess thyroid dysfunction in patients with NS and to correlate thyroid hormones with albumin level of those subjects. Forty diagnosed patients of idiopathic NS and same number of age matched healthy control were selected in this study. Thyroid status was evaluated in all the subjects. In patients with NS mean (± SD) of T4, T3 and TSH were 39.34 (±29.49), 1.05 (±0.83) and 11.34 (±18.15) respectively. Mean (±SD) of T4, T3 and TSH in healthy control were 83.34 (±27.23), 2.04 (±0.70) and 2.73 (±1.79) respectively. Mean serum total T4 and T3 of patients with NS were found to be significantly lower (t= -6.935, df= 78, p<0.001 and t = -5.750, df = 78, p<0.001 respectively) and mean TSH was found to be significantly higher (t= 2.984, df = 78, p<0.01) in patients with NS as compared to healthy control. Sub clinical hypothyroidism was observed in 20 (50%) and overt hypothyroidism in 4 (10%) of patients. Significant positive correlation was found between serum albumin and serum total T4 (r = 0.818, p <0.001) and also with total T3 level (r = 0.903, p <0.001). But no correlation was found between serum albumin and serum TSH (r = - 0. 292, p>0.05) in patients with NS. So, nephrotic range proteinuria may be associated with loss of thyroid hormone in urine and can lead to subclinical or even overt hypothyroidism.TAJ 2015; 28(1): 40-44

scholarly journals Chinese Herbal Injections for Primary Nephrotic Syndrome in Adults: A Systematic Review and Network Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-11 ◽  
Author(s):  
Shisheng Han ◽  
Tianwen Yao ◽  
Yanhua Lu ◽  
Yan Lu ◽  
Yanqiu Xu ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Serum Albumin ◽  
Remission Rate ◽  
Meta Analysis ◽  
Urinary Protein Excretion ◽  
Urinary Protein ◽  
Primary Nephrotic Syndrome ◽  
Chinese Herbal ◽  
Protein Excretion ◽  
Total Remission

Primary nephrotic syndrome (PNS) is a common renal disease that presents with heavy proteinuria and hypoalbuminemia. Despite notable advances in its treatment, some patients show poor responses and clinical outcomes when treated with conventional Western medicine (WM). Chinese herbal injections (CHIs) have been reported to have beneficial effects for PNS. The aim of the present study was to comprehensively determine the efficacy and safety of CHIs for PNS in adults using a network meta-analysis approach. PubMed, Embase, the Cochrane library, and four Chinese databases were systematically searched to identify randomized controlled trials (RCTs) using CHIs for treatment of PNS published before June 1, 2019. Quality assessment of the identified RCTs was performed according to the Cochrane Handbook. Pooled odds ratios (OR) or mean differences (MD) with corresponding 95% confidence intervals (CI) were calculated for discrete or continuous variables, respectively. The primary outcome was complete/total remission and secondary outcomes were serum albumin and urinary protein excretion. The surface under the cumulative ranking curve (SUCRA) value and cluster analyses were used to rank treatment by probability. Eighty-five studies involving 11 CHIs and 5801 subjects were included. Compared with WM alone, CHI plus WM showed an improved complete/total remission rate as well as higher serum albumin and lower 24-hour urinary protein excretion, except in the following: Yinxingye injection plus WM did not improve the total remission rate, and Dengzhanhua or Xueshuantong injection plus WM did not lower the 24-hour urinary protein excretion. Either Danhong (DH) or Dengzhanhua (DZH) injection plus WM was the preferable treatment for PNS based on SUCRA and cluster analyses of clinical remission and adverse events. However, considering that literature in this area is limited, these results need further validation. CHIs administered as adjuvants to WM showed favourable outcomes for PNS. DH + WM and DZH + WM might be the potential optimal therapies for PNS.

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