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Persistent proteinuria in children.

1969; BMJ; Volume: 44; Issue: 236 Linguagem: Inglês

10.1136/adc.44.236.443

1468-2044

Y. C. Tsao, Weng C. Chan, John B. Gibson,

Metabolism and Genetic Disorders

Proteinuria may be considered persistent in a child when it lasts longer than 3 weeks.Since 1963 we have investigated persistent proteinuria of all degrees of severity in children admitted to hospital in Hong Kong.In most of the cases the proteinuria was idiopathic; in others it was secondary to a recognized renal disease.Renal biopsy was carried out in all of them and repeated in many to establish a histological diagnosis.Most of the biopsies were examined for the presence of globulins in the lesions.Urinary differential protein clearances were esti- mated in many cases.The study, which is still in progress, has reached a stage where it is possible to make a correlation of the biopsy and other findings with the clinical presentation and with the response to treatment and short-term prognosis. Clinical Data and Methods of InvestigationThere were 176 patients aged between 2 and 12 years at the time of the study, of whom 129 were boys and 47 were girls.They representec' a typical cross-section of the Chinese population of Hong Kong.Proteinuria of more than 3 weeks' duration was the sole criterion for including a child in the study, and in most of the cases proteinuria was known to have been present for several months and in some for 3 to 4 years.The cases can be divided according to their clinical features as follows.Idiopathic nephrotic syndrome (67%).These 119 patients, of whom 25 were girls, presented with gross oedema, often with ascites, heavy proteinuria of up to 6-7 g. in 24 hours, and low serum proteins.In many, the serum albumin was less than 1 g./100 ml., the lowest being 0*4 g./100 ml.Serum total cholesterol was high.Azotaemia and haematuria were absent or slight and transient.Persistent symptomless proteinuria (2%).These 3 boys did not have oedema, and proteinuria was discovered on routine urine tests carried out for unrelated purposes.Orthostatic proteinuria was ex- cluded in all 3. Chronic renal failure (20o).Renal disease was unsuspected in any of these 3 boys until they were Received January 24, 1969.admitted in chronic renal failure.One died soon after admission and the kidneys were examined at necropsy.Post-streptococcal glomerulonephritis (15%).In these 27 cases, 18 boys and 9 girls, the characteristic features of acute glomerulonephritis were recorded, and there was a history of a preceding streptococcal infection, or a raised antistreptolysin-0 titre.In some cases the acute episode dated as far back as 2 months before the time of biopsy.The number represents only 9 4% of all the cases of acute glomerulonephritis admitted into hospital during the period.Schonlein-Henoch syndrome with renal involve- ment (110o/).The 19 cases, 8 boys and 11 girls, had skin lesions of the characteristic morphology and distribution, abdominal pain or intestinal haemorrhage, and joint symptoms.Proteinuria was taken to indicate renal involvement whether it was associated with haematuria or not.In 4 children proteinuria was heavy, the nephrotic syndrome appeared, and renal failure developed.In the others the proteinuria lasted from 6 weeks to 10 months.Miscellaneous (3 %).This group consists of 1 boy and 1 girl with systemic lupus erythematosus and the nephrotic syndrome, and 1 case each of diphtheria, meningococcaemia, and Takayasu's arteriopathy. Renal BiopsyRenal biopsies were performed by the method of White (1963) and with his modification of the Silverman biopsy needle (1962).The biopsies were all taken by the same person (Y.C.T.).No death or serious complication was encountered in a total of 248 biopsies.Transient haematuria occurred in 38% of the patients, but in no instance was severe enough to require blood transfusion or surgical exploration of the kidney.Usually two pieces of tissue were obtained.One was used for ordinary histological examination, and the classification of Blainey et al. (1960) in an expanded form was applied.The other piece of tissue was studied by immunofluorescence techniques, as described by Chan and Tsao (1966).The use of fluorescein- tagged antihuman IgG-globulin goat serum (Sylvana) was supplemented in later cases by tagged antihuman flc/l1A-globulin goat serum (Hyland).