[Objectives]To evaluate the clinical efficacy and safety of Kunkui Kidney Preserving Paste in the treatment of diabetic kidney disease(DKD)patients with damp-heat stasis syndrome in the clinical proteinuria stage.[Met...[Objectives]To evaluate the clinical efficacy and safety of Kunkui Kidney Preserving Paste in the treatment of diabetic kidney disease(DKD)patients with damp-heat stasis syndrome in the clinical proteinuria stage.[Methods]Retrospective analysis was made on 30 patients with DKD who were diagnosed with damp-heat stasis syndrome in the clinical proteinuria stage from March 2021 to March 2023 in Jiangsu Province Hospital of Chinese Medicine,and who took Kunkui Kidney Preserving Paste continuously for six months.The urinary albumin/creatinine ratio(UACR),urinary complement C3,and urea nitrogen(BUN)of DKD patients before and after treatment were compared,and estimated glomerular filtration rate(eGFR),blood creatinine(Scr),and cystatin C(CysC)were estimated,and the therapeutic effects on renal function and urinary protein were evaluated.[Results]After treatment,UACR significantly decreased(P<0.01),and urinary complement C3 and Scr decreased(P<0.05),while other indicators showed no significant statistical difference(P>0.05).In terms of evaluating the efficacy of urinary protein therapy,8 cases showed recent relief;8 cases showed significant effect;9 cases were effective,and 5 cases were invalid after treatment,with a total effective rate of 83.33%.In terms of renal function efficacy evaluation,8 cases showed significant effect;4 cases were effective;11 cases were stable,and 7 cases were invalid,with a total effective rate of 76.67%.In the safety evaluation,there were no obvious adverse reactions.[Conclusions]The Kunkui Kidney Preserving Past has significant clinical efficacy and safety in treating DKD patients with damp-heat stasis syndrome in the clinical proteinuria period.It has significant advantages in reducing urinary protein and protecting renal function,which is worthy of clinical promotion.展开更多
Background: Pre-eclampsia has long been considered as a disease that disappears after the removal of the placenta. It has now been shown that its symptoms can persist for months after giving birth. Objectives: To stud...Background: Pre-eclampsia has long been considered as a disease that disappears after the removal of the placenta. It has now been shown that its symptoms can persist for months after giving birth. Objectives: To study the evolution of proteinuria and renal function in women with pre-eclampsia. Patients and Methods: An analytical prospective study was carried out in the Hospitalization Unit of the Gynecology Department of the Teaching Hospital of Cocody (Abidjan) from May 3, 2021 to November 15, 2021. It focused on the follow-up of proteinuria and renal function in 50 women who had pre-eclampsia during their pregnancy, in the three months following their delivery. Results: The average age of the patients was 30.38 ± 6 years (range 18 and 40 years). Thirty-two percent were nulliparous and 62% had no risk factors for pre-eclampsia. The diagnosis of pre-eclampsia was made in 52% of cases before 37 weeks of amenorrhea. Sixty-two percent had Grade 3 arte-rial hypertension. The average proteinuria/creatininuria ratio was 3592.08 ± 7009.57 mg/g and 32% of women had glomerular grade proteinuria. The mean serum creatinine was 13.61 ± 12.62 mg/l. AKI (Acute Renal Failure) was present in 30% of women. All patients had received a central antihypertensive drug of which 88% were a calcium channel blocker. For the delivery mode, a Caesarean section was performed in 88% of cases. In the three months postpartum, 40% of women had persistent hypertension, 58% had persistent proteinuria and 6% had persistent impaired renal function. Prematurity (p = 0.0091), IUGR (intrauterine growth restriction) (p = 0.0012) and IUFD (intrauterine fetal death) (p = 0.0012) were associated with the persistence of proteinuria at M3 postpartum. Conclusion: Symptoms of pre-eclampsia do not automatically disappear after the delivery. Proteinuria and renal failure can persist beyond three months after the delivery and require treatment by a nephrologist.展开更多
Objective:To assess if microhaematuria and proleinuria as measured by reagent strips could estimate intensity of Schistosoma haematobium(S.haematobium) infection in endemic areas and evaluate their screening performan...Objective:To assess if microhaematuria and proleinuria as measured by reagent strips could estimate intensity of Schistosoma haematobium(S.haematobium) infection in endemic areas and evaluate their screening performance among children in Benue State,Nigeria.Methods:A lolal of 1124 urine samples were collected,screened for microhaematuria and proteinuria using reagent strips(Combi 9) and results were compared to filtration technique,the gold standard method.Results:A significant correlation was ohserved between microhaematuria(rho= 0.66. P【0.01).proteinuria(rho = 0.71.P【0.01) and intensity of.S.haematobium eggs.Proteinuria had sensitivity of 95.7%and specificity of 67.2%.while microhaematuria had sensitivity of 64.8%and specificity of 89.6%.The proportion of false positive diagnoses was higher in proleinuria(19.2%) than microliaematuria(6.0%).Conclusios:The findings suggest that use of urine reagent strips could potentially estimate intensity of.S.haematobium infection and their performance to screen urinary schistosomiasis agreed with previous observations.展开更多
To study the relationship between serum vascular endothelial growth factor (VEGF) and proteinuria in adriamycin induced nephrotic rats, a rat model of adriamycin induced nephrotitis was developed by injection of adria...To study the relationship between serum vascular endothelial growth factor (VEGF) and proteinuria in adriamycin induced nephrotic rats, a rat model of adriamycin induced nephrotitis was developed by injection of adriamycin into a tail vein in a rat. At different time points, 24 h urinary protein excretion was measured by using Coomassie brilliant blue method and the serum VEGF levels detected by using ELISA assay. The interventional effect of VEGF on this model was observed. The results showed that: (1) The adriamycin induced nephrotic syndrome rat model was developed successfully; (2) Serum VEGF levels and proteinuria were significantly increased at 7th day after intravenous injection of adriamycin. There was a positive correlation between serum VEGF levels and 24 h urinary protein excretion ( r=0.67, P <0.05). (3) The 24 h urinary protein excretion was significantly increased in the rats receiving administration of VEGF ( P <0.05). It was concluded that VEGF might play an important role in the pathogenesis of proteinuria in adriamycin induced nephrotic rats.展开更多
In human immunodef iciency virus(HIV)-infected people kidney disease is as an important cause of morbidity and mortality. Clinical features of kidney damage in HIV-infected patients range from asymptomatic microalbumi...In human immunodef iciency virus(HIV)-infected people kidney disease is as an important cause of morbidity and mortality. Clinical features of kidney damage in HIV-infected patients range from asymptomatic microalbuminuria to nephrotic syndrome. The lack of specif ic clinical features despite the presence of heavy proteinuria may mask the renal involvement. Indeed, it is important in HIV patients to monitor renal function to early discover a possible kidney injury. After the introduction of antiretroviral therapy, mortality and morbidity associated to HIV-infection have shown a substantial reduction, although a variety of side effects for longterm use of highly active antiretroviral therapy, including renal toxicity, has emerged. Among more than 20 currently available antiretroviral agents, many of them can occasionally cause reversible or irreversible nephrotoxicity. At now, three antiretroviral agents, i.e., indinavir, atazanavir and tenofovir disoproxil fumarate have a well established association with direct nephrotoxicity. This review focuses on major causes of proteinuria and other pathological f indings related to kidney disease in HIV-infected children and adolescents.展开更多
Controlling blood pressure and reducing proteinuria are common goals in Chronic Kidney Disease associated with hypertension and proteinuria and lead to fewer cardiovascular outcomes. This review summarizes the availab...Controlling blood pressure and reducing proteinuria are common goals in Chronic Kidney Disease associated with hypertension and proteinuria and lead to fewer cardiovascular outcomes. This review summarizes the available literature.展开更多
Introduction: Early detection of proteinuria is early detection is a cost-effective method of assessing individuals with and without risk factors for chronic renal disease. Proteinuria is common in adults and may pres...Introduction: Early detection of proteinuria is early detection is a cost-effective method of assessing individuals with and without risk factors for chronic renal disease. Proteinuria is common in adults and may present a clinical challenge in the absence of obvious renal disease or risk factors especially in the tropics. Few studies in Nigeria have assessed the prevalence of proteinuria in adults using the dipstick method. The aim of this study was to document the prevalence of proteinuria among residents of a community in Enugu, south east Nigeria. Methods: This was a cross-sectional descriptive study carried out in an isolated urban slum settlement in Enugu, south east Nigeria. Dipstick testing of freshly voided early morning mid-stream urine samples was done to detect proteinuria. For database management and statistical analyses, SPSS version 23 was used. Results: A total of 262 individuals were recruited for the study, 165 (63%) females and 97 (37%) males. The participants’ age ranged from 18 to 90 years, averaging 43.7 ± 15.5. Trace amounts of protein were detected in urine samples of 225 (85.9%) individuals. Significant proteinuria was detected in 3.8% of the participants and was significantly higher 40 - 49-year-olds (6%). p = 0.02 and 0.02 respectively. Significant correlates of proteinuria were lower diastolic blood pressure and current tobacco use. Lower body mass index weakly correlated with proteinuria. Conclusion: The prevalence of significant early morning proteinuria in a community-based study in Enugu was 3.8%. Significant correlates of proteinuria included low diastolic blood pressure and tobacco use. Community based awareness programs targeted at prevention of chronic renal diseases should be incorporated in public health programs.展开更多
Two pregnant women who initially developed proteinuria alone followed by serious preeclampsia are presented to emphasize that there is no adequate technical term to express the period of proteinuria alone based on the...Two pregnant women who initially developed proteinuria alone followed by serious preeclampsia are presented to emphasize that there is no adequate technical term to express the period of proteinuria alone based on the current criteria of pregnancy-induced hypertension. Case 1 exhibited a urinary protein concentration of 46 mg/dL in the absence of hypertension, and abdominal pain due to placental abruption with hypertension at gestational week (GW) 29–3/7 and 29–4/7, respectively. Case 2 exhibited a urinary protein/creatinine ratio of 2.67, developed hypertension, required cesarean section, and developed posterior reversible encephalopathy syndrome at GW 28–1/7, 29–6/7, and 32–0/7, and on postpartum day 2, respectively. As women with proteinuria alone are not diagnosed as having preeclampsia and as a diagnosis of gestational proteinuria can be made only at 12 weeks postpartum, a prospective technical term applicable to the condition of proteinuria alone is needed to increase physicians’ attention to this condition.展开更多
Objectives: The objectives of this work were to calculate the frequency of arterial hypertension during pregnancy, describe the epidemiological profile, and identify the most common type of hypertension and to establi...Objectives: The objectives of this work were to calculate the frequency of arterial hypertension during pregnancy, describe the epidemiological profile, and identify the most common type of hypertension and to establish fetal prognosis based on uricemia and maternal proteinuria. Methodology: This was a six (6) month descriptive prospective study performed in the Obstetrics and Gynecology Department of Donka National Hospital-CHU Conakry. The study took place from july 1 st to December 31st, 2015. Results: The frequency of arterial hypertension during pregnancy was 8.82% in the service. The epidemiological profile was that of teenagers (32.8%), nulliparous (56%), coming from home (69.2%), not having performed CPN (52%), not schooled (68%) and housewives. The primary factor was the risk factor (52.4%). Gestational age greater than 37 was the most concerned (62%). The reasons for consultation are dominated by headache (76%) and vertigo (68%). The main type of hypertension was pre-eclampsia (48%) followed by Transient HTA (28%). The predominant clinical form during the admission was pre-eclampsia (47.2%) followed by eclampsia (23%). At the first minute, 35.68% of newborns had an APGAR score of less than 7 and the fifth 25.5% had a score of less than 7. Fetal morbidity was dominated by fetal hypotrophy (30.19%), followed by prematurity (23.92%). In 90.90% of hypotrophy, there are ?85.24% of premature babies, 95.55% of SFA, and 80% of MIU;the serum uric acid was greater than 350 mmol. We recorded 204 children born with mothgers with proteinuria greater than or equal to 30 mg/dl, or 80% of children. 30 cases of MFIU and 7 cases of neonatal death out of 255 births, that is 14.50% were noted. Conclusion: The detection of risk factors by a good prenatal follow-up and the regular training of the care providers for adequate and multidisciplinary care (obstetrician, intensive care nephrologist and pediatrician) of hypertensive pregnant women and their newborns can improve the maternal prognosis and fetal.展开更多
Background: The prevalence of asymptomatic renal scarring, such as a focal segmental glomerulosclerosis (FSGS), was suggested to be high in women who develop preeclampsia. FSGS is a risk factor for endstage renal dise...Background: The prevalence of asymptomatic renal scarring, such as a focal segmental glomerulosclerosis (FSGS), was suggested to be high in women who develop preeclampsia. FSGS is a risk factor for endstage renal disease. Objective: To document preeclamptic women with proteinuria that developed eight weeks prior to hypertension with confirmed FSGS postpartum. Case: A 20-year-old nulliparous Japanese woman with a negative dipstick test result at gestational week (GW) 18 exhibited proteinuria 1+ on dipstick test at GW 22. Proteinuria determined from the random urine protein to creatinine ratio (P/Cr, g/g) was increased from 3.7 at GW 26 to 4.6 and 8.9 at GW 28 and 30, respectively. She developed hypertension (142/66 mmHg) at GW 30. Due to increased edema, emergency cesarean section was performed at GW 33. She gave birth to an otherwise healthy female small-for-gestational-age infant, weighing 1290 g. Postpartum course was uneventful except for persisting proteinuria: P/Cr of 9.8 just before delivery decreased to 3.6 and 1.7 on postpartum weeks 9 and 17, respectively. Renal biopsy on postpartum week 13 revealed FSGS in this patient. Conclusion: Hidden FSGS may have manifested as preeclampsia in this patient. This case highlighted the need to determine the prevalence of asymptomatic FSGS among women who later develop preeclampsia.展开更多
Hypertension defined as a systolic blood pressure of ≥140 and a diastolic blood pressure ≥90 is anextremely prevalent condition;and it is responsible for significant mortality and morbidity. NHANESdata from 2005-200...Hypertension defined as a systolic blood pressure of ≥140 and a diastolic blood pressure ≥90 is anextremely prevalent condition;and it is responsible for significant mortality and morbidity. NHANESdata from 2005-2006 found that nearly 30% of adult US population has HTN;and nearly 8% of the population has undiagnosed HTN. HBP mortality in 2008 was 61,005. Any mentioned mortality in 2008 was 347,689 (NHLBI tabulation of NCHS mortality data). More than 20% of patients with systemic hypertension have chronic renal insufficiency (NHANES). Hypertensive nephropathy is a leading cause of end-stage renal disease (ESRD) requiring dialysis or transplantation or leading to death. The incidence of hypertension is high but only a subset of hypertensive patients progress to frank renal failure. A subset of hypertensive patients develop proteinuria during the course of disease and manifest nephrotic syndrome. This syndrome includes marked proteinuria, edema, and low serum albumin. Neither the incidence nor the clinical significance of proteinuria in hypertension without diabetes is known. Progression to chronic renal failure in some patients is preceded by proteinuria as indicated on “dip-stick” analyses of random urine samples. It appears that proteinuria is likely to increase both prior to and during evident loss of glomerular filtration, but this clinical observation has never been formally confirmed. There is a need for large studies to answer these questions. We also need to focus on the roles that genetic and environmental factors play in development and progression of renal disease in the setting of hypertension and proteinuria.展开更多
<strong>Objective:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">To determine the prevalence of proteinuria in children living ...<strong>Objective:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">To determine the prevalence of proteinuria in children living with HIV (CLHIV) and identify associated factors. </span><b><span style="font-family:Verdana;">Patients and methods: </span></b><span style="font-family:Verdana;">This was a cross-sectional, descriptive and analytical study carried out from April to August 2017 in the HIV care centres in Brazzaville and Pointe-Noire. The study included CLHIV with dipstick urinalysis test “Combur</span><sup><span style="font-family:Verdana;">10</span></sup><span style="font-family:Verdana;"> Test</span><sup><span style="font-family:Verdana;">®</span></sup><span style="font-family:Verdana;"> M”. </span><b><span style="font-family:Verdana;">Re</span><span style="font-family:Verdana;">sults: </span></b><span style="font-family:Verdana;">Thirty seven CLHIV on HAART presented a proteinuria, 21.8%. Children were male gender in 21 case</span></span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> (56.8%) and female gender in 16 cases (43.2%). Mean age was 10.9 ± 3.9 years. The children were infected with type 1 virus in 35 cases (94.6%), vertical transmission in all the cases (100%). Children were living with HIV for about 2 to 4 years of average n = 18 (48.6%)</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> and they were WHO clinical stage 2 in 18 cases (48.6%). 13 children (35%) had CD4 level < 200 cells/mm</span><sup><span style="font-family:Verdana;">3</span></sup><span style="font-family:Verdana;">. All CLHIV (100%) were on HAART thus 20 (37.7%) on the combination of zidovudine (AZT), lamivudine (3TC) and nevirapine (NVP). This combination AZT, 3TC, NVP was a protective factor regarding the occurrence of proteinuria (OR: 0.43;IC (95%). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Proteinuria </span><span style="font-family:Verdana;">is less observe</span></span><span style="font-family:Verdana;">d</span><span style="font-family:Verdana;"> in CLHIV on HAART. Systematic screening and early management of proteinuria during follow</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">up of these children improve their survival</span><span style="font-family:Verdana;">.</span>展开更多
In the occurrence and development of glomerulonephritis, proteinuria is themain manifestation, which is easily recurrent but not easily got rid of in a short period of time. It may remain even after disappearance ... In the occurrence and development of glomerulonephritis, proteinuria is themain manifestation, which is easily recurrent but not easily got rid of in a short period of time. It may remain even after disappearance of the general symptoms. In some patients, there are no symptoms and signs at all in the initial stage, except proteinuria, the only distinct manifestation. Prof. Ye Chuanhui, from Chengdu University of Traditional Chinese Medicine, has accumulated rich experience for treating this disorder, which is introduced in the following.……展开更多
Objective:Our goal was to examine the impact of Zhuangshen Gujing decoction on proteinuria associated with chronic nephritis.Methods:72 patients with chronic nephritis proteinuria were divided randomly into two groups...Objective:Our goal was to examine the impact of Zhuangshen Gujing decoction on proteinuria associated with chronic nephritis.Methods:72 patients with chronic nephritis proteinuria were divided randomly into two groups;one group was treated with Zhuangshen Gujing(n=36;treatment group)and the other group was treated with irbesartan(n=36;control group).After 6 months’treatment,urine protein and renal function were evaluated.Results:Proteinuria resolved completely in four patients in the treatment group;complete disease resolution was observed only among three individuals in the control group.Of the 32 cases remaining in the treatment group,15 had substantial responses to Zhuangshen Gujing decoction,9 had partial responses,and 8 had no response to treatment;the overall the response rate was 73.33%.Among the 33 cases remaining in the control group,12 had a substantial response to irbesartan,5 had a partial response,and 16 had no response to treatment;the overall response rate among the controls was 57.67%(P=0.031).We also observed statistically significant differences with respect to quantitative comparisons of urinary protein at 24 days after a single course of treatment(P=0.001).Conclusion:Zhuangshen Gujing decoction is effective in treating chronic nephritis proteinuria.展开更多
Objective To explore the relationship between HBV DNA and the clinical manifestations, pathological types, injury severity, and prognosis with HBV-GN. Methods 102 patients with HBV-GN were divided into 3 groups, accor...Objective To explore the relationship between HBV DNA and the clinical manifestations, pathological types, injury severity, and prognosis with HBV-GN. Methods 102 patients with HBV-GN were divided into 3 groups, according to the serum titer of the HBV DNA. 24-h urine protein excretion, and other parameters were measured. Renal biopsy were performed. The association between HBV DNA and the pathological stage of membranous nephropathy was analyzed in 78 patients with HBV-MN. 24-h urine protein excretion was used for the evaluation of the prognosis, and the relationship between HBV DNA and prognosis were analyzed. Results Several findings were demonstrated with the increase of serum HBV DNA: 24-h urine protein excretion, plasma cholesterol, and triglycerides increased significantly(P<0.05), while the plasma level of albumin decreased significantly(P<0.05); The changes of serum creatinine, C3 and C4 were found but no statistical significance. Glomerular deposition of HBVAg increased, and the pathological injury was more severe. The clinical remission rate was lower in the high replication group after treatment as compared with the low replication group(P<0.01). Conclusion With the increase of serum HBV DNA, the urine protein excretion and the kidney injury were more severe, and the clinical remission rate was decreased.展开更多
Objective:To observe the podocyte injury in diabetic nephropathy(DN) patients by identifying the urinary podocytes and the situation of detached podocytes in glomeruli and to demonstrate the correlation between podocy...Objective:To observe the podocyte injury in diabetic nephropathy(DN) patients by identifying the urinary podocytes and the situation of detached podocytes in glomeruli and to demonstrate the correlation between podocyte excretion and proteinuria,blood glucose,serum creatinine in different phases in DN patients.Methods:Urinary podocytes and the podocalyxin(PCX) expression state of podocytes in glomeruli were identified and observed by indirect immunofluorescent method.The DN patients were divided into three groups according to the volume of proteinuria,namely small,medium and large volume proteinuria groups.The podocytes in the urine of every group were calculated.The DN patients were divided into five groups according to the chronic kidney disease(CKD) phases,then the positive podocytes in urine were calculated.Meanwhile,the 24-hour protein in urine,fasting blood glucose(FBG) and the serum creatinine of DN patients were tested.The correlations among the proteinuria,serum creatinine,FBG and the number of positive podocytes in the urine of DN patients were statistically analyzed.Results:Urinary positive podocytes were found in 88% of the patients with DN,whereas podocytes were found in 0% of patients with minimal changed disease(MCD) and healthy cases.The expression of PCX was absent in DN patients.In contrast,PCX was expressed integrally in MCD patients.The positive podocytes was 1.49±0.95/ml in small-volume proteinuria group,2.15±0.70/ml in the medium-volume proteinuria group,and 3.48±1.27/ml in the large-volume proteinuria group.There was no significant difference between the small-and medium-volume proteinuria groups,and there were significant differences between other groups(P<0.05).The positive podocyte number tended to increase as proteinuria was increased.By Pearson analysis,the correlation between podocyte number and proteinuria was positive statistically.The difference of the number of positive podocytes in urine from different groups of DN patients,CKD Ⅰ-Ⅴ group was significant statistically.The correlation between serum creatinine of CKD Ⅰ-Ⅲ group and positive podocytes in urine was positive statistically.The correlation between serum creatinine of CKD Ⅳ-Ⅴ group and positive podocytes in urine was not significant statistically.The correlation between FBG and positive podocytes in urine was not significant either.Conclusion:The mechanism of the podocyte injury in DN patients is present.The podocyte injury in DN may positively correlate to proteinuria and serum creatinine of CKD Ⅰ-Ⅲ DN patients,but not to the FBG and serum creatinine of CKD Ⅳ-Ⅴ patients.展开更多
AIM: To determine whether complement membrane attack complex(C5b-9) has a pathogenic role in tubulointerstitial injury in a renal disease model characterized by acute highly selective proteinuria. METHODS: Protein-ove...AIM: To determine whether complement membrane attack complex(C5b-9) has a pathogenic role in tubulointerstitial injury in a renal disease model characterized by acute highly selective proteinuria. METHODS: Protein-overload nephropathy(PON) was induced in adult female Piebald-Viral-Glaxo rats with or without complement C6 deficiency(C6- and C6+) by daily intraperitoneal injections of bovine serum albumin(BSA, 2 g/d), and examined on days 2, 4 and 8.RESULTS: Groups with PON developed equivalent levels of heavy proteinuria within 24 h of BSA injection. In C6+ rats with PON, the tubulointerstitial expression of C5b-9 was increased and localized predominantly to the basolateral surface of tubular epithelial cells(TECs), whereas it was undetectable in C6- animals. TEC proliferation(as assessed by the number of BrdU +cells) increased by more than 50-fold in PON, peaking on day 2 and declining on days 4 to 8. There was a trend for a reduction in the number of BrdU + TECs on day 4 in the C6- PON group(P = 0.10 compared to C6+) but not at any other time-point. Kidney enlargement, TEC apoptosis(TUNEL+ cells) and markers of tubular injury(tubule dilatation, loss of TEC height, protein cast formation) were not altered by C6 deficiency in PON. Interstitial monocyte(ED-1+ cell) accumulation was partially reduced in C6- animals with PON on day 4(P = 0.01) but there was no change in myofibroblast accumulation. CONCLUSION: These data suggest that C5b-9 does not mediate tubulointerstitial injury in acute glomerular diseases characterized by selective proteinuria.展开更多
Background: Acute kidney injury associated with proteinuria has been reported following vaccination against SARS-CoV-2 several times since 2021. Decisions about subsequent revaccination in these patients have been dif...Background: Acute kidney injury associated with proteinuria has been reported following vaccination against SARS-CoV-2 several times since 2021. Decisions about subsequent revaccination in these patients have been difficult because of the uncertainty of the consequences of doing so, and the absence of publications to help determine whether revaccination may be considered safe or not. Purpose: We present a case report of a 59-year-old Canadian man who developed severe acute kidney injury associated with moderate proteinuria following his first COVID-19 vaccine with the Moderna vaccine (an mRNA vaccine). He required haemodialysis for 2 weeks, which was initiated when his creatinine reached 1002 μmol/l. A kidney biopsy showed changes consistent with acute tubular necrosis. The patient was cautioned that repeat vaccination might result in further kidney injury which might be irreversible. However, he badly wanted to attempt a second COVID-19 vaccination, to facilitate a family vacation across several countries in Europe, at a time when travel restrictions were in place in many countries for persons who had not completed a course of vaccines. Method: Following deliberations, the patient chose to try a different type of Covid-19 vaccine. On this occasion, he was vaccinated with the Novavax vaccine (a subunit COVID-19 vaccine). Following this, close monitoring of his urine to detect proteinuria and blood testing for acute kidney injury were carried out on days 1, 3, 7, and 60 after vaccination. Furthermore, a year after his repeat vaccination, his kidney function and urinalysis were again assessed. Result and Conclusions: The patient did not develop acute kidney injury or worsening proteinuria following repeat vaccination. It remains unclear if acute kidney injury with proteinuria is caused by Covid-19 vaccination, or simply an incidental association. This case report suggests that it is may be reasonable for patients with acute kidney injury after COVID-19 vaccination to consider trying a different type of vaccine. In situations where a new virulent strain of virus emerges or in patients at risk of severe complication from infection, it may be reasonable to consider revaccination following appropriate counselling with close monitoring of renal function.展开更多
基金Supported by the National Natural Science Foundation of China(82174293,82374355,82004286)Science and Technology Support Program of Jiangsu Province(ZD202208,ZT202206)Postgraduate Research and Practice Innovation Program of Jiangsu Province(SJCX22_0718).
文摘[Objectives]To evaluate the clinical efficacy and safety of Kunkui Kidney Preserving Paste in the treatment of diabetic kidney disease(DKD)patients with damp-heat stasis syndrome in the clinical proteinuria stage.[Methods]Retrospective analysis was made on 30 patients with DKD who were diagnosed with damp-heat stasis syndrome in the clinical proteinuria stage from March 2021 to March 2023 in Jiangsu Province Hospital of Chinese Medicine,and who took Kunkui Kidney Preserving Paste continuously for six months.The urinary albumin/creatinine ratio(UACR),urinary complement C3,and urea nitrogen(BUN)of DKD patients before and after treatment were compared,and estimated glomerular filtration rate(eGFR),blood creatinine(Scr),and cystatin C(CysC)were estimated,and the therapeutic effects on renal function and urinary protein were evaluated.[Results]After treatment,UACR significantly decreased(P<0.01),and urinary complement C3 and Scr decreased(P<0.05),while other indicators showed no significant statistical difference(P>0.05).In terms of evaluating the efficacy of urinary protein therapy,8 cases showed recent relief;8 cases showed significant effect;9 cases were effective,and 5 cases were invalid after treatment,with a total effective rate of 83.33%.In terms of renal function efficacy evaluation,8 cases showed significant effect;4 cases were effective;11 cases were stable,and 7 cases were invalid,with a total effective rate of 76.67%.In the safety evaluation,there were no obvious adverse reactions.[Conclusions]The Kunkui Kidney Preserving Past has significant clinical efficacy and safety in treating DKD patients with damp-heat stasis syndrome in the clinical proteinuria period.It has significant advantages in reducing urinary protein and protecting renal function,which is worthy of clinical promotion.
文摘Background: Pre-eclampsia has long been considered as a disease that disappears after the removal of the placenta. It has now been shown that its symptoms can persist for months after giving birth. Objectives: To study the evolution of proteinuria and renal function in women with pre-eclampsia. Patients and Methods: An analytical prospective study was carried out in the Hospitalization Unit of the Gynecology Department of the Teaching Hospital of Cocody (Abidjan) from May 3, 2021 to November 15, 2021. It focused on the follow-up of proteinuria and renal function in 50 women who had pre-eclampsia during their pregnancy, in the three months following their delivery. Results: The average age of the patients was 30.38 ± 6 years (range 18 and 40 years). Thirty-two percent were nulliparous and 62% had no risk factors for pre-eclampsia. The diagnosis of pre-eclampsia was made in 52% of cases before 37 weeks of amenorrhea. Sixty-two percent had Grade 3 arte-rial hypertension. The average proteinuria/creatininuria ratio was 3592.08 ± 7009.57 mg/g and 32% of women had glomerular grade proteinuria. The mean serum creatinine was 13.61 ± 12.62 mg/l. AKI (Acute Renal Failure) was present in 30% of women. All patients had received a central antihypertensive drug of which 88% were a calcium channel blocker. For the delivery mode, a Caesarean section was performed in 88% of cases. In the three months postpartum, 40% of women had persistent hypertension, 58% had persistent proteinuria and 6% had persistent impaired renal function. Prematurity (p = 0.0091), IUGR (intrauterine growth restriction) (p = 0.0012) and IUFD (intrauterine fetal death) (p = 0.0012) were associated with the persistence of proteinuria at M3 postpartum. Conclusion: Symptoms of pre-eclampsia do not automatically disappear after the delivery. Proteinuria and renal failure can persist beyond three months after the delivery and require treatment by a nephrologist.
基金the Local Government chairmen of Katsina-Ala and Buruku Areas and their respective education authorities for granting permission before commencement of the research
文摘Objective:To assess if microhaematuria and proleinuria as measured by reagent strips could estimate intensity of Schistosoma haematobium(S.haematobium) infection in endemic areas and evaluate their screening performance among children in Benue State,Nigeria.Methods:A lolal of 1124 urine samples were collected,screened for microhaematuria and proteinuria using reagent strips(Combi 9) and results were compared to filtration technique,the gold standard method.Results:A significant correlation was ohserved between microhaematuria(rho= 0.66. P【0.01).proteinuria(rho = 0.71.P【0.01) and intensity of.S.haematobium eggs.Proteinuria had sensitivity of 95.7%and specificity of 67.2%.while microhaematuria had sensitivity of 64.8%and specificity of 89.6%.The proportion of false positive diagnoses was higher in proleinuria(19.2%) than microliaematuria(6.0%).Conclusios:The findings suggest that use of urine reagent strips could potentially estimate intensity of.S.haematobium infection and their performance to screen urinary schistosomiasis agreed with previous observations.
文摘To study the relationship between serum vascular endothelial growth factor (VEGF) and proteinuria in adriamycin induced nephrotic rats, a rat model of adriamycin induced nephrotitis was developed by injection of adriamycin into a tail vein in a rat. At different time points, 24 h urinary protein excretion was measured by using Coomassie brilliant blue method and the serum VEGF levels detected by using ELISA assay. The interventional effect of VEGF on this model was observed. The results showed that: (1) The adriamycin induced nephrotic syndrome rat model was developed successfully; (2) Serum VEGF levels and proteinuria were significantly increased at 7th day after intravenous injection of adriamycin. There was a positive correlation between serum VEGF levels and 24 h urinary protein excretion ( r=0.67, P <0.05). (3) The 24 h urinary protein excretion was significantly increased in the rats receiving administration of VEGF ( P <0.05). It was concluded that VEGF might play an important role in the pathogenesis of proteinuria in adriamycin induced nephrotic rats.
文摘In human immunodef iciency virus(HIV)-infected people kidney disease is as an important cause of morbidity and mortality. Clinical features of kidney damage in HIV-infected patients range from asymptomatic microalbuminuria to nephrotic syndrome. The lack of specif ic clinical features despite the presence of heavy proteinuria may mask the renal involvement. Indeed, it is important in HIV patients to monitor renal function to early discover a possible kidney injury. After the introduction of antiretroviral therapy, mortality and morbidity associated to HIV-infection have shown a substantial reduction, although a variety of side effects for longterm use of highly active antiretroviral therapy, including renal toxicity, has emerged. Among more than 20 currently available antiretroviral agents, many of them can occasionally cause reversible or irreversible nephrotoxicity. At now, three antiretroviral agents, i.e., indinavir, atazanavir and tenofovir disoproxil fumarate have a well established association with direct nephrotoxicity. This review focuses on major causes of proteinuria and other pathological f indings related to kidney disease in HIV-infected children and adolescents.
文摘Controlling blood pressure and reducing proteinuria are common goals in Chronic Kidney Disease associated with hypertension and proteinuria and lead to fewer cardiovascular outcomes. This review summarizes the available literature.
文摘Introduction: Early detection of proteinuria is early detection is a cost-effective method of assessing individuals with and without risk factors for chronic renal disease. Proteinuria is common in adults and may present a clinical challenge in the absence of obvious renal disease or risk factors especially in the tropics. Few studies in Nigeria have assessed the prevalence of proteinuria in adults using the dipstick method. The aim of this study was to document the prevalence of proteinuria among residents of a community in Enugu, south east Nigeria. Methods: This was a cross-sectional descriptive study carried out in an isolated urban slum settlement in Enugu, south east Nigeria. Dipstick testing of freshly voided early morning mid-stream urine samples was done to detect proteinuria. For database management and statistical analyses, SPSS version 23 was used. Results: A total of 262 individuals were recruited for the study, 165 (63%) females and 97 (37%) males. The participants’ age ranged from 18 to 90 years, averaging 43.7 ± 15.5. Trace amounts of protein were detected in urine samples of 225 (85.9%) individuals. Significant proteinuria was detected in 3.8% of the participants and was significantly higher 40 - 49-year-olds (6%). p = 0.02 and 0.02 respectively. Significant correlates of proteinuria were lower diastolic blood pressure and current tobacco use. Lower body mass index weakly correlated with proteinuria. Conclusion: The prevalence of significant early morning proteinuria in a community-based study in Enugu was 3.8%. Significant correlates of proteinuria included low diastolic blood pressure and tobacco use. Community based awareness programs targeted at prevention of chronic renal diseases should be incorporated in public health programs.
文摘Two pregnant women who initially developed proteinuria alone followed by serious preeclampsia are presented to emphasize that there is no adequate technical term to express the period of proteinuria alone based on the current criteria of pregnancy-induced hypertension. Case 1 exhibited a urinary protein concentration of 46 mg/dL in the absence of hypertension, and abdominal pain due to placental abruption with hypertension at gestational week (GW) 29–3/7 and 29–4/7, respectively. Case 2 exhibited a urinary protein/creatinine ratio of 2.67, developed hypertension, required cesarean section, and developed posterior reversible encephalopathy syndrome at GW 28–1/7, 29–6/7, and 32–0/7, and on postpartum day 2, respectively. As women with proteinuria alone are not diagnosed as having preeclampsia and as a diagnosis of gestational proteinuria can be made only at 12 weeks postpartum, a prospective technical term applicable to the condition of proteinuria alone is needed to increase physicians’ attention to this condition.
文摘Objectives: The objectives of this work were to calculate the frequency of arterial hypertension during pregnancy, describe the epidemiological profile, and identify the most common type of hypertension and to establish fetal prognosis based on uricemia and maternal proteinuria. Methodology: This was a six (6) month descriptive prospective study performed in the Obstetrics and Gynecology Department of Donka National Hospital-CHU Conakry. The study took place from july 1 st to December 31st, 2015. Results: The frequency of arterial hypertension during pregnancy was 8.82% in the service. The epidemiological profile was that of teenagers (32.8%), nulliparous (56%), coming from home (69.2%), not having performed CPN (52%), not schooled (68%) and housewives. The primary factor was the risk factor (52.4%). Gestational age greater than 37 was the most concerned (62%). The reasons for consultation are dominated by headache (76%) and vertigo (68%). The main type of hypertension was pre-eclampsia (48%) followed by Transient HTA (28%). The predominant clinical form during the admission was pre-eclampsia (47.2%) followed by eclampsia (23%). At the first minute, 35.68% of newborns had an APGAR score of less than 7 and the fifth 25.5% had a score of less than 7. Fetal morbidity was dominated by fetal hypotrophy (30.19%), followed by prematurity (23.92%). In 90.90% of hypotrophy, there are ?85.24% of premature babies, 95.55% of SFA, and 80% of MIU;the serum uric acid was greater than 350 mmol. We recorded 204 children born with mothgers with proteinuria greater than or equal to 30 mg/dl, or 80% of children. 30 cases of MFIU and 7 cases of neonatal death out of 255 births, that is 14.50% were noted. Conclusion: The detection of risk factors by a good prenatal follow-up and the regular training of the care providers for adequate and multidisciplinary care (obstetrician, intensive care nephrologist and pediatrician) of hypertensive pregnant women and their newborns can improve the maternal prognosis and fetal.
文摘Background: The prevalence of asymptomatic renal scarring, such as a focal segmental glomerulosclerosis (FSGS), was suggested to be high in women who develop preeclampsia. FSGS is a risk factor for endstage renal disease. Objective: To document preeclamptic women with proteinuria that developed eight weeks prior to hypertension with confirmed FSGS postpartum. Case: A 20-year-old nulliparous Japanese woman with a negative dipstick test result at gestational week (GW) 18 exhibited proteinuria 1+ on dipstick test at GW 22. Proteinuria determined from the random urine protein to creatinine ratio (P/Cr, g/g) was increased from 3.7 at GW 26 to 4.6 and 8.9 at GW 28 and 30, respectively. She developed hypertension (142/66 mmHg) at GW 30. Due to increased edema, emergency cesarean section was performed at GW 33. She gave birth to an otherwise healthy female small-for-gestational-age infant, weighing 1290 g. Postpartum course was uneventful except for persisting proteinuria: P/Cr of 9.8 just before delivery decreased to 3.6 and 1.7 on postpartum weeks 9 and 17, respectively. Renal biopsy on postpartum week 13 revealed FSGS in this patient. Conclusion: Hidden FSGS may have manifested as preeclampsia in this patient. This case highlighted the need to determine the prevalence of asymptomatic FSGS among women who later develop preeclampsia.
文摘Hypertension defined as a systolic blood pressure of ≥140 and a diastolic blood pressure ≥90 is anextremely prevalent condition;and it is responsible for significant mortality and morbidity. NHANESdata from 2005-2006 found that nearly 30% of adult US population has HTN;and nearly 8% of the population has undiagnosed HTN. HBP mortality in 2008 was 61,005. Any mentioned mortality in 2008 was 347,689 (NHLBI tabulation of NCHS mortality data). More than 20% of patients with systemic hypertension have chronic renal insufficiency (NHANES). Hypertensive nephropathy is a leading cause of end-stage renal disease (ESRD) requiring dialysis or transplantation or leading to death. The incidence of hypertension is high but only a subset of hypertensive patients progress to frank renal failure. A subset of hypertensive patients develop proteinuria during the course of disease and manifest nephrotic syndrome. This syndrome includes marked proteinuria, edema, and low serum albumin. Neither the incidence nor the clinical significance of proteinuria in hypertension without diabetes is known. Progression to chronic renal failure in some patients is preceded by proteinuria as indicated on “dip-stick” analyses of random urine samples. It appears that proteinuria is likely to increase both prior to and during evident loss of glomerular filtration, but this clinical observation has never been formally confirmed. There is a need for large studies to answer these questions. We also need to focus on the roles that genetic and environmental factors play in development and progression of renal disease in the setting of hypertension and proteinuria.
文摘<strong>Objective:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">To determine the prevalence of proteinuria in children living with HIV (CLHIV) and identify associated factors. </span><b><span style="font-family:Verdana;">Patients and methods: </span></b><span style="font-family:Verdana;">This was a cross-sectional, descriptive and analytical study carried out from April to August 2017 in the HIV care centres in Brazzaville and Pointe-Noire. The study included CLHIV with dipstick urinalysis test “Combur</span><sup><span style="font-family:Verdana;">10</span></sup><span style="font-family:Verdana;"> Test</span><sup><span style="font-family:Verdana;">®</span></sup><span style="font-family:Verdana;"> M”. </span><b><span style="font-family:Verdana;">Re</span><span style="font-family:Verdana;">sults: </span></b><span style="font-family:Verdana;">Thirty seven CLHIV on HAART presented a proteinuria, 21.8%. Children were male gender in 21 case</span></span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> (56.8%) and female gender in 16 cases (43.2%). Mean age was 10.9 ± 3.9 years. The children were infected with type 1 virus in 35 cases (94.6%), vertical transmission in all the cases (100%). Children were living with HIV for about 2 to 4 years of average n = 18 (48.6%)</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> and they were WHO clinical stage 2 in 18 cases (48.6%). 13 children (35%) had CD4 level < 200 cells/mm</span><sup><span style="font-family:Verdana;">3</span></sup><span style="font-family:Verdana;">. All CLHIV (100%) were on HAART thus 20 (37.7%) on the combination of zidovudine (AZT), lamivudine (3TC) and nevirapine (NVP). This combination AZT, 3TC, NVP was a protective factor regarding the occurrence of proteinuria (OR: 0.43;IC (95%). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Proteinuria </span><span style="font-family:Verdana;">is less observe</span></span><span style="font-family:Verdana;">d</span><span style="font-family:Verdana;"> in CLHIV on HAART. Systematic screening and early management of proteinuria during follow</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">up of these children improve their survival</span><span style="font-family:Verdana;">.</span>
文摘 In the occurrence and development of glomerulonephritis, proteinuria is themain manifestation, which is easily recurrent but not easily got rid of in a short period of time. It may remain even after disappearance of the general symptoms. In some patients, there are no symptoms and signs at all in the initial stage, except proteinuria, the only distinct manifestation. Prof. Ye Chuanhui, from Chengdu University of Traditional Chinese Medicine, has accumulated rich experience for treating this disorder, which is introduced in the following.……
文摘Objective:Our goal was to examine the impact of Zhuangshen Gujing decoction on proteinuria associated with chronic nephritis.Methods:72 patients with chronic nephritis proteinuria were divided randomly into two groups;one group was treated with Zhuangshen Gujing(n=36;treatment group)and the other group was treated with irbesartan(n=36;control group).After 6 months’treatment,urine protein and renal function were evaluated.Results:Proteinuria resolved completely in four patients in the treatment group;complete disease resolution was observed only among three individuals in the control group.Of the 32 cases remaining in the treatment group,15 had substantial responses to Zhuangshen Gujing decoction,9 had partial responses,and 8 had no response to treatment;the overall the response rate was 73.33%.Among the 33 cases remaining in the control group,12 had a substantial response to irbesartan,5 had a partial response,and 16 had no response to treatment;the overall response rate among the controls was 57.67%(P=0.031).We also observed statistically significant differences with respect to quantitative comparisons of urinary protein at 24 days after a single course of treatment(P=0.001).Conclusion:Zhuangshen Gujing decoction is effective in treating chronic nephritis proteinuria.
基金supported by the Education Department of Shandong Province,China,No.J11LF21
文摘Objective To explore the relationship between HBV DNA and the clinical manifestations, pathological types, injury severity, and prognosis with HBV-GN. Methods 102 patients with HBV-GN were divided into 3 groups, according to the serum titer of the HBV DNA. 24-h urine protein excretion, and other parameters were measured. Renal biopsy were performed. The association between HBV DNA and the pathological stage of membranous nephropathy was analyzed in 78 patients with HBV-MN. 24-h urine protein excretion was used for the evaluation of the prognosis, and the relationship between HBV DNA and prognosis were analyzed. Results Several findings were demonstrated with the increase of serum HBV DNA: 24-h urine protein excretion, plasma cholesterol, and triglycerides increased significantly(P<0.05), while the plasma level of albumin decreased significantly(P<0.05); The changes of serum creatinine, C3 and C4 were found but no statistical significance. Glomerular deposition of HBVAg increased, and the pathological injury was more severe. The clinical remission rate was lower in the high replication group after treatment as compared with the low replication group(P<0.01). Conclusion With the increase of serum HBV DNA, the urine protein excretion and the kidney injury were more severe, and the clinical remission rate was decreased.
文摘Objective:To observe the podocyte injury in diabetic nephropathy(DN) patients by identifying the urinary podocytes and the situation of detached podocytes in glomeruli and to demonstrate the correlation between podocyte excretion and proteinuria,blood glucose,serum creatinine in different phases in DN patients.Methods:Urinary podocytes and the podocalyxin(PCX) expression state of podocytes in glomeruli were identified and observed by indirect immunofluorescent method.The DN patients were divided into three groups according to the volume of proteinuria,namely small,medium and large volume proteinuria groups.The podocytes in the urine of every group were calculated.The DN patients were divided into five groups according to the chronic kidney disease(CKD) phases,then the positive podocytes in urine were calculated.Meanwhile,the 24-hour protein in urine,fasting blood glucose(FBG) and the serum creatinine of DN patients were tested.The correlations among the proteinuria,serum creatinine,FBG and the number of positive podocytes in the urine of DN patients were statistically analyzed.Results:Urinary positive podocytes were found in 88% of the patients with DN,whereas podocytes were found in 0% of patients with minimal changed disease(MCD) and healthy cases.The expression of PCX was absent in DN patients.In contrast,PCX was expressed integrally in MCD patients.The positive podocytes was 1.49±0.95/ml in small-volume proteinuria group,2.15±0.70/ml in the medium-volume proteinuria group,and 3.48±1.27/ml in the large-volume proteinuria group.There was no significant difference between the small-and medium-volume proteinuria groups,and there were significant differences between other groups(P<0.05).The positive podocyte number tended to increase as proteinuria was increased.By Pearson analysis,the correlation between podocyte number and proteinuria was positive statistically.The difference of the number of positive podocytes in urine from different groups of DN patients,CKD Ⅰ-Ⅴ group was significant statistically.The correlation between serum creatinine of CKD Ⅰ-Ⅲ group and positive podocytes in urine was positive statistically.The correlation between serum creatinine of CKD Ⅳ-Ⅴ group and positive podocytes in urine was not significant statistically.The correlation between FBG and positive podocytes in urine was not significant either.Conclusion:The mechanism of the podocyte injury in DN patients is present.The podocyte injury in DN may positively correlate to proteinuria and serum creatinine of CKD Ⅰ-Ⅲ DN patients,but not to the FBG and serum creatinine of CKD Ⅳ-Ⅴ patients.
基金Supported by The United States National Institutes of Health(Nos.DK34198 and DK07467)to Dr.CouserThe Don Jacquot Fellowship(Australian and New Zealand Society of Nephrology Travelling Fellowship)+3 种基金The BJ Amos Travelling Fellowships(Westmead Hospital)The Medical Research Fund of Western AustraliaThe Fremantle Hospital Medical Research FoundationThe National Health and Medical Research Council(No.230500)to Dr.Rangan
文摘AIM: To determine whether complement membrane attack complex(C5b-9) has a pathogenic role in tubulointerstitial injury in a renal disease model characterized by acute highly selective proteinuria. METHODS: Protein-overload nephropathy(PON) was induced in adult female Piebald-Viral-Glaxo rats with or without complement C6 deficiency(C6- and C6+) by daily intraperitoneal injections of bovine serum albumin(BSA, 2 g/d), and examined on days 2, 4 and 8.RESULTS: Groups with PON developed equivalent levels of heavy proteinuria within 24 h of BSA injection. In C6+ rats with PON, the tubulointerstitial expression of C5b-9 was increased and localized predominantly to the basolateral surface of tubular epithelial cells(TECs), whereas it was undetectable in C6- animals. TEC proliferation(as assessed by the number of BrdU +cells) increased by more than 50-fold in PON, peaking on day 2 and declining on days 4 to 8. There was a trend for a reduction in the number of BrdU + TECs on day 4 in the C6- PON group(P = 0.10 compared to C6+) but not at any other time-point. Kidney enlargement, TEC apoptosis(TUNEL+ cells) and markers of tubular injury(tubule dilatation, loss of TEC height, protein cast formation) were not altered by C6 deficiency in PON. Interstitial monocyte(ED-1+ cell) accumulation was partially reduced in C6- animals with PON on day 4(P = 0.01) but there was no change in myofibroblast accumulation. CONCLUSION: These data suggest that C5b-9 does not mediate tubulointerstitial injury in acute glomerular diseases characterized by selective proteinuria.
文摘Background: Acute kidney injury associated with proteinuria has been reported following vaccination against SARS-CoV-2 several times since 2021. Decisions about subsequent revaccination in these patients have been difficult because of the uncertainty of the consequences of doing so, and the absence of publications to help determine whether revaccination may be considered safe or not. Purpose: We present a case report of a 59-year-old Canadian man who developed severe acute kidney injury associated with moderate proteinuria following his first COVID-19 vaccine with the Moderna vaccine (an mRNA vaccine). He required haemodialysis for 2 weeks, which was initiated when his creatinine reached 1002 μmol/l. A kidney biopsy showed changes consistent with acute tubular necrosis. The patient was cautioned that repeat vaccination might result in further kidney injury which might be irreversible. However, he badly wanted to attempt a second COVID-19 vaccination, to facilitate a family vacation across several countries in Europe, at a time when travel restrictions were in place in many countries for persons who had not completed a course of vaccines. Method: Following deliberations, the patient chose to try a different type of Covid-19 vaccine. On this occasion, he was vaccinated with the Novavax vaccine (a subunit COVID-19 vaccine). Following this, close monitoring of his urine to detect proteinuria and blood testing for acute kidney injury were carried out on days 1, 3, 7, and 60 after vaccination. Furthermore, a year after his repeat vaccination, his kidney function and urinalysis were again assessed. Result and Conclusions: The patient did not develop acute kidney injury or worsening proteinuria following repeat vaccination. It remains unclear if acute kidney injury with proteinuria is caused by Covid-19 vaccination, or simply an incidental association. This case report suggests that it is may be reasonable for patients with acute kidney injury after COVID-19 vaccination to consider trying a different type of vaccine. In situations where a new virulent strain of virus emerges or in patients at risk of severe complication from infection, it may be reasonable to consider revaccination following appropriate counselling with close monitoring of renal function.
