Evaluation and Management of Proteinuria and Nephrotic Syndrome in Children: Recommendations From a Pediatric Nephrology Panel Established at the National Kidney Foundation Conference on Proteinuria, Albuminuria, Risk, Assessment, Detection, and Elimination (PARADE)

Hogg, Ronald J.; Portman, Ronald J.; Milliner, Dawn S.; Lemley, Kevin V.; Eddy, Allison A.; Ingelfinger, Julie R.

doi:10.1542/peds.105.6.1242

Cited by 275 publications

(253 citation statements)

References 37 publications

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“…Sequelae of interest included proteinuria, glomerular filtration rate (GFR), a combination of proteinuria and low GFR, and hypertension. Proteinuria was defined as ≥ 1+ by dipstick analysis (8)(9)(10). GFR was calculated by the Schwartz formula with less than 90ml / minute / 1.73 m 2 was classified as an abnormal value (10)(11)(12).…”

Section: Methodsmentioning

confidence: 99%

Duration of oliguria and anuria as predictors of chronic renal-related sequelae in post-diarrheal hemolytic uremic syndrome

et al. 2008

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Prior long-term retrospective studies have described renal sequelae in 25-50 % of post diarrheal hemolytic uremic syndrome (D+HUS ) survivors, but the ability to predict the likelihood of chronic renal related sequelae at the time of hospital discharge is limited. We surveyed 357 children in our HUS registry who had survived an acute episode of D+HUS and were without end stage renal disease (ESRD) at the time of hospital discharge. Of the 357 patients surveyed, 159 had at least one year (mean 8.75 years) of follow-up. Of these, 90 individuals were identified as having had at least one day of oliguria, with 69 individuals having had at least one day of anuria. Incidence of renal related sequelae (proteinuria, low glomerular filtration rate [GFR], and hypertension) were determined among experimental groups based on the duration of oliguria and anuria. One or more sequelae (e.g. proteinuria, low GFR, hypertension) were seen in 25 (36.2%) of those who had no recorded oliguria and 34 (37.8%) of those with no recorded anuria. The prevalence of chronic sequelae increased markedly in those with more than 5 days of anuria or 10 days of oliguria; with anuria being a better predictor of most related sequelae than oliguria. A particularly high incidence of hypertension was seen in patients with > 10 days of anuria (55.6%) in comparison to those with no anuria (OR = 12.8; 95% CI = 2.9 to 57.5). Patients with > 10 days of anuria were also at substantially increased risk for low GFR and proteinuria (OR = 35.2; 95% CI = 5.1 to 240.5). These findings may help to identify children who need periodic and extended follow-up after discharge from the hospital.

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Section: Methodsmentioning

confidence: 99%

Duration of oliguria and anuria as predictors of chronic renal-related sequelae in post-diarrheal hemolytic uremic syndrome

et al. 2008

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“…200 mg/g creatinine [18,19]. The threshold in 24-h urine collection is 96 mg/m 2 /day for children and 150 mg/day for adults.…”

Section: Prevalence Of Post-transplant Proteinuria and Methods For Itmentioning

confidence: 99%

“…The currently recommended method to assess the glomerular type of proteinuria (albuminuria) is determination of the albumin/creatinine ratio, with a threshold of 3 mg/ mmol creatinine, i.e. 30 mg/g creatinine [18,19]. The tubular type of proteinuria is usually assessed by measuring the urinary excretion of microglobulins, such as alpha-1-microglobulin or beta-2-microglobulin, with a threshold of 0.55 and 0.04 mg/mmol creatinine for alpha-1-microglobulinuria and beta-2-microglobulin, respectively.…”

Section: Prevalence Of Post-transplant Proteinuria and Methods For Itmentioning

confidence: 99%

“…), or both [18,[48][49][50]. The mechanisms by which proteinuria may induce renal injury include: (1) the release of fibrosis-promoting factors from renal cells activated by the proteinuria, resulting in interstitial fibrosis; (2) the uptake of urinary proteins from proximal tubular cells, triggering an increased production of angiotensin II, endothelin, cytokines, chemoattractants and transcriptional factors that promote lymphocyte and monocyte recruitment with transdifferentiation of tubular epithelial cells into fibroblasts, leading to scarring [18,43,[48][49][50][51][52][53]. Moreover, many studies using multivariate analysis have shown that proteinuria is an independent risk factor for graft loss after adjustment for other possible causes, such as rejection or hypertension [4,10,46].…”

Section: Consequences To Renal Allograftmentioning

confidence: 99%

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Management of proteinuria in the transplanted patient

Seeman

2014

Pediatr Nephrol

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Proteinuria is a relatively frequent complication in children after renal transplantation (40-80 %). It is usually mild and non-nephrotic in nature and predominantly tubular in origin. The major causes of post-transplant proteinuria are recurrence of primary glomerulonephritis [mostly focal segmental glomerulosclerosis (FSGS)], rejection (acute and chronic), mTOR inhibitors or hypertension. Proteinuria is a risk factor for graft loss and patient death in adults, and even a mild proteinuria (0.1-0.2 g/day) is associated with impaired graft and patient survival. In children, proteinuria seems to be associated with graft but not patient survival. Proteinuria (protein/creatinine ratio) should be assessed regularly in all children. In children with prior chronic kidney disease due to idiopathic FSGS, proteinuria should be assessed daily during the first month after transplantation to enable early diagnosis of recurrence. The cause of proteinuria should be identified, and graft biopsy should be considered in children with unexplained proteinuria, especially with new onset proteinuria or deterioration of previously mild proteinuria. Treatment must be primarily targeted at the cause of proteinuria, and in normotensive children symptomatic antiproteinuric therapy with angiotensinconverting enzyme inhibitors/angiotensin II receptor antagonists should also be initiated. Other antihypertensive drugs should be used to achieve target blood pressure of<75th percentile. Target proteinuria should be <20 mg/mmol creatinine.

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“…Significant proteinuria was quantified as a uP/C ratio.0.50 mg protein/mg creatinine for children age #24 months and .0.20 mg protein/mg creatinine for children .24 months (35). If proteinuria was identified, urinalysis was repeated three times in a first morning sample to rule out an orthostatic effect.…”

Section: Definitions Of Ckd Signs and Hypertensionmentioning

confidence: 99%

CKD and Hypertension during Long-Term Follow-Up in Children and Adolescents Previously Treated with Extracorporeal Membrane Oxygenation

Zwiers¹,

IJsselstijn²,

Rosmalen³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Many children receiving extracorporeal membrane oxygenation develop AKI. If AKI leads to permanent nephron loss, it may increase the risk of developing CKD. The prevalence of CKD and hypertension and its predictive factors during long-term follow-up of children and adolescents previously treated with neonatal extracorporeal membrane oxygenation were determined.Design, setting, participants, & measurements Between November of 2010 and February of 2014, neonatal survivors of extracorporeal membrane oxygenation who visited the prospective follow-up program at 1, 2, 5, 8, 12, and 18 years of age were screened for CKD and hypertension (BP$95th percentile of reference values). CKD was suspected in children with either an eGFR,90 ml/min per 1.73 m 2 or proteinuria (urinary protein-tocreatinine ratio .0.50 for children ages #24 months and .0.20 at .24 months). The RIFLE classification (risk, injury, or failure as 150%, 200%, or 300% of serum creatinine reference values) was used to define AKI during extracorporeal membrane oxygenation without preemptive hemofiltration.Results Median follow-up of 169 screened participants was 8.2 years (interquartile range=5.2-12.1 years). Nine children had a lower eGFR, but all rates were .60 ml/min per 1.73 m 2 . Proteinuria was observed in 20 children (median=0.26 mg protein/mg creatinine; interquartile range=0.23-0.32 mg protein/mg creatinine), and 32 children had hypertension. Only history of AKI was associated with CKD (P=0.004). Children with RIFLE scores injury and failure had 4.3 times higher odds of CKD signs or hypertension than those without AKI (95% confidence interval, 1.6 to 12.1; P=0.004).Conclusions Altogether, 54 participants (32%) had at least one sign of CKD and/or hypertension. However, most values were marginally abnormal, with no immediate consequences for clinical care. Nevertheless, a prevalence of 32% clearly indicates that survivors of neonatal extracorporeal membrane oxygenation, especially those with AKI, are at risk of a more rapid decline of kidney function with increasing age. Therefore, screening for CKD development in adulthood is recommended.

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Evaluation and Management of Proteinuria and Nephrotic Syndrome in Children: Recommendations From a Pediatric Nephrology Panel Established at the National Kidney Foundation Conference on Proteinuria, Albuminuria, Risk, Assessment, Detection, and Elimination (PARADE)

Abstract: These recommendations are intended to provide primary care physicians with a useful reference when they are faced with a young child or teenager who presents with proteinuria, whether this is mild and asymptomatic or more severe, leading to nephrotic syndrome.

Cited by 275 publications

References 37 publications

Duration of oliguria and anuria as predictors of chronic renal-related sequelae in post-diarrheal hemolytic uremic syndrome

Duration of oliguria and anuria as predictors of chronic renal-related sequelae in post-diarrheal hemolytic uremic syndrome

Management of proteinuria in the transplanted patient

CKD and Hypertension during Long-Term Follow-Up in Children and Adolescents Previously Treated with Extracorporeal Membrane Oxygenation

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