Prognostic significance of the number of renal glomeruli in reflux nephropathy

Abstract

determined to explore the potential association between these variables and the total renal scars, renal function (glomerular filtration rate, GFR), or daily urinary protein excretion. RESULTSThe number of glomeruli was closely correlated with the actual size of glomeruli ( y = 14.783 − 0.052 x, R = 0.782). To a lesser extent, the number of glomeruli was also closely correlated with the size of glomeruli expressed in SD s ( y = 6.264 − 0.832 x, R = 0.630). There was a good correlation between the number of glomeruli and the extent of renal scarring, renal function, or daily urinary protein excretion, although its association with renal function (GFR) was least evident. CONCLUSIONThere was an association between the decrease in the number of glomeruli and glomerular hypertrophy, decreased renal function, or increased proteinuria. A renal biopsy taken from radiographically and macroscopically normal regions can be useful for assessing RN, and the size and number of glomeruli in the specimens might provide an important measure for estimating the prognosis of RN.

Significance of the Renal Functional Reserve in Reflux Nephropathy: An Evaluation According to the Degree of Glomerular Damage

“…[10,16] However, from the results of this study, we confirmed that the renal functional reserve was still present in patients with a glomerular size of < +4SD, and the positive effects of therapeutic intervention were thus expected in these patients.…”

“…[10,16] For the treatment of RN, early intervention is therefore necessary to minimize the decrease in nephrons.…”

“…[10] We consider the glomerular size to thus be a highly useful indicator of the progression of renal damage in PN patients. [16] Considering that the increase in the glomerular filtration rate (GFR) serves as an indicator of the renal functional reserve, it seems quite rational and natural to evaluate the correlation between the progression of RN and the glomerular size. However, it should be noted that renal biopsy specimens are not always available for a renal functional reserve test, and we thus obtained the samples for this study during a renal biopsy to determine the prognosis for progressive RN patients.…”

Guidelines for the medical management of pediatric vesicoureteral reflux

“…decreased glomerular filtration rate), proteinuria and/or hypertension, indicate progressive RN. It is generally thought that RN progresses when the remnant normal region mass, a decrease of which negatively correlates with an increase in the damaged region mass in the renal parenchyma, is reduced to the level below threshold, but details, such as marginal regions, remain unknown . Many patients with progressive RN have bilateral multiple renal parenchymal injury …”

Urinary Tract Infection in Children

“…Reflux nephropathy is the main concerning as 13~25% of patients develop end-stage renal disease from the inflammatory and immunological processes (Askari and Belman 1982;Craig, Irwig et al 2000;Ardissino, Avolio et al 2004). The risk of developing "Reflux nephropathy" is multiprediposing and related to the host susceptibility and virulence of bacteria (Matsuoka, Nakashima et al 2006;Cendron 2008;Coulthard 2008). Although the management of VUR remains controversial, the ultimate goal is to prevent the further renal injury from reflux and repeat UTIs.…”