Screening for proteinuria in ‘at-risk’ patients with spinal cord injuries: lessons learnt from failure

Abstract

Spinal cord injury patients may develop proteinuria as a result of glomerulosclerosis due to urosepsis, hydronephrosis, vesicoureteric reflux, and renal calculi. Proteinuria in turn contributes to progression of kidney disease. We report one paraplegic and two tetraplegic patients, who developed recurrent urine infections, urinary calculi, and hydronephrosis. These patients required several urological procedures (nephrostomy, cystoscopy and ureteric stenting, ureteroscopy and lithotripsy, extracorporeal shock wave lithotripsy). These patients had not received antimuscarinic drugs nor had they undergone video-urodynamics. Proteinuria was detected only at a late stage, as testing for proteinuria was not performed during follow-up visits. Urine electrophoresis showed no monoclonal bands in any; Serum glomerular basement membrane antibody screen was negative. Serum neutrophil cytoplasmic antibodies screen by fluorescence was negative. All patients were prescribed Ramipril 2.5 mg daily and there was no further deterioration of renal function.Spinal cord injury patients, who did not receive antimuscarinic drugs to reduce intravesical pressure, are at high risk for developing reflux nephropathy. When such patients develop glomerulosclerosis due to recurrent urosepsis, renal calculi, or hydronephrosis, risk of proteinuria is increased further. Take home message: (1) Screening for proteinuria should be performed regularly in the ‘at-risk’ patients. (2) In the absence of other renal diseases causing proteinuria, spinal cord injury patients with significant proteinuria may be prescribed angiotensin-converting enzyme inhibitor or angiotensin-II receptor antagonist to slow progression of chronic renal disease and reduce the risk of cardiovascular mortality.

Retrospective Study to Assess the Effect of Telmisartan on Urine Albumin-To-Creatinine Ratio (UACR) in Indian Hypertensive Patients with Diabetes

“…[10,11] ARBs reduce protein excretion by approximately 35% to 40%, which is greater than other antihypertensive agents. [12] Reduction in proteinuria correlates with slowing the progression of kidney disease.…”

Effect of telmisartan on kidney function in patients with chronic kidney disease: an observational study

“…[10] ARBs reduce protein excretion by approximately 35% to 40%, which is greater than other antihypertensive agents. [13] As CKD continues to rise, measures to prevent disease progression is an important goal. Among RAAS inhibitors, ARBs are preferred because of advantage discussed earlier and also because of the fact that ACE inhibitors are known to cause dry cough in a higher proportion of the Asian population.…”