Sleep Apnea, Proteinuria, and Nephrotic Syndrome

Chaudhary, Bashir A.; Sklar, Allan H.; Chaudhary, T.; Kolbeck, Ralph C.; Speir, William A.

doi:10.1093/sleep/11.1.69

Cited by 50 publications

(28 citation statements)

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“…As already noted, several case reports and cross-sectional studies found a relation between sleep apnea and proteinuria [20,21,22,23,24], while others did not [44, 45]. Two reports restudied a small number of patients after treatment for SDB and found a reduction in proteinuria levels with no change in overall patient characteristics [20, 21]. One study in children assessed the presence of various proteins in urine samples of children with and without sleep apnea.…”

Section: Discussionmentioning

confidence: 80%

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Sleep-Disordered Breathing and Proteinuria in Overweight and Obese Children and Adolescents

Verhulst

Hoeck²,

Schrauwen³

et al. 2008

Horm Res Paediatr

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Objectives: To assess whether sleep-disordered breathing (SDB) in overweight children and adolescents has an additional effect on the spectrum of urinary albumin to protein loss, as markers of early kidney dysfunction. Methods: Prospective study in a clinical sample of overweight children and adolescents. Each subject underwent anthropometry, blood sampling, oral glucose tolerance test and polysomnography. From a 24-hour urine collection, albumin excretion rate and total urinary protein to creatinine ratio (UPCR) were calculated. Results: 94 nondiabetic subjects were included (mean age = 11.0 ± 2.5, 42 boys). Average BMI z-score was 2.25 ± 0.47 (26 overweight subjects and 68 obese subjects). There was no difference in albumin excretion rate or UPCR between subjects with and without SDB. None of the SDB parameters correlated with the transformed albumin excretion rate or UPCR. Albumin excretion rate significantly correlated with fasting insulin and C-peptide and with post-challenge glucose, insulin and C-peptide levels, while UPCR correlated with fasting and post-challenge C-peptide levels. Multiple regression indicated that post-challenge glucose levels were the most important predictors of albumin excretion rate. Conclusion: Insulin resistance, and not SDB, was associated with increased levels of albuminuria, indicating early renal dysfunction, in this clinical sample of overweight children and adolescents.

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Section: Discussionmentioning

confidence: 80%

“…It is therefore possible that SDB could further exacerbate the obesity-related renal injury. Indeed, several studies in adults reported a positive association between SDB and proteinuria [20,21,22,23,24]. To the best of our knowledge, this aspect has not been studied yet in obese children and adolescents.…”

Section: Introductionmentioning

confidence: 97%

Sleep-Disordered Breathing and Proteinuria in Overweight and Obese Children and Adolescents

Verhulst

Hoeck²,

Schrauwen³

et al. 2008

Horm Res Paediatr

View full text Add to dashboard Cite

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“…Support for an association between hypoxia and development of progressive chronic kidney disease comes from numerous in-vitro and in-vivo studies of the effect of hypoxia on tubular and interstitial cells [3], while human physiology studies also demonstrate alterations in renal hemodynamics directly attributable to hypoxia [4], [5]. Although the Sleep Heart Health Study suggested an association between nocturnal hypoxia and risk of hypertension [6], reports on the effect of sleep disordered breathing on renal function are not consistent [7], [8], [9], [10], [11], [12], [13] and there are no studies examining loss of kidney function as the primary outcome.…”

Section: Introductionmentioning

confidence: 99%

Nocturnal Hypoxia and Loss of Kidney Function

et al. 2011

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BackgroundAlthough obstructive sleep apnea (OSA) is more common in patients with kidney disease, whether nocturnal hypoxia affects kidney function is unknown.MethodsWe studied all adult subjects referred for diagnostic testing of sleep apnea between July 2005 and December 31 2007 who had serial measurement of their kidney function. Nocturnal hypoxia was defined as oxygen saturation (SaO2) below 90% for ≥12% of the nocturnal monitoring time. The primary outcome, accelerated loss of kidney function, was defined as a decline in estimated glomerular filtration rate (eGFR) ≥4 ml/min/1.73 m2 per year.Results858 participants were included and followed for a mean study period of 2.1 years. Overall 374 (44%) had nocturnal hypoxia, and 49 (5.7%) had accelerated loss of kidney function. Compared to controls without hypoxia, patients with nocturnal hypoxia had a significant increase in the adjusted risk of accelerated kidney function loss (odds ratio (OR) 2.89, 95% confidence interval [CI] 1.25, 6.67).ConclusionNocturnal hypoxia was independently associated with an increased risk of accelerated kidney function loss. Further studies are required to determine whether treatment and correction of nocturnal hypoxia reduces loss of kidney function.

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“…Patients with OSAS (obstructive sleep apnoea syndrome) sometimes demonstrate proteinuria, which occasionally develops to the nephrotic stage and is associated with renal dysfunction [1][2][3][4][5][6][7][8]. Glomerular hypertrophy and/or focal segmental glomerulosclerosis are characteristic histological findings in biopsy studies of these patients [1][2][3]9].…”

Section: Introductionmentioning

confidence: 99%

Short-term use of continuous positive airway pressure ameliorates glomerular hyperfiltration in patients with obstructive sleep apnoea syndrome

et al. 2004

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Patients with OSAS (obstructive sleep apnoea syndrome) demonstrate renal signs such as proteinuria, glomerular hypertrophy and focal glomerular sclerosis. We performed a clinical study to investigate the glomerular function in OSAS patients and the short-term effect of CPAP (continuous positive airway pressure) on it. OSAS patients underwent a sodium thiosulphate and p-aminohippurate double clearance test, polysomnography and ambulatory blood pressure monitoring before and a week after the induction of CPAP. Twenty-seven consecutive patients (24 males) with moderate-to-severe OSAS admitted to our hospital for the induction of CPAP, and 32 healthy donors for renal transplantation as controls participated in the study. Before treatment, the glomerular filtration rate, estimated by the sodium thiosulphate clearance test, was within normal range, and the renal plasma flow was significantly lower than normal in the OSAS patients, thus the FF (filtration fraction) value was much higher than normal. FF before CPAP was not significantly correlated with age, body mass index or blood pressure; however, indices of increased hypoxaemia correlated with increased FF values. Polysomnographic variables after CPAP showed significant improvements in all patients, and only the nocturnal blood pressures were slightly lower than before CPAP. In 21 patients who underwent the clearance test after CPAP, FF significantly decreased from 0.26 +/- 0.04 to 0.23 +/- 0.03 (P < 0.001). OSAS patients were generally in a glomerular-hyperfiltrating condition that appeared to cause the renal findings associated with OSAS. CPAP might prevent nephropathy by ameliorating the glomerular hyperfiltration in OSAS patients.

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Sleep Apnea, Proteinuria, and Nephrotic Syndrome

Cited by 50 publications

References 0 publications

Sleep-Disordered Breathing and Proteinuria in Overweight and Obese Children and Adolescents

Sleep-Disordered Breathing and Proteinuria in Overweight and Obese Children and Adolescents

Nocturnal Hypoxia and Loss of Kidney Function

Short-term use of continuous positive airway pressure ameliorates glomerular hyperfiltration in patients with obstructive sleep apnoea syndrome

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