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Hematuria and Proteinuria. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 75-84.

This chapter about hematuria and proteinuria is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The author recommends that children presenting with hematuria or proteinuria should be considered in different clinical categories: children with hematuria without or with minimal proteinuria, children with hematuria associated with significant proteinuria, and children with proteinuria without accompanying hematuria. The first section of the chapter considers hematuria, covering definition, hemoglobinuria and myoglobinuria, colorants in urine, red blood cell morphology, urinary sediment, differential diagnosis, and recommended workup of hematuria. The section about proteinuria covers definition, differential diagnosis, and workup. Pediatricians are encouraged to orient the clinical investigations of children with these signs in an orderly way to make a correct differential diagnosis and thus identify children who need referral to a pediatric nephrologist. 4 figures. 2 tables. 15 references.

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Proteinuria Reduction and Progression to Renal Failure in Patients with Type 2 Diabetes Mellitus and Overt Nephropathy. American Journal of Kidney Diseases. 45(2): 281-287. February 2005.

This article reports on a study of the effects of blood pressure reduction by specific classes of antihypertensive drugs on the association between proteinuria reduction and progression of kidney insufficiency and development of end-stage renal disease (ESRD). The study focused on patients with overt diabetic nephropathy who had type 2 diabetes mellitus. The authors examined the influence of baseline and treatment-related changes in proteinuria on the renoprotection shown in the Irbesartan Diabetic Nephropathy Trial. The results showed that risk for kidney failure doubled for each doubling of baseline proteinuria level. For each halving of proteinuria level between baseline and 12 months with treatment, risk for kidney failure was reduced by more than half. For the same proportional change in proteinuria, the reduction in risk for kidney failure was significantly greater for irbesartan compared with amlodipine, but not control. Proteinuria reduction in the first 12 months of therapy with irbesartan is associated with 36 percent of the total renoprotective effect observed. The authors stress that baseline proteinuria is an important risk factor for kidney failure and provides a means to identify patients at greatest risk. The authors conclude that proteinuria reduction using an angiotensin receptor-blocking agent, such as irbesartan, should be regarded as an important treatment goal in renoprotective strategies. 4 figures. 23 references.

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Relationship between Predicted Creatinine Clearance and Proteinuria and the Risk of Developing ESRD in Okinawa, Japan. American Journal of Kidney Diseases. 44(5): 806-814. November 2004.

Chronic kidney disease and a low creatinine clearance (CrCl) are relatively common, particularly in the aged population. However, the renal outcome of a low CrCl is not known. This article reports on a study of a subset of participants in a 1993 mass screening conducted by the Okinawa General Health Maintenance Association in Okinawa, Japan, were investigated. A total of 95,255 subjects (40,157 men; 55,098 women) older than 20 years for whom serum creatinine (SCr) data were available were studied. CrCl was calculated as a surrogate marker of glomerular filtration rate (GFR, a measure of kidney function). Participants in the 1993 screening who later entered a dialysis program were identified and the cumulative incidence of end-stage renal disease (ESRD) was calculated according to baseline CrCl level in quartiles. Data was available for 181 subjects in the dialysis registry. The prevalence of a low CrCl was relatively high in the elderly population. Subjects with a low CrCl who had proteinuria were at high risk of developing ESRD. However, the cumulative incidence of ESRD was not as high in patients with a low CrCl but without proteinuria. The authors conclude that screening by means of dipstick for proteinuria is useful, particularly among the elderly, to identify subjects in a high-risk population. 3 figures. 4 tables. 27 references.

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