IMephrotic-Range Proteinuria in a Patient with High Renin Hypertension: Effect of Treatment with an ACE-lnhibitor

Docci, D; Moscatelli, G; C, Capponcini; Baldrati, L; Feletti, C

doi:10.1159/000168479

Cited by 12 publications

(11 citation statements)

References 7 publications

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“…For example, the clinical course of these patients was not uniform, i.e., some patients required chronic dialysis within 5-10 yr after onset, and the renal function of others slowly progressed to renal failure over a period of 20 yr after onset of the first symptoms. Variable histologic findings were also observed in the patients with progressive IgA nephropathy (42,45,46 In many chronic renal diseases, administration of an ACE inhibitor leads to a significant attenuation of proteinuria (16,49,50). Interestingly, it has been recently reported (51) that, in patients with insulin-dependent diabetes with normal renal function, the absence of the D polymorphism decreases the probability of development of microalbuminuria or proteinuria, but a strong correlation was not demonstrated in another study (52).…”

Section: Resultsmentioning

confidence: 99%

Role of the deletion of polymorphism of the angiotensin converting enzyme gene in the progression and therapeutic responsiveness of IgA nephropathy.

Yoshida¹,

Mitarai²,

Kawamura³

et al. 1995

J. Clin. Invest.

306

165

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Section: Resultsmentioning

confidence: 99%

Role of the deletion of polymorphism of the angiotensin converting enzyme gene in the progression and therapeutic responsiveness of IgA nephropathy.

Yoshida¹,

Mitarai²,

Kawamura³

et al. 1995

J. Clin. Invest.

306

165

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“…But perm selectivity changes of the glomerular filter with insufficient reabsorption of albumin and structural damage to glomeruli and arterioles may also be involved [1,20,21]. The renin-angiotensin system has been implicated by some authors as causative factors for marked proteinuria in patients with renal artery stenosis [22,23]. It is now generally accepted that proteinuria !1.0 g/day is not uncommon in HN [19,21,23].…”

Section: Discussionmentioning

confidence: 99%

“…The renin-angiotensin system has been implicated by some authors as causative factors for marked proteinuria in patients with renal artery stenosis [22,23]. It is now generally accepted that proteinuria !1.0 g/day is not uncommon in HN [19,21,23]. In a series of 500 patients followed by Perera [24], 42% had proteinuria.…”

Section: Discussionmentioning

confidence: 99%

Nephrotic Proteinuria as a Result of Essential Hypertension

Obialo

Hewan-Lowe

Fulong

2002

Kidney Blood Press Res

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Background: The presence of nephrotic-range proteinuria in a nondiabetic hypertensive patient is generally indicative of an underlying glomerular disease. A few published reports have noted nephrotic proteinuria in some patients with hypertensive nephrosclerosis. The frequency of this association is unknown. Methods: We retrospectively reviewed renal biopsy reports on all cases of nephrotic syndrome over an 8-year period (1993–2000). We excluded all cases of diabetes mellitus, lupus, hepatitis, human immunodeficiency virus, and chronic use of nonsteroidal anti-inflammatory drugs. Biopsy specimens showing glomerular eosinophilic hyalinosis lesions, positive immunofluorescence staining, or dense deposits on electron microscopy were also excluded. Thirteen of the remaining 237 (5.5%) biopsy specimens satisfied the standard histological criteria for hypertensive nephrosclerosis. Results: All patients were African-Americans with a mean age of 47.5 ± 13 years and an average mean arterial blood pressure of 122 ± 19 mm Hg. The mean values for urinary protein excretion, serum creatinine, albumin, and cholesterol were 8.9 g/day, 3.3 mg/dl, 3.1 g/dl, and 245 mg/dl, respectively. Optimal blood pressure control required at least three antihypertensive agents. Progression to end-stage renal disease occurred over a mean duration of 8.3 ± 6.5 months. Multivariate regression showed a strong but nonsignificant association between the level of proteinuria at the time of biopsy, duration of hypertension, and number of blood pressure medications (R² = 0.56, p = 0.38). Conclusions: Nephrotic syndrome may be more common in poorly controlled essential hypertension than previously realized. In African-American patients, the differential diagnosis of nephrotic syndrome should include hypertensive nephrosclerosis, but abrogation of renal biopsy is not implied.

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“…There are several adult case reports of re-nal artery stenosis presenting with proteinuria and/or nephrotic syndrome [1,2,3], but very few are documented in the pediatric population [4,5]. It is often asymptomatic, but may present as failure to thrive or with signs and symptoms of congestive heart failure (CHF).…”

Section: Introductionmentioning

confidence: 99%

Renal artery stenosis and nephrotic syndrome: a rare combination in an infant

Lang

Gowrishankar

2003

Pediatr Nephrol

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We describe an uncommon pediatric finding of unilateral renal artery stenosis, which presented as nephrotic syndrome, hypertension, failure to thrive, and hyponatremia. The child was a previously well 8-monthold male who looked well but had mild periorbital edema with severe hypertension. After 3 days of captopril therapy, the nephrotic-range proteinuria significantly improved. However, the hypertension persisted. Renal imaging revealed a small left kidney with reduced parenchymal uptake and no significant excretion. A renal angiogram demonstrated left renal artery stenosis with increased left renal vein renin activity. The hypertension resolved within 24 h of a left nephrectomy, but nonnephrotic-range proteinuria persisted for 8 months post operatively. Pathology of the left kidney was consistent with fibromuscular dysplasia. Although a few glomeruli (1%) had changes consistent with focal segmental glomerulosclerosis, such a few abnormal glomeruli were unlikely to account for the nephrotic syndrome. Hypertension-induced changes in the unaffected right kidney probably caused the nephrotic-range proteinuria.

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IMephrotic-Range Proteinuria in a Patient with High Renin Hypertension: Effect of Treatment with an ACE-lnhibitor

Cited by 12 publications

References 7 publications

Role of the deletion of polymorphism of the angiotensin converting enzyme gene in the progression and therapeutic responsiveness of IgA nephropathy.

Role of the deletion of polymorphism of the angiotensin converting enzyme gene in the progression and therapeutic responsiveness of IgA nephropathy.

Nephrotic Proteinuria as a Result of Essential Hypertension

Renal artery stenosis and nephrotic syndrome: a rare combination in an infant

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