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The glomerular changes in children with reflux nephropathy
Author(s) -
Morita Miyako,
Yoshiara Shoichi,
White Richard H. R.,
Raafat Faro
Publication year - 1990
Publication title -
the journal of pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.964
H-Index - 184
eISSN - 1096-9896
pISSN - 0022-3417
DOI - 10.1002/path.1711620311
Subject(s) - reflux nephropathy , reflux , nephropathy , urology , medicine , vesicoureteral reflux , endocrinology , disease , diabetes mellitus
While heavy proteinuria and focal segmental glomerulosclerosis (FSGS) are well‐recognized features of progressive reflux nephropathy in adults, little is known of their early evolution. We have studied the glomerular changes in renal biopsy specimens obtained from 24 patients aged 5·2–18·8 years, in whom urinary protein excretion was measured as early morning urine protein/creatinine ratios, using the Coomassie blue dye‐binding method. Segmental sclerotic lesions were found in eight biopsies and traced through serial sections to a hilar origin in every instance. There was a strong positive correlation between the extent of glomerular involvement and the amount of proteinuria ( P <0·0001). Parahilar hyaline deposits were observed in 16 biopsies, including five of the eight showing FSGS. All unsclerosed glomeruli were enlarged, and the hilar arterioles showed both enlargement and thickening, their walls frequently containing subendothelial hyaline deposits. Since in most patients renal function was comparatively well preserved, despite extensive loss of renal substances, we believe that these glomerular and vascular changes represent the stages in the evolution of hyperfiltration. Microproteinuria is the earliest clinical manifestation of FSGS, and should be sought routinely in all patients with reflux nephropathy.