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Protein Selectivity in the Assessment of Patients with Proteinuria
Author(s) -
Petrie J. J. B.,
Maclean Pamela R.,
Robson J. S.
Publication year - 1973
Publication title -
australian and new zealand journal of medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 0004-8291
DOI - 10.1111/j.1445-5994.1973.tb03126.x
Subject(s) - proteinuria , medicine , excretion , glomerulonephritis , lesion , urology , endocrinology , urine , gastroenterology , pathology , kidney
Summary: Differential protein clearance studies were performed in 221 patients who excreted one gram or more of protein per 24 hours for four weeks or more from the time of presentation. The usefulness of the “selectivity index” was assessed in relation to histological diagnosis, prognosis, and responsiveness to steroid therapy. An unselective pattern of protein excretion was found to exclude the diagnosis of minimal lesion glomerulonephritis. Selectivity determinations were of considerable prognostic significance at the extremes of the selectivity range, the lowest recorded values being associated with a very poor prognosis and the highest with a good prognosis. At inter‐mediate values, selectivity had less prognostic significance. In 43 patients with selective proteinuria treated with steroids, proteinuria was abolished in 22. In 39 patients with unselective proteinuria steroids did not abolish protein excretion in a single case. Responsiveness to steroids was uniform and dramatic in patients with minimal lesion glomerulonephritis. Patients with proliferative glomerulonephritis and selective proteinuria showed a significant reduction in protein excretion following steroid therapy when compared with unselective proliferative controls, but proteinuria was abolished in only a small proportion of these cases. No benefit from steroids could be detected in patients with membranous or membrano‐proliferative lesions regardless of selectivity.