Non-Nephrotic Proteinuria in Children: A Review

Mohsen Akhavan Sepahi

Journal of Pediatric Nephrology, Vol. 7 No. 3 (2019), , Page 1-7

Proteinuria is defined as an increased abnormal urinary excretion of proteins. In normal conditions, few proteins are lost through the urine. Proteinuria is a problem and dilemma in pediatric practice. Non- nephrotic proteinuria is described and its follow-up is discussed in the following.


Keywords: Proteinuria; Non-nephrotic proteinuria; Nephrotic syndrome; Child.

Original Research Papers

Analysis of the Relationship among Kidney Volume, Obesity, and Blood Pressure in Mexican-American Children

Hongwei Wang, Fernando G Quintana, Francisco J Cervantes, Margarita Faz

Journal of Pediatric Nephrology, Vol. 7 No. 3 (2019), , Page 1-7

Background and Aim: Obesity causes a decrease kidney function and an increase in kidney volume. The aim of this study was to understand the relationship among kidney volume, obesity and blood pressure in Mexican-American children in South Texas.

Methods: To study those effects, data was collected from 454 ultrasound done on 289 girls and 762 ultrasound done on 382 boys visiting a pediatric clinic in South Texas from 2003 to 2018. The relationship between kidney volume and obesity was analyzed. IBM SPSS is used for data analysis.

Results: Children with fatty livers have a higher kidney volume when compared to children with non-fatty livers. When comparing children classified as BMI percentile (0, 50%), BMI percentile [50%, 85%), BMI percentile [85%, 95%), and BMI percentile above 95%, the kidney volume is increasing as BMI percentile increases. We also found that there is a positive relationship between the kidney volume and systolic blood pressure. Children with high systolic blood pressure (above 119 mmHg) have a larger volume when compared to children with low blood pressure (above 110 but less than or equal 119 mmHg), 110 and below mmHg. 

Conclusion: Obesity causes inflammation, and lipid accumulation. These effects can cause an increase in kidney volume. Kidney volume increases can be caused by hypertension. This is even severe for Mexican-American children in south Texas.

Keywords: Obesity; Kidney volume; Hypertension; Child.


Clinicopathological Spectrum and Treatment Outcome of Clinically Suspected Rapidly Progressive Glomerulonephritis: An Analysis of 35 Cases in a Tertiary Care Center, Bangladesh

Ranjit Ranjan Roy, Jahanara Arju, Jakia Sultana, Farhana Rahman, Mohammad Imrul Hasan, Abdullah Al Mamun, Tahmina Jesmin, Syed Saimul Huque, Afroza Begum, Golam Muin Uddin, Md Habibur Rahman

Journal of Pediatric Nephrology, Vol. 7 No. 3 (2019), , Page 1-8

Background and Aim: Rapidly progressive glomerulonephritis (RPGN) is characterized by a rapid decline in the renal function and urinary abnormalities. There is limited information on epidemiological factors and clinical and histopathological patterns of RPGN from developing countries. Therefore, the objective of this study was to identify the etiology, clinical features, histopathological patterns, and treatment outcomes of patients with clinically suspected RPGN.

Methods: This retrospective study was conducted in the Pediatric Nephrology Department of Bangabandhu Sheikh Mujib Medical University from January 2014 to January 2019. Patients with clinically suspected RPGN that underwent renal biopsy were enrolled in this study.

Results: Thirty-five patients were recruited in this study. Macroscopic hematuria, edema, hypertension, uremia, and oliguria were common clinical presentations. Diffuse proliferative GN (28.5%) and crescentic GN (22.8%) were the most common histological diagnoses in this study. Immune mediated GN (62%) followed by idiopathic GN (25%) were found to be the most frequent cause of crescentic GN. Renal replacement therapy was required in 45% of the cases and 11.4% of the patients developed end-stage renal disease.

Conclusion: Renal histology is an integral part of the investigation of patients with suspected RPGN for both diagnostic and prognostic purposes. Diffuse proliferative GN was the most common histopathological diagnosis in patients with clinical RPGN in our population. Preservation of renal function depends on early intervention and detection of RPGN in pediatric patients.

Keywords: Nephritis; Glomerulonephritis; ESRD; End-Stage Kidney Disease; Child. 

Association of Matrix Metalloproteinases-2, Metalloproteinases-9, and Endothelial Dysfunction with Carotid Intima-Media Thickness and Left Ventricular Mass Index in Children with End-Stage Renal Disease

Amin Abedini, Alaleh Gheissari, Rokhsareh Meamar, Mehrbod Vakhshoori, Mohammad Shafiei, Yahya Madihi, Esfandiar Najafi Tavana

Journal of Pediatric Nephrology, Vol. 7 No. 3 (2019), , Page 1-11

Background and Aim: Cardiovascular disease (CVD) has been recognized as a major cause of death among children with end-stage renal disease (ESRD). Matrix metalloproteinases (MMP-2 and MMP-9) and endothelial dysfunction play a significant role in the development of CVD in these children. This study was conducted to assess the association of MMP-2 and 9 and endothelial dysfunction markers (sE-selectin and brachial flow mediated dilatation (FMD)) with carotid intima media thickness (c-IMT) and left ventricular mass index (LVMI).

Methods: Thirty-one pediatric ESRD patients and 18 healthy controls were included in this research. The case and control groups were matched in terms of sex and age. Serum levels of MMP-2, MMP-9, sE-selectin, and other biochemical parameters were measured. Brachial FMD, c-IMT and LVMI were also measured in the two groups.

Results: C-IMT had a positive correlation with diastolic blood pressure, MMP-2, MMP-9, low-density lipoprotein (LDL), triglyceride, phosphorus, PTH, and calcium × phosphorus (Ca × P) product, and a negative correlation with FMD, high-density lipoprotein (HDL), and calcium. LVMI demonstrated correlations with systolic blood pressure, MMP-2, FMD, cholesterol, triglyceride, HDL, phosphorus, PTH, and Ca × P product. The area under the curve (AUC) in ROC curve analysis was used to determine the abnormal c-IMT and LVH values for MMP-2, which was 0.76 and 0.71, respectively (p<0.05).

Conclusion: C-IMT and LVMI are two major CVD markers in pediatric ESRD patients. These two markers correlated with MMP-2, MMP-9 and endothelial dysfunction markers. According to this study, MMP-2 may determine abnormal c-IMT and LVH in ESRD children.


Keywords: End-stage renal disease; Cardiovascular disease; Left ventricular hypertrophy; Atherosclerosis; Matrix metalloproteinases.

Histopathological Pattern of Difficult Childhood Nephrotic Syndrome in A Tertiary Care Centre, Bangladesh

Ranjit Ranjan Roy, Farhana Rahman, Jahanara Arju, Jakia Sultana, Agomoni Chaki, Amina Akter, Abdullah Al Mamun, Tahmina Jesmin, Syed Saimul Huque, Afroza Begum, Golam Muin Uddin, Md Habibur Rahman

Journal of Pediatric Nephrology, Vol. 7 No. 3 (2019), , Page 1-7


The aim of this study was to know the spectrum of histopathology in children who underwent a renal biopsy for difficult NS in a tertiary care pediatric nephrology center.


This prospective observational study took place in Pediatric Nephrology department of Bangabandhu Sheikh Mujib Medical University, Dhaka Bangladesh, from January 2011 to July 2018. Patients presented with difficult pattern of nephrotic syndrome and underwent renal biopsy were enrolled in this study.


Total 140 patients were recruited in this study. Patients with SRNS & nephrotic syndrome with atypical presentation had renal biopsy ; a good number of atypical NS were SDNS. They were grouped into Group A: SRNS, Group B: SDNS, Group C:Nephrotic Syndrome with atypical presentation. Comparison among 3 groups were done. Regarding lab parameters, serum creatinine was raised in 40.6% patients in  nephrotic syndrome with atypical presentation and 16.2%in SRNS. In patients with SDNS, MCD (51.3%) was the most common histological pattern followed by MesPGN (33.3%); whereas MesPGN was the commonest histological pattern in SRNS (56.8%) and atypical presentation (54.7%) followed by MCD and FSGS.Most of the patients response to immunosuppressive therapy. In SRNS partial response achieved in 18.9% and CKD  developed in 16.2% cases. In comparison, nephrotic syndrome atypical presentation 10.9% patients achieved partial response and 7.8% developed CKD but these are not statistically significant. 5.4% patients of SRNS died.


Mesangioproliferative glomerulonephritis was the most common histopathological diagnosis in patients with SRNS & nephrotic syndrome atypical presentation  in our population. MCD is predominant among SDNS.

Effect of Different Heparin Volumes on Blood Gas Analysis

Narges Gholami, Zahra Pournasiri, Fatemeh Fereshteh Mehregan, Hamidreza Hatami

Journal of Pediatric Nephrology, Vol. 7 No. 3 (2019), , Page 1-4


Background and Aim: Blood gas analysis is an important laboratory test for diagnosis and treatment of a variety of medical conditions in emergency rooms. Inaccurate sample collection is one of the reasons for errors in blood gas analysis. This study was conducted to evaluate different volumes of heparin in syringes and the effect of sample dilution on blood gas analysis as one of the main factors affecting the results of blood gas analysis.

Methods: One hundred children (4 months to 12 years) who presented to Loghman Hakim Hospital, Tehran, Iran, were enrolled in this study. Two samples were taken from each patient. For the first sample, the syringes were filled with heparin sodium and then emptied completely to achieve a very thin layer anticoagulant coating. For the second sample, the syringes were filled with 0.1 mL of liquid heparin sodium 5000 U/mL (5%). The blood gas parameters including pH, PO2, PCO2, HCO3 and BE (base excess) were measured. Data were analyzed using SPSS version 18.

Results: All parameter had lower levels in second samples (0.1 mL heparin 5%) except for PO2 compared to the first samples (P < 0.001).

Conclusion: This study found that a small amount of heparin in the syringe changed the result of blood gas analysis.


Keywords: Blood Gas Analysis; Heparin; pH; PCO2; HCO3.

Case Reports

Meningitis retention syndrome (MRS) is an underreported clinical syndrome in children that presents with meningitis and acute retention of urine. It is usually associated with aseptic meningitis, but there are case reports of MRS associated with viral and other kind of meningitis. There is no imaging abnormalities in the brain and spine associated with acute urinary retention. Here we report a case of an 11-year-old boy who presented with signs of meningism and acute urinary retention. Further evaluation revealed features of meningitis in cerebrospinal fluid analysis and normal imaging of the brain and spine. He completely recovered from urinary retention after meningitis treatment.


Keywords: Meningitis; Urinary Retention; Child; Case Report

Tuberculosis (TB) is a serious and important infectious disease worldwide. Children commonly develop renal tuberculosis (TB) as a complication of primary pulmonary infection with Mycobacterium tuberculosis characterized by hilar lymphadenopathy often with lung opacity. Renal TB accounts for up to 27% of extra-pulmonary cases. The disease is more prevalent in children with immunodeficiency syndromes and the recipients of organ transplantations. The signs and symptoms of renal TB are non-specific and challenging.  Most patients present with persistent non-glomerular microscopic hematuria without abdominal or flank pain. Some may have signs and symptoms of the lower urinary tract such as voiding dysfunction. A diagnosis of renal TB is suspected upon detecting pyuria in the absence of common bacterial infections and is confirmed by isolation of acid-fast lactobacillus in the urine or tissue biopsy. Anti-tuberculosis drugs most frequently used in the pediatric age group are a combination of isoniazid, rifampicin, pyrazinamide, and ethambutol.

Keywords: Non-glomerular hematuria; Renal tuberculosis; Diagnosis; Treatment; Child; Mycobacterium tuberculosis.

Brief Reports

Percutaneous Urine Sampling from Renal Pelvis: A Minimally-Invasive Method to Determine the Origin of Post-Transplant Proteinuria

Ali Babaei Jandaghi, Hamidreza Badeli, Afagh Hassanzadeh Rad, Ramin Pourghorban

Journal of Pediatric Nephrology, Vol. 7 No. 3 (2019), , Page 1-3

A 14-year-old boy with end-stage renal disease secondary to focal segmental glomerulosclerosis complicated with heavy proteinuria received a non- related living kidney transplantation. Postoperatively he continued to excrete higher level of proteinuria. Allograft biopsy showed mild mesangial expansion and hypercellularity. Urine sample was collected from allograft renal pelvis under local anesthesia and ultrasound guidance.

Based on the importance of heavy proteinuria and lack of definite method of differentiating its source during the early weeks after kidney transplantation, it seems that percutaneous renal pelvis urine sampling may be noted as a preferred method of detecting the source of proteinuria.

Keywords: Focal Segmental Glomerulosclerosis; Kidney Transplantation; Ultrasonography; Proteinuria; Allografts.

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