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Second, I wanted to post these for anyone else that may see high levels on their bloodwork. Other factors that can falsely increase serum creatinine also need to be taking into consideration that will change the range value of eGFR, such as certain medications ie; ACE inhibitors, certain antibiotics and hydration status. Cystatin C is another blood test that is used on renal function, that has no influence on one's muscle mass, protein intake or physical activity. Adverse outcomes of chronic kidney disease can often be prevented or delayed through early detection and treatment. The presence of chronic kidney disease should be established, based on presence of kidney damage and level of kidney function (glomerular filtration rate [GFR]), irrespective of diagnosis. Among patients with chronic kidney disease, the stage of disease should be assigned based on the level of kidney function, irrespective of diagnosis, according to the KDOQI CKD classification Table 10. The USRDS provides reliable nationwide data regarding the incidence, prevalence, treatment patterns, outcomes, and cost of kidney failure treated by dialysis and transplantation, the most severe stage of chronic kidney disease. Chronic kidney disease is defined according to the presence or absence of kidney damage and level of kidney function—irrespective of the type of kidney disease (diagnosis). Table 12 illustrates the classification of individuals based on the presence or absence of markers of kidney disease and level of GFR, according to definition and staging of chronic kidney disease proposed by this guideline.
All individuals with kidney damage are classified as having chronic kidney disease, irrespective of the level of GFR. The methods to estimate GFR and assess markers of kidney damage are not completely sensitive or specific in detecting decreased GFR and kidney damage, respectively.
Other causes of chronically decreased GFR without kidney damage in adults include vegetarian diets, unilateral nephrectomy, extracellular fluid volume depletion, and systemic illnesses associated with reduced kidney perfusion, such as heart failure and cirrhosis.
High blood pressure in chronic kidney disease and in individuals with decreased GFR without kidney disease (R).
Prevalence of chronic kidney disease and level of kidney function in the general population (S). Definition (O) Kidney damage is defined as structural or functional abnormalities of the kidney, initially without decreased GFR, which over time can lead to decreased GFR.
Albuminuria was persistent on repeat evaluation in only 61% of individuals; hence, these prevalence estimates based on a single spot urine are likely overestimates, especially for microalbuminuria. Among adults, the prevalence of albuminuria varies by age (Table 19) and presence (Table 20) or absence (Table 21) of diabetes. Similarly, the prevalence of increased urine albumin excretion on initial screening varies from 1% to 10% (Table 23). Data from NHANES III are shown in Figs 9 and 10; these include men and women in the general population, including those with chronic kidney disease. In part, the inclusion of women and individuals with chronic kidney disease may account for the slightly lower mean values observed in the NHANES III compared to the data from normal men in Fig 9. As discussed earlier, individuals with decreased GFR should be evaluated for markers of kidney damage to determine whether they have chronic kidney disease and to determine the cause of reduced kidney function. The KDOQI definition of kidney failure differs in two important ways from the definition of ESRD. The Work Group anticipated that most kidney transplant recipients would be considered to have chronic kidney disease according to the proposed classification. Nutritional indications for the initiation of renal replacement therapy are detailed in Guideline 27 of the KDOQI Clinical Practice Guidelines on Nutrition in Chronic Renal Failure, part of which is reproduced as Guideline 2 of the PD Adequacy Guideline.
The CKD Work Group searched for studies of measures of kidney function, dietary intake, and nutritional status at the onset of kidney replacement therapy. These data show that estimated GFR provides only a rough approximation of other measures of kidney function. Tables 30, 31, and 32 summarize other studies of the level of kidney function at initiation of dialysis. Overall, the results of these studies are consistent with the data from the MDRD Study (Table 27) and the large study shown in Fig 11. There are a number of limitations to the proposed definition and classification of chronic kidney disease. First, as described later in Guideline 6, the known markers of kidney damage are not sensitive, especially for tubulointersitial and vascular disease and for diseases in the kidney transplant. There are a large number of clinical applications of the proposed definition and stages of chronic kidney disease.
Implementation of a new approach to the patient, classification of severity, and assessment of risk for chronic kidney disease will require appropriate professional, patient, and public education effort, as well as administrative and regulatory changes. Components of the implementation plan, which determined the success of KDOQI, are under development and will be applied to these guidelines. The Workgroup acknowledges that the proposed definition and classification chronic kidney disease and stages is arbitrary and can be refined by further research. A Evaluating Proteinuria in ChildrenA  This is a corrected version of the article that appeared in print.
See related patient information handout on proteinuria, written by the author of this article, is provided on page 1158.
Assessment of urinary protein excretion in the adolescent: effect of body position and exercise.
Quantitation of proteinuria by the use of protein-to-creatinine ratios in single urine samples. Proteinuria: a six-year study of normal infants, pre-school, and school-age populations previously screened for urinary tract disease.
Prognosis in postural (ortho-static) proteinuria: forty to fifty-year follow-up of six patients after diagnosis by Thomas Addis. Renal biopsy in children with asymptomatic hematuria or proteinuria: survey of pediatric nephrologists. Effect of angiotensin-converting enzyme inhibitor therapy on proteinuria in children with renal disease. Earlier stages of chronic kidney disease can be detected through routine laboratory measurements. Adverse outcomes of chronic kidney disease can be prevented through early detection and treatment. This guideline provides a definition of chronic kidney disease as well as definitions and estimates of prevalence of earlier stages of kidney disease. Among individuals with chronic kidney disease, the stages are defined based on the level of kidney function.
Among individuals with chronic kidney disease, the stage is defined by the level of GFR, with higher stages representing lower GFR levels. In addition, it includes columns for the presence or absence of high blood pressure, because of the complex relationship of high blood pressure and chronic kidney disease. The rationale for including these individuals is that reduction in kidney function to this level or lower represents loss of half or more of the adult level of normal kidney function, which may be associated with a number of complications (Part 6).
Thus, misclassification is possible, and clinicians should carefully consider all aspects of the patient’s clinical presentation in interpreting test results and determining evaluation and management. High blood pressure is not included in the definition of chronic kidney disease or its stages.
The prevalence of chronic kidney disease, based on the definition above, was estimated using data from NHANES III and USRDS (Fig 7 and Tables 13 and 14). As described earlier, markers of kidney damage include abnormalities in the composition of the blood or urine or abnormalities in imaging tests. Proteinuria is an early and sensitive marker of kidney damage in many types of chronic kidney disease. Table 15 shows definitions for proteinuria and albuminuria, including gender specific cut-off values for microalbuminuria and albuminuria. Table 18 shows the prevalence of albuminuria estimated from the albumin-to-creatinine ratio in a single spot urine collection in 14,836 adults studied in NHANES III. On repeat examination, 73% of a subsample with albuminuria (n = 44) had a persistently positive test. NHANES III did not ascertain other markers of kidney damage, such as abnormalities of the urine sediment and abnormal imaging tests; thus, any estimate based on NHANES III data is likely to underestimate the true prevalence of chronic kidney damage.
The level of GFR is accepted as the best measure of overall kidney function in health and disease. Even if there is no evidence of kidney damage, individuals with chronically decreased GFR may be at increased risk for adverse outcomes (for example, toxicity from drugs excreted by the kidney, and acute kidney failure in a wide variety of circumstances).
Decreased GFR is associated with a wide range of complications in other organ systems, manifested by high blood pressure, laboratory abnormalities, and symptoms. The Schwartz formula was used to estimate GFR in children aged 12 to 19 years in the NHANES III database. End-stage renal disease (ESRD) is an administrative term in the United States, based on the conditions for payment for health care by the Medicare ESRD Program, specifically the level of GFR and the occurrence of signs and symptoms of kidney failure necessitating initiation of treatment by replacement therapy.
First, GFR is lower in patients with a solitary kidney and is even lower in kidney transplant recipients because of toxicity from immunosuppressive agents used to prevent and treat rejection, such as cyclosporine and tacrolimus.
A number of measurements, including GFR, have been used to quantify the level of kidney function among patients with kidney failure.
Urea clearance should be normalized to total body water (V) and creatinine clearance should be expressed per 1.73 m2 of body surface area. The largest and most comprehensive study is the one reported in abstract by the MDRD Study Group.76 This study included 88 patients who were referred to their physicians by the MDRD Study investigators for initiation of dialysis because of symptoms or findings of uremia prior to the end of the study. Clinicians initiate replacement therapy based on the level of kidney function, presence of signs and symptoms of uremia, the availability of therapy, and patient or surrogate preferences. Timing of initiation of replacement therapy varies by modality, clinical characteristics, and sociodemographic characteristics.


The incidence and the prevalence of reported ESRD have doubled in the past 10 years in the United States (Fig 2). On December 31, 1998, there were approximately 75,000 adults over 70 years of age (97 per million) with kidney failure treated by dialysis, compared to approximately 1,800 children (2.1 per million). The Work Group believes that these limitations should be identified, but does not think that they invalidate the proposal. Thus, the prevalence of chronic kidney disease may be substantially higher than the Work Group has estimated, and recognition of patients with chronic kidney disease may be limited due to misclassification. An overall approach to evaluation and treatment of patients with chronic kidney disease is given in Guideline 2, and recommendations for individuals at increased risk of chronic kidney disease are given in Guideline 3.
For example, classification of kidney disease by the International Classification of Disease (9th Edition) (ICD-9) is based on duration (acute versus chronic), diagnosis, clinical presentation, markers of damage, and kidney function impairment. It would be useful to conduct a large cross-sectional study of GFR in general population, across the full range of age, gender, race, ethnicity, protein intake, with adjustment for other factors, including high blood pressure, diabetes, and other conditions that affect GFR. A cohort study of patients with chronic kidney disease would enable definition of the relationship between factors and outcomes of stages of chronic kidney disease. It can be identified as either a transient or a persistent finding and can represent a benign condition or a serious disease. The barriers consist of the endothelial cells lining the capillary loops, the glomerular basement membrane and the visceral epithelial cells (Figure 1).
Proteins in solution cause a change in the color of a reagent strip impregnated with tetrabromophenol blue. It is generally believed that children with isolated proteinuria not exceeding 1 g per 24 hours have a better prognosis than those with higher amounts of protein in their urine. The physical examination should include measurements of height, weight and blood pressure, identification of edema, ascites and skin pallor, and palpation of the kidneys in newborn infants.A urinalysis should be performed, and blood obtained for determination of electrolyte, blood urea nitrogen, creatinine, total protein and albumin levels, as well as a complete blood cell count and C3 complement. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Identifying the presence and stage of chronic kidney disease in an individual is not a substitute for accurate assessment of the cause of kidney disease, extent of kidney damage, level of kidney function, comorbid conditions, complications of decreased kidney function, or risks for loss of kidney function or cardiovascular disease in that patient. For the definition of chronic kidney disease, the Work Group selected cut-off levels for GFR and markers of kidney damage that maximize specificity, acknowledging potential loss of sensitivity. However, high blood pressure is a common cause and consequence of chronic kidney disease, and as reviewed later, patients with chronic kidney disease and high blood pressure are at higher risk of loss of kidney function and development of cardiovascular disease. This section will emphasize proteinuria as a marker of kidney damage because it has been studied most thoroughly, including in NHANES III. Albumin (molecular weight [MW] = 68,000 daltons) is the most abundant urine protein in most types of chronic kidney disease.
Albumin excretion is increased by physiological variables, such as upright posture, exercise, pregnancy, and fever. Because protein excretion varies throughout the day, the normal ratio varies throughout the day. Although increased urine albumin excretion reflects glomerular injury better than other urinary proteins in both adults and children, many pediatric nephrologists continue to monitor levels of total protein rather than albumin in patients with proteinuria.
A compilation of studies shows that 1% to 10% of children may have proteinuria on initial screening using the urine dipstick, but that <1% have persistent proteinuria, as defined by positive results on repeated testing (Table 22). In principle, the level of GFR is the product of the number of nephrons and the single nephron GFR.
GFR estimated from serum creatinine using MDRD Study equation based on age, gender, and race (see Part 10, Appendix 3).
The interpretation of decreased GFR varies depending on age, duration, and the presence or absence of markers of kidney damage. For example, it is well known that a brief period of mildly decreased blood flow to the kidneys or transient partial obstruction of the urinary tract may cause decreased GFR without kidney damage.
Severity of complications worsens as level of GFR declines (Part 6, Guidelines 7 through 12).
The prevalence of persistent albuminuria by GFR level and age group have not been determined, preventing an accurate estimate of the prevalence of chronic kidney disease among the elderly. ESRD includes patients treated by dialysis or transplantation, irrespective of the level of GFR. Second, biopsy studies demonstrate pathologic damage due to acute and chronic rejection in virtually all transplant recipients, even if serum creatinine is normal. The KDOQI Nutrition in Chronic Renal Failure Guidelines75 and Peritoneal Dialysis Adequacy Guidelines Update 200016 recommend the decision to initiate dialysis in adults be based on a combination of measurements of kidney function, as well as nutritional status. There is variability among individuals in the relationship of level of kidney function to signs and symptoms of uremia. Patients who receive a pre-emptive transplant or who are started on peritoneal dialysis begin replacement therapy at higher mean levels of GFR than patients starting hemodialysis. Data from the 2000 Annual Data Report of the USRDS documents the incidence of ESRD in 1998 of more than 85,000, or 308 per million individuals per year at risk. Instead, these limitations should serve to stimulate further research to refine the definition and classification.
The KDOQI classification proposes that both diagnosis and stage (severity) should be included in the classification of chronic kidney disease.
This study would permit validation of prediction equations based on serum creatinine or other filtration markers within the normal range of GFR. This would be particularly useful in defining the relationships among stages of chronic kidney disease, progression of chronic kidney disease, initiation and progression of cardiovascular disease, health service utilization, and barriers to care. It would be useful to conduct cross-sectional and cohort studies of elderly individuals with normal and abnormal blood pressure and GFR to assess the effect of high blood pressure and decreased GFR in this population. A rapid but qualitative assessment of proteinuria can be made using dipstick or sulfosalicylic acid methods. The passage of macromolecules across the glomerular capillary wall is inversely proportional to their size.The rightsholder did not grant rights to reproduce this item in electronic media. Because tetrabromophenol is a pH indicator, the dipstick is buffered to prevent the influence of normal variations in urine pH on color change. In all of these circumstances, proteinuria resolves spontaneously after the cessation of the causal factor, and an extensive work-up is usually not recommended.Persistent ProteinuriaIn general, the finding of proteinuria during a routine examination does not warrant an extensive work-up.
In a six-year retrospective study of 31 children with proteinuria of 10 months' duration, renal biopsies were performed in 17 children.23 Of these children, 12 had pathologic findings on biopsy, including eight with focal and segmental glomerulosclerosis. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. It is interesting to speculate whether the increasing incidence of end-stage renal disease in the elderly could be due, in part, to age-associated decline in GFR. In clinical practice, it may be difficult to determine whether individuals with decreased GFR have chronic kidney disease. High blood pressure is also common in older individuals without chronic kidney disease and is associated with accelerated GFR decline with age and more marked pathological abnormalities in the kidneys. Elevated albumin-to-creatinine excretion was persistent in 61% of the subjects with albuminuria (n = 163). Low molecular weight (LMW) globulins are the most abundant urine proteins in some types of chronic kidney disease.
The ratio in a first morning specimen correlates most closely with overnight protein excretion rate, whereas the ratio in mid-morning specimens correlates most closely with 24-hour protein excretion rate. Hence, reports of normal albumin rates in children are relatively few in number, and most have been published in the past 15 years. Therefore, GFR can be affected by chronic kidney disease, which reduces the number of nephrons, or by hemodynamic factors that affect single nephron GFR.
Pregnancy has a major effect on GFR, with GFR reaching values of 140% of normal during the end of the second trimester. However, a sustained decrease in blood flow or prolonged obstruction is often associated with kidney damage. Reliable estimates of prevalence of categories of decreased GFR (mild, moderate, or severe) in children are not available from NHANES III.
The Work Group acknowledges that the level of GFR selected for this definition is arbitrary and may need to be modified based on advances in kidney replacement therapy. The median interval from final GFR to initiation of dialysis in the study group was 89 days.
Notably, there is variability within and among health care systems in the availability of therapy. Dialysis is initiated at higher mean levels of GFR among patients who are older, or who have diabetes, cardiovascular disease, and other comorbid conditions.
The point prevalence of ESRD on December 31, 1998 was more than 320,000, or 1,160 per million population, of whom 72% were treated by dialysis (230,000 patients, or 835 per million population) and 28% had functioning kidney transplants (90,000 patients, or 325 per 100,000). Third, as described earlier, the cause of age-related decline in GFR and high blood pressure is not known.
Finally, additional recommendations for evaluation, diagnosis, and treatment of chronic kidney disease are given in Part 9.
This would facilitate using administrative databases for epidemiological and outcomes surveys. False-positive results can be obtained when the urine is alkaline (pH greater than 7) or when it contains heavy mucus, blood, pus, semen or vaginal secretions. Among 12 of the 14 patients who were not biopsied and four of the five patients with normal histology, proteinuria completely resolved in 11 patients (69 percent).In a study24 of 53 Japanese children with asymptomatic proteinuria, significant glomerular changes were observed on renal biopsy in 25 patients (47 percent). If fixed isolated proteinuria is ascertained, the work-up depends on the degree of proteinuria. Nonetheless, staging of chronic kidney disease will facilitate application of clinical practice guidelines, clinical performance measures and quality improvement efforts to the evaluation, and management of chronic kidney disease.


Recommendations for a clinical approach to elderly individuals with decreased GFR is given in Part 9.
Individuals with high blood pressure should be carefully evaluated for the presence of chronic kidney disease, especially those with decreased GFR. Therefore, these estimates of prevalence should be considered as rough approximations of the true prevalence. In this and later guidelines, the term proteinuria includes albuminuria, increased urinary excretion of other specific proteins, and increased excretion of total urine protein. Major constituents of normal urine protein are albumin, LMW proteins filtered from the blood, and proteins derived from the urinary tract.
Creatinine excretion is higher in normal men than women; therefore, the values in the general population (Fig 8) and cut-off values for abnormalities in urine albumin-to-creatinine ratio are lower for men than women (Table 15).
However, a literature search of articles describing albumin excretion in children revealed one study in 1970. On repeat examination, 54% (n = 102) of a subsample with albuminuria had a persistently positive result. In chronic kidney disease, as in normal individuals, GFR is modulated by hemodynamic factors.
Although these definitions are arbitrary, evidence compiled in later guidelines supports these broad categories and cut-off levels. Such patients would not be classified as having chronic kidney disease by the proposed classification. Because these patients were participating in a clinical trial, the mean level of kidney function and nutritional status may be higher than in patients beginning dialysis in the general population. Orthostatic proteinuria is a benign condition characterized by the presence of protein in urine samples collected in the upright position during the day and its absence in samples collected in the supine position.
A reduced number of functioning nephrons, as occurs in chronic renal failure, leads to increased filtration of proteins in the remaining nephrons and to proteinuria. The strips react preferentially with albumin and are relatively insensitive to other proteins such as gamma globulins. The finding of at least two positive urine tests out of three specimens would suggest persistent proteinuria and warrants a work-up (Figure 2). The rationales for these assumptions and cut-off levels are discussed in more detail below. On the other hand, the term albuminuria has been used only when referring to increased urinary albumin excretion. This original paper20 considered the best measurement of glomerular integrity to be albumin clearance factored by creatinine clearance.
The Work Group arbitrarily chose a cut-off value of greater than 3 months for the definition of chronic kidney disease. Tables 27 and 28 show measures of kidney function and nutritional status in these patients with kidney failure just prior to initiation of dialysis.
Persistent proteinuria and proteinuria associated with hematuria or other signs of renal disease carry a more severe prognosis. In addition to urinalysis with microscopic examination, a test for quantitation of urinary protein excretion should also be performed. Seven patients with abnormal glomerular histology developed renal insufficiency; none of the patients with normal glomerular histology developed renal insufficiency.
Older laboratory methods, such as the urine dipstick or acid precipitation, detect most urine proteins.
It concluded that the ratio of the concentration of albumin to creatinine in spot urine samples is the most accurate method for estimating albumin clearance and provides a better marker of glomerular permeability to albumin than the 24-hour albumin excretion rate. Thus, all patients with a kidney transplant would be considered either to have chronic kidney disease or to be at increased risk of chronic kidney disease. In the latter test, three drops of a 20 percent solution of sulfosalicylic acid are added to 5 mL of urine to cause acidic pH and precipitation of proteins. Traditionally this has been done by collecting a 24-hour urine sample to measure the amount of protein excreted in mg per 24 hours. In a survey of pediatric nephrologists,25 36 percent of the physicians surveyed would perform a renal biopsy in a nine-year-old child with moderate proteinuria (600 mg per day). Microalbuminuria refers to excretion of small but abnormal amounts of albumin, which requires recently developed, more sensitive laboratory methods that are now widely available. The results were expressed as mg albumin per mg creatinine, but subsequent papers have used a variety of methods to express albumin excretion, making comparisons between studies very difficult. Fifth, the association of level of GFR with complications of chronic kidney disease does not prove a causal relationship between the two.
If the laboratory test results are abnormal—for example, if the patient has increased creatinine levels or hypocomplementemia or hematuria, a chronic glomerular disease may be present.
Tables 16 and 17 give mean values and ranges for albumin excretion rate and albumin-to-creatinine ratio in children (neonates through age 20 years), and also emphasize some of the ways in which published reports have differed. Nonetheless, in many cases there is adequate evidence of a causal relationship, and even if there is not, the associations accurately describe the burden of illness associated with the severity of chronic kidney disease.
This test is more accurate than the dipstick method because all classes of proteins are detected.
Measurement of C3 complement is optional in patients with isolated proteinuria, unless hematuria is also present. Renal biopsy is indicated in these patients, and referral to a pediatric nephrologist is recommended.The existence of an antecedent streptococcal infection may be investigated by measuring antistreptolysin-O and anti-deoxyribonuclease B titers.
Sixth, prevalence estimates for stages of chronic kidney disease and the associations of level of GFR with complications are based largely on an analysis of data from NHANES III that has not yet been peer-reviewed. False-positive results can occur in the presence of radiographic contrast material and in samples from children receiving high dosages of penicillin, cephalosporins or sulfonamides. Postinfectious glomerulonephritis is usually self-limited, and a renal biopsy is not indicated. However, the Work Group believes that Appendix 2 provides sufficient detail to evaluate the methods.
However, except in very mild cases, the patient should be referred to a pediatric nephrologist. Urinary protein electrophoresis and direct measurements of low-molecular-weight proteins such as β2 microglobulin may be performed in special circumstances but are not part of the routine evaluation of a child with proteinuria. If all laboratory tests are normal except for persistently elevated protein excretion, the possibility of orthostatic proteinuria should be investigated, particularly if the child is older than six years of age. If urinary protein excretion is in the nephrotic range and the patient is older than six years of age, idiopathic nephrotic syndrome is less likely, and referral to a pediatric nephrologist is recommended. Similarly, the determination of microalbuminuria in diabetic children requires the use of more sensitive methods such as radioimmunoassay or enzyme-linked immunosorbent assay.In adults, a protein excretion of less than 150 mg per 24 hours is considered normal.
Renal biopsy will identify the type of glomerular disease responsible for the nephrotic syndrome (Table 2).Other Treatment ConsiderationsExcessive restrictions on the child's lifestyle and physical activity are not necessary. In children, however, physiologic proteinuria varies with age and the size of the child (Table 1). The patient is instructed to urinate just before going to bed at night and to discard the urine.
Dietary protein supplementation to replace the loss of protein is not recommended and may be harmful. After the first year of life, daily protein excretion in children, expressed in mg per m2 per 24 hours, is relatively constant. He or she must remain supine all night and urinate the next morning immediately after arising.
The traditional way of quantitating urinary protein excretion has been to measure protein in a urine sample collected over a 12- or 24-hour period.The patient is instructed to void when waking up in the morning and to discard that urine and mark the time. Avoiding excessive salt intake is desirable, and more rigorous salt restriction may be necessary if edema develops. The urine from each subsequent voiding is then collected for the next 24 hours; the final urine sample is to be voided precisely 24 hours after the timed collection was begun.
In practice, however, the collection of 24-hour urine samples is fraught with error, and the collection often has to be repeated. The duration of collection time for the latter sample can be shortened to 12 hours or less. Furthermore, timed urine collections are impractical in young children and impossible in infants without subjecting them to bladder catheterization.Determining the amount of excreted creatinine in the same 24-hour urine sample may be helpful in evaluating the accuracy of the collection. The long-term prognosis for young adults with orthostatic proteinuria is excellent, even after 20 to 50 years of follow-up.19,20 It is believed that the prognosis in children and adolescents is equally good. Yearly follow-up is recommended for children diagnosed with this condition.Proteinuria Secondary to Glomerular DiseaseMany glomerular diseases result in proteinuria (Table 2).
Human immunodeficiency virus (HIV) infection has emerged as an important cause of proteinuria and nephrotic syndrome in both adults and children.21 The most characteristic glomerular lesion is focal and segmental glomerulosclerosis, which, in adults, is often associated with progressive azotemia.
In one study,13 a collection error was found in 57 percent of 24-hour urine samples, as assessed by a high or low urinary creatinine content. When the glomerular filtration rate is normal, the proteinuria is usually of tubular origin. As the glomerular filtration rate decreases as a result of significant nephron loss, hemodynamic mechanisms contribute to glomerular proteinuria.



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