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Screening for proteinuria in ‘at-risk’ patients with spinal cord injuries: lessons learnt from failure
Spinal cord injury patients may develop proteinuria as a result of glomerulosclerosis due to urosepsis, hydronephrosis, vesicoureteric reflux, and renal calculi. Proteinuria in turn contributes to progression of kidney disease. We report one paraplegic and two tetraplegic patients, who developed rec...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064104/ https://www.ncbi.nlm.nih.gov/pubmed/24955116 http://dx.doi.org/10.1186/1754-9493-8-25 |
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author | Vaidyanathan, Subramanian Abraham, Kottarathil Abraham Singh, Gurpreet Soni, Bakul Hughes, Peter |
author_facet | Vaidyanathan, Subramanian Abraham, Kottarathil Abraham Singh, Gurpreet Soni, Bakul Hughes, Peter |
author_sort | Vaidyanathan, Subramanian |
collection | PubMed |
description | Spinal cord injury patients may develop proteinuria as a result of glomerulosclerosis due to urosepsis, hydronephrosis, vesicoureteric reflux, and renal calculi. Proteinuria in turn contributes to progression of kidney disease. We report one paraplegic and two tetraplegic patients, who developed recurrent urine infections, urinary calculi, and hydronephrosis. These patients required several urological procedures (nephrostomy, cystoscopy and ureteric stenting, ureteroscopy and lithotripsy, extracorporeal shock wave lithotripsy). These patients had not received antimuscarinic drugs nor had they undergone video-urodynamics. Proteinuria was detected only at a late stage, as testing for proteinuria was not performed during follow-up visits. Urine electrophoresis showed no monoclonal bands in any; Serum glomerular basement membrane antibody screen was negative. Serum neutrophil cytoplasmic antibodies screen by fluorescence was negative. All patients were prescribed Ramipril 2.5 mg daily and there was no further deterioration of renal function. Spinal cord injury patients, who did not receive antimuscarinic drugs to reduce intravesical pressure, are at high risk for developing reflux nephropathy. When such patients develop glomerulosclerosis due to recurrent urosepsis, renal calculi, or hydronephrosis, risk of proteinuria is increased further. Take home message: (1) Screening for proteinuria should be performed regularly in the ‘at-risk’ patients. (2) In the absence of other renal diseases causing proteinuria, spinal cord injury patients with significant proteinuria may be prescribed angiotensin-converting enzyme inhibitor or angiotensin-II receptor antagonist to slow progression of chronic renal disease and reduce the risk of cardiovascular mortality. |
format | Online Article Text |
id | pubmed-4064104 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-40641042014-06-21 Screening for proteinuria in ‘at-risk’ patients with spinal cord injuries: lessons learnt from failure Vaidyanathan, Subramanian Abraham, Kottarathil Abraham Singh, Gurpreet Soni, Bakul Hughes, Peter Patient Saf Surg Short Report Spinal cord injury patients may develop proteinuria as a result of glomerulosclerosis due to urosepsis, hydronephrosis, vesicoureteric reflux, and renal calculi. Proteinuria in turn contributes to progression of kidney disease. We report one paraplegic and two tetraplegic patients, who developed recurrent urine infections, urinary calculi, and hydronephrosis. These patients required several urological procedures (nephrostomy, cystoscopy and ureteric stenting, ureteroscopy and lithotripsy, extracorporeal shock wave lithotripsy). These patients had not received antimuscarinic drugs nor had they undergone video-urodynamics. Proteinuria was detected only at a late stage, as testing for proteinuria was not performed during follow-up visits. Urine electrophoresis showed no monoclonal bands in any; Serum glomerular basement membrane antibody screen was negative. Serum neutrophil cytoplasmic antibodies screen by fluorescence was negative. All patients were prescribed Ramipril 2.5 mg daily and there was no further deterioration of renal function. Spinal cord injury patients, who did not receive antimuscarinic drugs to reduce intravesical pressure, are at high risk for developing reflux nephropathy. When such patients develop glomerulosclerosis due to recurrent urosepsis, renal calculi, or hydronephrosis, risk of proteinuria is increased further. Take home message: (1) Screening for proteinuria should be performed regularly in the ‘at-risk’ patients. (2) In the absence of other renal diseases causing proteinuria, spinal cord injury patients with significant proteinuria may be prescribed angiotensin-converting enzyme inhibitor or angiotensin-II receptor antagonist to slow progression of chronic renal disease and reduce the risk of cardiovascular mortality. BioMed Central 2014-06-09 /pmc/articles/PMC4064104/ /pubmed/24955116 http://dx.doi.org/10.1186/1754-9493-8-25 Text en Copyright © 2014 Vaidyanathan et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Short Report Vaidyanathan, Subramanian Abraham, Kottarathil Abraham Singh, Gurpreet Soni, Bakul Hughes, Peter Screening for proteinuria in ‘at-risk’ patients with spinal cord injuries: lessons learnt from failure |
title | Screening for proteinuria in ‘at-risk’ patients with spinal cord injuries: lessons learnt from failure |
title_full | Screening for proteinuria in ‘at-risk’ patients with spinal cord injuries: lessons learnt from failure |
title_fullStr | Screening for proteinuria in ‘at-risk’ patients with spinal cord injuries: lessons learnt from failure |
title_full_unstemmed | Screening for proteinuria in ‘at-risk’ patients with spinal cord injuries: lessons learnt from failure |
title_short | Screening for proteinuria in ‘at-risk’ patients with spinal cord injuries: lessons learnt from failure |
title_sort | screening for proteinuria in ‘at-risk’ patients with spinal cord injuries: lessons learnt from failure |
topic | Short Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064104/ https://www.ncbi.nlm.nih.gov/pubmed/24955116 http://dx.doi.org/10.1186/1754-9493-8-25 |
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