Proteinuria nephrotic range

Vitamin D-binding protein and its associated vitamin are lost in nephrotic urine. Biochemical abnormalities in nephrotic patients (children and adults) include hypocalcemia, both total (protein-bound) and ionized hypocalciuria, reduced intestinal calcium absorption and negative calcium balance reduced plasma 25-hydroxycholecalciferol and 24,25-dihydroxycholecalciferol and, surprisingly, also 1,25-dihydroxycholecalciferol and blunted response to parathormon (PTH) administration and increased PTH levels. Clinically, both osteomalacia and hyperparathyroidism have been described in nephrotic patients, more commonly in children than in adults, but bone biopsies are commonly normal, and clinically significant bone disease is very rare in nephrotic subjects. There is, however, evidence that patients with renal failure accompanied by nephrotic range proteinuria may be particularly prone to develop renal osteodystrophy. 

Medications in this class include delavirdine, efa-virenz, and nevirapine. Similar to the NRTls, these agents bind to viral reverse transcriptase and block DNA polymerase activity. A key difference is that NNRTIs do not require intracellular phosphorylation and are not incorporated into viral DNA. Clinically significant kidney toxicities or specific fluid-electrolyte complications have not been reported with this class of agents. In the rat model, efavirenz was associated wifh a species specific dependent kidney toxicity which occurred secondary to the development of a unique glutathione conjugate produced as a metabolite of efavirenz associated with renal tubular epifhelial cell necrosis [125-126]. This toxicity has not been observed in humans. One patient was recently reported to have reversible nephrotic-range proteinuria attributed to efavirenz use, in which a kidney biopsy showed diffuse podocyte foot process effacement [127]. Another report noted the development of rhabdomyolysis and acute tubular necrosis as a result of a drug interaction between delavirdine and atorvastatin [128]. Kidney toxicity due to nevirapine has not been reported. 

In spite of the nephrotic range proteinuria, the most impressive histopathologic findings in NSAlEt-induced nephrotic syndrome involve the interstitium and tubules [91]. A focaUy, diffuse inflammatory infiltrate can be found around the proximal and distal tubules. While this infiltrate consists primarily of cytotoxic T lymphocytes, it also contains other T cells, some B... 

Sauter M, Julg B, Porubsky S, Cohen C, FIschereder M, SItterT, Schlondorff D, Grone HJ. Nephrotic-range proteinuria following pamidronate therapy In a patient with metastatic breast cancer mitochondrial toxicity as a pathogenetic concept Am J Kidney DIs 2006 47 1075-1080. 

Chan-Tack KM, Ahuja N, Weiman EJ Wall RK, Uche A, Greisman LA, Drachenberg C, Hawkins PN, Redfield RR. Acute renal failure and nephrotic range proteinuria due to amyloidodsis in an HIV-infected patient. Am J Med Sci 2006 332 (6) 364-367... 

J-M. Halimi, J Ribstein, G. Du Cailar, et al. Nephrotic-range proteinuria in patients with renovascular disease. American Journal of Medicine 108, 120(2000). 

The presenting clinical features in nephrotic adults with minimal-change nephropathy can be indistinguishable from that of FSGS, and renal biopsy is therefore critical in the treatment of adults with nephrotic syndrome. FSGS is two to four times more common in black patients than in white patients. They tend to present with proteinuria more frequently in the nephrotic range and are more likely to experience a rapid decline in renal function. 

A meta-analysis was conducted to evaluate the data from prospective trials using steroids and cytotoxic agents. The cytotoxic agents, but not steroids, were found to be effective in reducing nephrotic-range proteinuria as well as increasing the likelihood of complete or partial remission. ... 

Urinalysis of patients with PSGN reveals hematuria, dysmorphic red blood cells, and red cell casts. Proteinuria is common, but often not in the nephrotic range. Renal function is frequently mildly impaired, and serum creatinine concentration is often normal. However, blood urea concentration may be disproportionately high. 

Nephrotic range proteinuria—Proteinuria >3 grams/day associated with glomerular disease and nephrotic syndrome. 

There have been reports of nephrotic range proteinuria and focal segmental glomerulosclerosis on biopsy, in patients who are being treated with IFN-a for... 

Both of these forms of mercury can lead to kidney involvement with nephrotic range proteinuria. The ef-... 

Kiykim AA, Genctoy G, Horoz M, Sari S, Gok E, Coskun B, Yilmaz N, Gurses I. Nephrotic-range proteinuria with small glomerular fibrillary deposits in a patient on diphenylhydantoin treatment. Med Sci Monit 2009 15(8) CS132. ... 

The retrospective analysis of 35 cases of large persistent AL pleural effusions versus 120 AL cardiomyopathy patients without effusions offers perspective on the role of cardiac dysfunction and elevated filling pressures on amyloid pleural effusions. No differences in multiple echocardiographic parameters (interventricular septal thickness, left ventricular ejection fraction, or sensitive measures of diastolic function) could be identified between the pleural effusions group and the effusion-free cardiomyopathy group (21). Ironically, nephrotic range proteinuria and hypoalbuminemia were more prevalent in the... 

Nephrotic range proteinuria >40 mg/m per hour Calcium in spot urine ... 

Proteinuria, ranging in degree from traces to a frank, but reversible nephrotic syndrome (85,86), was sometimes observed, and a possible role of contaminants has been... 

---