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Urinary Tract Disease
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Serum creatinine, BUN, and electrolytes as well as 24-hour urine collection for protein and creatinine clearance. A 24-hour urine >300-mg protein is considered abnormal and correlates roughly to 1+ proteinuria on a urine dipstick. Urine dipstick should not be the only testing for women with suspected renal disease, as this can miss up to 1 in 11 hypertensive pregnant women with actual proteinuria [32]. A 24-hour urine collection has long been the gold standard, although a random protein-creatinine ratio has been shown to accurately predict baseline proteinuria in early pregnancy [33, 34]. Renal biopsy should be reserved to those whose diagnosis is in question, particularly in those with sudden deterioration in renal function for no known reason, as it may change the management in up to 66% of cases [35]. It is generally recommended only before 32 weeks of pregnancy, as delivery after 32 weeks may be accomplished with relatively good outcomes for the neonate after which the biopsy may be performed. Severe renal disease may increase the risk of complications from the renal biopsy. A skilled physician and ultrasound guidance should be used in the performance of a renal biopsy in a pregnant individual [10].
Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
The short-term adverse effects of ciclosporin include hypertrichosis, gingival hyperplasia, hypertension, tremor and a rise in plasma creatinine mediated by glomerular vasoconstriction. The major factor limiting the prolonged use of ciclosporin is concern about potential chronic nephrotoxicity, which has been reported in SSNS patients taking ciclosporin continuously for more than two years [23]. Plasma creatinine concentration does not provide any indication of structural damage until a relatively advanced stage has been reached. For this reason, it is widely accepted practice to perform a renal biopsy after 1 8 - 2 4 months of therapy. Ciclosporin may be continued beyond two years in those patients with no histological evidence of chronic nephrotoxicity.
Renal system
Published in Pankaj Desai, Pre-eclampsia, 2020
As has been made amply clear, alterations in renal function are profound in pre-eclampsia. Also, the renal system is not on a priority list of the pregnant woman when she faces a crisis. Therefore, pathological alterations get all the more amplified. Compensatory processes in renal systems for a crisis are present, but once they crash, the renal systems get handsomely beaten up. Besides these, the renal system is relatively easily accessible to the investigating scientific community. Urine is easy to procure and profusely available. Also, renal biopsy is easily doable with some experience. Thus, functional and structural alterations can be studied with relative ease. By 1998, 23 groups had already published their studies on renal changes in pre-eclampsia as has been tabulated by Conrad and Lindheimer in 1998.17
Progress in understanding primary glomerular disease: insights from urinary proteomics and in-depth analyses of potential biomarkers based on bioinformatics
Published in Critical Reviews in Clinical Laboratory Sciences, 2023
Lili Ge, Jianhua Liu, Baoxu Lin, Xiaosong Qin
In the past few decades, chronic kidney disease (CKD) has become a global public health challenge [1]. The prevalence of CKD is high, between 11 and 13%, and glomerular disease (GD), especially primary glomerular disease (PGD), is one of the most common causes of CKD [2]. Patients with PGD may develop end-stage renal disease (ESRD) [3]. Determining the pathological type of PGD together with understanding the pathogenesis of the disease is therefore pertinent and conducive to treatment. However, the invasive method of renal biopsy remains the gold standard for determining the pathological type of PGD, and there is a lack of painless diagnostic methods for PGD. Renal biopsy is challenging for patients with severely impaired renal function. Risks associated with renal biopsy include bleeding, pain, infection and kidney vein thrombosis. Problems with biopsy include lack of glomeruli in the tissue obtained, and the sampling site not being reflective of the overall lesion in the kidney. Repeated renal biopsies to monitor disease progression cannot be performed because of the significant risks of bleeding and kidney vein thrombosis. Thus there is great interest in identifying biomarkers for the diagnosis of PGD.
Urinary exosomes derived circRNAs as biomarkers for chronic renal fibrosis
Published in Annals of Medicine, 2022
Yuhan Cao, Yuanhui Shi, Yanlang Yang, Zhangli Wu, Nana Peng, Jie Xiao, Fan Dou, Jingjing Xu, Wenjun Pei, Cong Fu, Pingsheng Chen, Yuwei Wang
Renal biopsy was the golden standard for the diagnosis of chronic fibrosis at present. Renal biopsy was an invasive procedure that may cause severe complications such as bleeding. In clinical practice, it was hard to repeat renal biopsy the dynamic detecting process of renal fibrosis development. So far, there was no non-invasive detection method to accurately diagnose renal fibrosis [3]. In recent years, urine biomarkers attracted researchers. Li et al. firstly established a quantitative PCR method for urinary RNA detection [4]. The development of microarray technology made urine RNA detection become a research hotspot. Recently, the role of non-coding RNA such as circRNAs in CKD had become one of the hot issues [5]. CircRNAs had the potential to become a biomarker of kidney disease [6,7].
Direct Immunofluorescence Results of the Skin Biopsy and Frequency of Systemic Involvement in Children with Henoch-Schonlein Purpura
Published in Fetal and Pediatric Pathology, 2019
Mehdi Ataeepour, Maryam Monajemzadeh, Peyman Sadeghi, Vahid Ziaee
HSP usually tends to have a good prognosis without significant sequelae. However, in a subset of patients, renal involvement results in an adverse outcome. HSP nephritis is generally a self-limited disease, presenting with hematuria and/or mild proteinuria, however in some patients, it may progress to a more severe renal impairment [1]. It is reported in up to 50% of pediatric patients, 1%–7% of which eventually develop renal failure [1]. Although HSP nephritis usually occurs within 4–6 weeks of the initial presentation, it might also be a delayed complication, so a 6-month follow-up with urinary evaluations is recommended after the onset of HSP [1,2]. Renal biopsy is a definitive but invasive way to diagnose renal involvement, yet it is not routinely obtained. It would be advantageous to determine a noninvasive measure to predict renal involvement in HSP patients. In a systematic review by Chan et al, the following risk factors were associated with higher renal involvement in pediatric patients: male gender, age more than 10 years, severe GI symptoms (abdominal pain, GI bleeding, and severe bowel angina), arthritis/arthralgia, persistent purpura or relapse, white blood cells >15,000/µL, platelets >500,000/µL, elevated antistreptolysin O, and low C3 [13].