Adelman R D, Restaino I G, Alon U S, Blowey D L
Phoenix Children's Hospital, Phoenix, Arizona 85006, USA.
J Pediatr. 2001 Apr;138(4):481-5. doi: 10.1067/mpd.2001.113006.
To describe the clinical and laboratory features of obesity associated proteinuria and focal segmental glomerulosclerosis.
The patients were seen over a 12-year period at two large children's hospitals. Renal biopsies, performed for the diagnosis of unexplained heavy proteinuria and prepared for light, immunofluorescent, and electron microscopy, were read independently by two pediatric pathologists. Blood pressure, body mass index, serum levels of creatinine, albumin, and cholesterol, and 24-hour urinary protein were measured.
Seven African American adolescents were identified with obesity-associated proteinuria, which was characterized by severe obesity (120 +/- 30 kg), markedly elevated body mass index (46 +/- 11), mild hypertension (134/74 +/- 10/18 mm Hg), slightly low to normal serum albumin levels (3.6 +/- 0.2 g/dL), moderately elevated serum cholesterol levels (196 +/- 60 mg/dL), and elevated 24-hour protein excretion (3.1 +/- 1.3 g/dL). Calculated creatinine clearance was normal in 6 patients and decreased in one. Typical renal histologic features included glomerular hypertrophy, focal segmental glomerulosclerosis, increased mesangial matrix and cellularity, relative preservation of foot process morphology, and absence of evidence of inflammatory or immune-mediated pathogenesis. One patient showed a dramatic reduction in proteinuria in response to weight reduction. Three patients who were given angiotensin-converting enzyme inhibitors had reduced urinary protein losses from 2.9 g to 0.7 g per day. One patient developed end-stage renal disease.
Obese adolescents should be monitored for proteinuria, which has distinct clinical and pathologic features and may be associated with significant renal sequelae. Such proteinuria may respond to weight reduction and/or treatment with angiotensin-converting enzyme inhibitors.
描述肥胖相关性蛋白尿和局灶节段性肾小球硬化的临床及实验室特征。
在两家大型儿童医院对患者进行了为期12年的观察。为诊断不明原因的大量蛋白尿而进行的肾活检标本，分别由两位儿科病理学家独立进行光镜、免疫荧光和电镜检查。测量血压、体重指数、血清肌酐、白蛋白和胆固醇水平以及24小时尿蛋白量。
确定了7名非裔美国青少年患有肥胖相关性蛋白尿，其特征为严重肥胖（120±30千克）、体重指数显著升高（46±11）、轻度高血压（134/74±10/18毫米汞柱）、血清白蛋白水平略低至正常（3.6±0.2克/分升）、血清胆固醇水平中度升高（196±60毫克/分升）以及24小时蛋白排泄增加（3.1±1.3克/分升）。6例患者计算的肌酐清除率正常，1例降低。典型的肾脏组织学特征包括肾小球肥大、局灶节段性肾小球硬化、系膜基质和细胞增多、足突形态相对保留以及无炎症或免疫介导发病机制的证据。1例患者体重减轻后蛋白尿显著减少。3例接受血管紧张素转换酶抑制剂治疗的患者尿蛋白丢失量从每天2.9克降至0.7克。1例患者发展为终末期肾病。
肥胖青少年应监测蛋白尿，其具有独特的临床和病理特征，可能伴有严重的肾脏后遗症。这种蛋白尿可能对体重减轻和/或血管紧张素转换酶抑制剂治疗有反应。
