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Isolated Proteinuria in Asymptomatic Patients

  • Roscoe R. Robinson
Conference paper

Abstract

A 38-year-old man was evaluated at the Duke University Medical Center for routine follow-up of known proteinuria for 19 years. Qualitative proteinuria was first detected during routine urinalysis when he entered military service at age 19. Repetitive examination of randomly collected urine specimens over the next several days documented the presence of proteinuria, and the patient was then admitted to Wilford Hall USAF Medical Center for further evaluation.

Keywords

Capillary Wall Percutaneous Renal Biopsy Glomerular Capillary Wall Renal Tubular Reabsorption Endogenous Creatinine Clearance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Berggard I: Plasma proteins in normal human urine. In Manuel Y, Revillard JP, Betuel H (eds.): Proteins in Normal and Pathological Urine. Basel, Karger, 1970Google Scholar
  2. 2.
    Free AH, Rupe CO, Metzler I: Studies with a new colorimetric test for proteinuria. Clin Chem 3: 716–727, 1957PubMedGoogle Scholar
  3. 3.
    Hinberg IH, Katz L, Waddell L: Sensitivity of in vitro diagnostic dipstick tests to urinary protein. Clin Biochem 11: 62–64, 1978PubMedCrossRefGoogle Scholar
  4. 4.
    Poortman I, Jeanloz RW: Quantitative immunological determination of plasma proteins excreted in human urine collected before and after exercise. J Clin Invest 47: 386–393, 1968CrossRefGoogle Scholar
  5. 5.
    Castenfors J, Piscator M: Renal haemodynamics, urine flow and urine protein excretion during exercise in supine position at different loads. Acta Med Scand (Suppl) 472: 231–244, 1967Google Scholar
  6. 6.
    Ryan GB, Karnovsky MJ: An ultrastructural study of the mechanisms of proteinuria in aminonucleoside nephrosis. Kidney Int 8: 219–232, 1975PubMedCrossRefGoogle Scholar
  7. 7.
    Caulfield JF, Farquhar MG: The permeability of glomerular capillaries to graded dextrans: Identification of the basement membrane as the primary filtration barrier. J Cell Biol 63: 883–903, 1974PubMedCrossRefGoogle Scholar
  8. 8.
    Farquhar MG: The primary glomerular filtration barrier—Basement membrane or epithelial slits? Kidney Int 8: 197–211, 1975PubMedCrossRefGoogle Scholar
  9. 9.
    Brenner BM, Bohrer MP, Baylis C, Deen WM: Determinants of glomerular permselectivity: Insights derived from observations in vivo. Kidney Int 12: 229–237, 1977PubMedCrossRefGoogle Scholar
  10. 10.
    Dirks JH, Clapp JR, Berliner RW: The protein concentration in the proximal tubule of the dog. J Clin Invest 43: 916–921, 1964PubMedCrossRefGoogle Scholar
  11. 11.
    Leber PD, Marsh DJ: Micropuncture study of concentration and fate of albumin in rat nephron. Am J Physiol 219: 358–363, 1970PubMedGoogle Scholar
  12. 12.
    Oken DE, Flamenbaum W: Micropuncture studies of proximal tubule albumin concentrations in normal and nephrotic rats. J Clin Invest 50: 1498–1505, 1971PubMedCrossRefGoogle Scholar
  13. 13.
    Van Liew JB, Buentig W, Stolte H, Boylan JW: Protein excretion: Micropuncture study of rat capsular and proximal tubule fluid. Am J Physiol 219: 299–305, 1970PubMedGoogle Scholar
  14. 14.
    Bourdeau JE, Carone FA, Ganote CE: Serum albumin uptake in isolated perfused renal tubules: Quantitative and electron microscope radioautographic studies in three anatomical segments of the rabbit nephron. J Cell Biol 54: 382–398, 1972PubMedCrossRefGoogle Scholar
  15. 15.
    Maack T, Johnson V, Kau ST, Figueirdo J, Sigulem D: Renal filtration, transport, and metabolism of low-molecular-weight proteins: A review. Kidney Int 16: 251–270, 1979PubMedCrossRefGoogle Scholar
  16. 16.
    Wallenius G: Renal clearance of dextran as a measurement of glomerular permeability. Acta Soc Med Upsal 59 (SuppI4): 1–19, 1954Google Scholar
  17. 17.
    Chang RLS, Ueki IF, Troy JL, Deen WM, Robertson CR, Brenner BM: Permselectivity of the glomerular capillary wall to macromolecules. II. Experimental studies in rats using neutral dextran. Biophys J 15: 887–906, 1975PubMedCrossRefGoogle Scholar
  18. 18.
    Chang RLS, Deen WM, Robertson CR, Brenner BM: Permselectivity of the glomerular capillary wall. III. Restricted transport of polyanions. Kidney Int 8: 212–218, 1975PubMedCrossRefGoogle Scholar
  19. 19.
    Chang RLS, Deen WM, Robertson CR, Bennett CM, Glassock RJ, Brenner BM: Permselectivity of the glomerular capillary wall: Studies of experimental glomerulonephritis in the rat using neutral dextran. J Clin Invest 57: 1272–1286, 1976PubMedCrossRefGoogle Scholar
  20. 20.
    Deen WM, Bohrer MP, Brenner BM: Macromolecule transport across glomerular capillaries: Application of pore theory. Kidney Int 16: 353–365, 1979PubMedCrossRefGoogle Scholar
  21. 21.
    Rennke HG, Cotran RS, Venkatachalam MA: Role of molecular charge in glomerular permeability: Tracer studies with cationized ferritins. J Cell Biol 67: 638–646, 1975PubMedCrossRefGoogle Scholar
  22. 22.
    Rennke HG, Venkatachalam MA: Glomerular permeability: In vivo tracer studies with polyanionic and polycationic ferritins. Kidney Int 11: 44–53, 1977PubMedCrossRefGoogle Scholar
  23. 23.
    Rennke HG, Patel Y, Venkatachalam MA: Glomerular filtration of proteins: Clearance of anionic, neutral, and cationic horseradish peroxidase in the rat. Kidney Int 13: 278–288, 1978PubMedCrossRefGoogle Scholar
  24. 24.
    Bohrer MP, Baylis C, Humes HD, Glassock RJ, Robertson CR, Brenner BM: Permselectivity of the glomerular capillary wall: Facilitated diffusion of circulating polycations. J Clin Invest 61: 72–78, 1978PubMedCrossRefGoogle Scholar
  25. 25.
    Eisenbach GM, Van Liew JB, Boylan JW: Effect of angiotensin on the filtration of protein in the rat kidney: A micropuncture study. Kidney Int 8: 80–87, 1975PubMedCrossRefGoogle Scholar
  26. 26.
    Bohrer MP, Deen WM, Robertson CR, Brenner BM: Mechanism of angiotensin II-induced proteinuria in the rat. Am J Physiol 2: F13–F21, 1977Google Scholar
  27. 27.
    Lathem W: Renal circulatory dynamics and urinary protein excretion during infusions of 1-norepinephrine and 1-epinephrine in patients with renal disease. J Clin Invest 36: 1277–1285, 1957CrossRefGoogle Scholar
  28. 28.
    Robinson RR, Lecocq FR, Phillippi PJ, Glen WG: Fixed and reproducible orthostatic proteinuria. III. Effect of induced renal hemodynamic alterations upon urinary protein excretion. J Clin Invest 42: 100–110, 1963PubMedCrossRefGoogle Scholar
  29. 29.
    Robinson RR, Glenn WG: Fixed and reproducible orthostatic proteinuria. IV. Urinary albumin excretion in healthy human subjects in the recumbent and upright positions. J Lab Clin Med 64: 717–721, 1964PubMedGoogle Scholar
  30. 30.
    Boylan J: Introduction to the symposium on proteinuria and renal protein catabolism. Kidney Int 16: 247–250, 1979PubMedCrossRefGoogle Scholar
  31. 31.
    Tamm I, Horsfall FL: A mucoprotein derived from human urine which reacts with influenza, mumps, and Newcastle disease viruses. J Exp Med 95: 71–97, 1952PubMedCrossRefGoogle Scholar
  32. 32.
    Hoyer JR, Seiler MW: Pathophysiology of Tamm-Horsfall protein. Kidney Int 16: 279–289, 1979PubMedCrossRefGoogle Scholar
  33. 33.
    Butler EA, Flynn FV: The proteinuria of renal tubular disorders. Lancet 1: 978–980, 1958CrossRefGoogle Scholar
  34. 34.
    Butler EA, Flynn FV: The occurrence of post-gamma protein in urine: A new protein abnormality. J Clin Pathol 15: 172–178, 1961CrossRefGoogle Scholar
  35. 35.
    Peterson PA, Ervin PE, Berggard I: Differentiation of glomerular, tubular, and normal proteinuria: Determinations of urinary excretion of β2-microglobulin, albumin, and total protein. J Clin Invest 48: 1189–1198, 1969PubMedCrossRefGoogle Scholar
  36. 36.
    Piscator M: Proteinuria in chronic cadmium poisoning. III. Electrophoretic and immunoelectrophoretic studies on urinary proteins from cadmium workers, with special reference to the excretion of low molecular weight proteins. Arch Environ Health 12: 335–344, 1966PubMedGoogle Scholar
  37. 37.
    Antoine B, Symvoulidis A, Dardenne M: La stabilité évolutive des états de proteinurie permanente isolée. Nephron 6: 526–536, 1969PubMedCrossRefGoogle Scholar
  38. 38.
    Antoine B, Symvoulidis A, Dardenne M, De Montera H, Bach JF: L’état de proteinurie permanente isolée. I. Diversité histologique. Presse Med 77: 9–14, 1969PubMedGoogle Scholar
  39. 39.
    Manuel Y, Revillard JP, Francois R, Traeger J, Gaillard L, Salle B, Freycon MT, Borenstein I: Trace proteinuria. In Manuel Y, Revillard JP, Betuel H (eds.): Proteins in Normal and Pathological Urine. Basel, Karger, 1970, pp. 198–208Google Scholar
  40. 40.
    Morel-Maroger L, Leroux-Robert C, Richet G: Renal histology in 30 cases of isolated proteinuria: Frequency of hyaline and fibrinoid deposits in renal arterioles. Isr J Med Sci 3: 98–105, 1967.PubMedGoogle Scholar
  41. 41.
    Muth RG: Asymptomatic mild intermittent proteinuria: A percutaneous renal biopsy study. Arch Intern Med 115: 569–574, 1965PubMedGoogle Scholar
  42. 42.
    Pollak VW, Pirani CL, Muehrcke RC, Kark RM: Asymptomatic persistent proteinuria: Studies by renal biopsies. Guy’s Hosp Rep 107: 353–372, 1958PubMedGoogle Scholar
  43. 43.
    Phillippi PJ, Reynolds J, Yamauchi H, Beering SC: Persistent proteinuria in asymptomatic individuals: Renal biopsy studies on 50 patients. Milit Med 131: 1311–1317, 1966Google Scholar
  44. 44.
    Revillard JP, Fries D, Salle B, Blanc N, Traeger J: Proteinuria in glomerular disease. In Manuel Y, Revillard JP, Betuel H (eds.): Proteins in Normal and Pathological Urine. Basel, Karger, 1970, pp. 188–197Google Scholar
  45. 45.
    Robinson RR, Glover SN, Phillippi PJ, Lecocq FR, Langelier PR: Fixed and reproducible orthostatic proteinuria. I. Light microscopic studies of the kidney. Am J Pathol 39: 291–306, 1961PubMedGoogle Scholar
  46. 46.
    Robinson RR, Ashworth CT, Glover SN, Phillippi PJ, Lecocq FR, Langelier PR: Fixed and reproducible and orthostatic proteinuria. II. Electron and microscopic study of renal biopsy specimens from five cases. Am J Pathol 39: 405–417, 1961PubMedGoogle Scholar
  47. 47.
    Sinniah R, Law CH, Pivee HS: Glomerular lesions in patients with asymptomatic persistent and orthostatic proteinuria discovered on routine medical examination. Clin Nephrol 7: 1–14, 1977PubMedGoogle Scholar
  48. 48.
    King SE: Albuminuria in renal diseases. II. Preliminary observations on the clinical course of patients with orthostatic proteinuria. NY State J Med 59: 825–835, 1959Google Scholar
  49. 49.
    King SE: Diastolic hypertension and chronic proteinuria. Am J Cardiol 9: 669–674, 1962PubMedCrossRefGoogle Scholar
  50. 50.
    Levitt JI: The prognostic significance of proteinuria in young college students. Ann Intern Med 66: 685–696, 1967PubMedGoogle Scholar
  51. 51.
    Diehl HS, McKinlay CA: Albuminuria in college men. Arch Intern Med 49: 45–55, 1932Google Scholar
  52. 52.
    Wolman IJ: The incidence, causes and intermittency of proteinuria in young men. Am J Med Sci 210: 86 - 100, 1945CrossRefGoogle Scholar
  53. 53.
    Lyall A: The classification of cases of albuminuria. Br Med J 2: 113–117, 1941PubMedCrossRefGoogle Scholar
  54. 54.
    Burden HJ: Persistent functional albuminuria. Am J Med Sci 188: 242–247, 1934CrossRefGoogle Scholar
  55. 55.
    Derow HA: The diagnostic value of serial measurements of albuminuria in ambulatory patients. N Engl J Med 227: 827–830, 1942CrossRefGoogle Scholar
  56. 56.
    King SE: Patterns of protein excretion by the kidney. Ann Intern Med 42: 296–308, 1955PubMedGoogle Scholar
  57. 57.
    Mery JP, Berger J, Milhaud A, Crosnier J: La proteinurie orthostatique: A propos de 300 observations. Rev Prat (Paris) 11: 3115–3118, 1961Google Scholar
  58. 58.
    Bull GM: Postural proteinuria. Clin Sci 7: 77–108, 1948PubMedGoogle Scholar
  59. 59.
    Fishberg AM: Orthostatic proteinuria. In: Hypertension and Nephritis, 5th ed. Philadelphia, Lea & Febiger, 1954, pp. 396–407Google Scholar
  60. 60.
    Prince CL: Orthostatic albuminuria. J Urol 50: 608–615, 1954Google Scholar
  61. 61.
    Thompson AL, Durrett RR, Robinson RR: Fixed and reproducible orthostatic proteinuria. VI. Results of a 10-year follow-up evaluation. Ann Intern Med 73: 235–244, 1970PubMedGoogle Scholar
  62. 62.
    Ruckley VA, MacDonald MK, MacLean PR, Robson JS: Glomerular ultrastructure and function in postural proteinuria. Nephron 3: 153–166, 1966PubMedCrossRefGoogle Scholar
  63. 63.
    Lang K, Treser G, Sagel I, Ty A, Wasserman E: Routine immunohistology in renal diseases. Ann Intern Med 64: 25–36, 1966Google Scholar
  64. 64.
    Greiner T, Henry JP: Mechanism of postural proteinuria. JAMA 157: 1373–1378, 1955Google Scholar
  65. 65.
    King SE, Baldwin DS: Renal hemodynamics during erect lordosis in normal man and subjects with orthostatic proteinuria. Proc Soc Exp Biol Med 86: 634–638, 1954PubMedGoogle Scholar
  66. 66.
    Tobian L, Nason P: The augmentation of proteinuria by an acute sodium depletion that stimulates the secretion of renin. J Clin Invest 43: 1301–1309, 1964CrossRefGoogle Scholar
  67. 67.
    Montoliu J, Botey A, Torras A, Darnell A, Revert L: Renin-induced massive proteinuria in man. Clin Nephrol11: 267–271, 1979Google Scholar
  68. 68.
    Chaptal J, Jean R, Bonnet H, Pages A: Etude histologique du rein dans 33 cas de proteinurie isolée de l’enfant. Arch Fr Pediatr 23: 385–390, 1966PubMedGoogle Scholar
  69. 69.
    Lagrue G, Bariety J, Druet PH, Mieliez P: Les divers types de proteinuries. In: Les Proteinuries. Paris, Sandoz, 1969Google Scholar
  70. 70.
    McLaine PN, Drummond KN: Benign persistent asymptomatic proteinuria. Pediatrics 46: 548–552, 1970PubMedGoogle Scholar
  71. 71.
    Robinson RR: Proteinuria in asymptomatic patients. In: Proc 5th Int Cong Nephrol, Vol. 3. Basel, Karger, 1974, pp. 27–33Google Scholar
  72. 72.
    Collaborative Study of the Adult Idiopathic Nephrotic Syndrome: A controlled study of short-term prednisone treatment in adults with membranous nephropathy. N Engl JMed 301: 1301–1306, 1979CrossRefGoogle Scholar

Copyright information

© International Society of Nephrology 1983

Authors and Affiliations

  • Roscoe R. Robinson

There are no affiliations available

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