Martin-Arevalo DL, Yee J, Pugh J, Burgess DN
Fixed and reproducible orthostatic proteinuria: A 35-year
follow-up study
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1323 1996
Data on 43 of 64 original subjects with orthostatic proteinuria were
reported with 35 year follow-up. Patients were originally aged 17-24,
detailed data were available in 25 patients. All 25, interestingly, had
normal 24 hour protein excretion; however, 13/25 had a decline in
creatinine clearance averaging 25 ml/min less than would be expected (range
2-55) based on the Baltimore longitudinal study on aging (0.73 ml/min/1.73
m2/yr post age 30). Only 3 of these 13 had comorbid conditions which might
account for renal functional loss. Of the remaining 39, 13 are alive -- 8
in "good health" without more details known, 1 had a known normal
creatinine, 1 has ESRD from diabetes, 1 has CRF and hypertension, and no
data were available on 2. Of the original 64 patients, 5 are deceased; 21
of the original 64 are unaccounted for. The authors conclude that about 20%
of patients with orthostatic proteinuria have a greater than expected
decline in renal function.
Comment: I believe this study contributes significantly to our
understanding
and management of patients with orthostatic proteinuria. Although these
patients can still be reassured that their long-term renal prognosis is
good, they must be aware of the lifelong need for follow-up, and of the
possibility for accelerated loss of renal function. It is interesting that
the 24 hour protein excretions normalized over the long term, which raises
the question of what the relationship really is between the original
orthostatic proteinuria and the subsequent loss of renal function in the
absence of proteinuria.
(Stephen Pastan, M.D., Emory Clinic, Atlanta, GA)
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Am Soc Nephrol
Proteinuria/Hematuria :
Diagnostic approach to proteinuria