[Work up and follow-up of a proteinuria: who does what and how?] / Bilan et suivi d'une protéinurie : qui fait quoi et comment ?

Reagent strip urinalysis is a very simple and affordable way to detect proteinuria. This mean, however efficient, generally requires further laboratory analysis of an early morning urine sample, as readily available. Lately, urinary albumin-to-creatinine ratio (ACR) has largely taken over other detection methods by its precision and ability to foreshow earlier stages of diabetic nephropathy. The confirmation of this biological abnormality enables chronic kidney disease staging, helps appreciate the risk it is associated with, and must lead to different interventions in order to reduce its burden : cause determination (which might eventually lead to a kidney biopsy) ; renin-angiotensin-system blockade in every ACR ⟩ 300 mg/g patients (or in ACR 30 - 300 mg/g diabetic patients) ; hypertension control ; or specific treatment (e.g. immunosuppressive drugs in glomerulonephritis).

La réalisation d'une tigette urinaire est un moyen très simple et peu coûteux pour détecter une protéinurie. Cette technique, déjà très efficace, nécessite généralement un complément par analyse au laboratoire d'un échantillon urinaire de première miction matinale, également facile d'accès. Ces dernières années, la détermination du rapport albumine/créatinine urinaire (" albumin-to-creatinin ratio " ou ACR) au cours de cette analyse a supplanté les autres méthodes de détection par sa précision et sa capacité à mettre en évidence des stades précoces de néphropathie diabétique. La confirmation de cette anomalie biologique permet ainsi de classer la sévérité d'une maladie rénale chronique, afin notamment d'en apprécier le risque associé, et dès lors mener à la réalisation de diverses interventions : détermination de la cause (éventuellement par la réalisation d'une biopsie rénale) ; mise en route d'une inhibition du système rénine-angiotensine-aldostérone dans tous les cas d'ACR ⟩ 300 mg/g (ou pour des ACR 30 - 300 mg/g chez les patients diabétiques) ; contrôle de l'hypertension artérielle ; voire instauration d'un traitement spécifique (par exemple immunosuppresseurs dans les glomérulonéphrites).

Renal biopsy findings in Belgium: a retrospective single center analysis.

Renal biopsy is the definitive diagnostic test in patients with renal parenchymal disease. Renal biopsy registry is an important tool which can provide valuable data concerning early and correct epidemiological description and clinical correlations of renal diseases. Records of 326 adult renal biopsies performed at our hospital from January 1991 till the end of December 2006 were retrospectively examined. Overall, secondary glomerular diseases (SGD) were predominant (39.9%), followed by primary glomerular diseases (PGD) (30.4%), vascular diseases (13.2%) and TIN (6.7%). Total sclerosis of the kidney did not allow histopathological diagnosis in 5.8% of all biopsied kidneys. Focal and Segmental Glomerular Sclerosis (FSGS), IgA Nephropathy (IgAGN) and Minimal Change Disease (MCD) and Membranous Glomerulopathy (MGN) were the most common PGD, altogether representing 75.7% of all PGD. FSGS was the most frequent (30.3%), followed by IgAGN (21.2%), MCD (19.1%) and MGN in 15.1%. Vasculitis, HIVAN, diabetic nephropathy and amyloidosis were the most common SGD, altogether representing 90% of all SGD. Immune Mediated Glomerulonephritis (IMGN) were the most frequent (32.3%), followed by HIVAN (16.9%), diabetic nephropathy (14.6%) and amyloidosis (10%). Nephroangiosclerosis (benign and malignant nephroangiosclerosis) was the most frequent vascular nephropathy responsible for 79% of all vascular diseases. Thrombotic microangiopathy was seen in 9.3% and atherothrombotic disease in 7% of all vascular diseases. Concerning tubular diseases, chronic TIN accounted for 63.6% of all tubular diseases, followed by light chain-cast nephropathy (22.7%) and acute TIN (13.6%). Because of lack of material, 3.4% of all biopsies could not be analyzed. These data demonstrate that the distribution of biopsy-proved renal diseases in a Belgian population of the Brussels area is strongly influenced by the indications of renal biopsy. Harmonization of these indications might reflect with more accuracy the actual incidence of different nephropathies in a given population. Nation and worldwide renal biopsy registers are important to follow patterns of renal diseases in different populations. This information is important not only for health organizations in order to plan health budget but also for helping clinicians to provide a better care to patients.

Late diagnosis of extra-pulmonary tuberculosis leads to irreversible kidney failure in a non-immunocompromised patient.

We report a case of extra pulmonary tuberculosis with multiple localizations including bone and kidney in a 21-year-old Pakistani immigrant living in Belgium. Late diagnosis of tuberculosis may lead to end stage renal disease and dialysis. Countries with low prevalence of tuberculosis should be vigilant towards high risk groups for tuberculosis because this preventable and curable disease may lead to devastating complications when diagnosed late.