Exploration of renal lesions despite normal proteinuria
A recent retrospective study has highlighted the complexity of cases of renal dysfunction without proteinuria, a situation that is more common than one might think. Analyzes reveal that, even in the absence of proteinuria, significant histopathological lesions may be present, making the diagnosis more difficult.
Glomerular and tubulointerstitial diseases in the front line
Among the 53 cases studied, approximately 80% of patients presented glomerular lesions (GD) or tubulointerstitial lesions (TID). These pathologies, although varied, indicate a substantial involvement of these two types of diseases in renal dysfunction not associated with visible proteinuria. The remaining 20% suffered from vascular diseases (SVD), highlighting the role of renal circulatory disorders in these conditions.
Non-severe glomerular diseases or tubulointerstitial involvement may exist without inducing notable proteinuria, but nevertheless cause progressive deterioration of renal function. This observation suggests that the assessment of renal function should not be limited to the detection of proteinuria but include a more comprehensive biopsy approach.
Hypertension and its role in renal dysfunction
The study also highlights the link between hypertension and kidney damage, particularly sclerosis of small arteries and arterioles, which could be the cause of kidney dysfunction in these patients. This observation highlights the importance of closely monitoring hypertensive patients, even in the absence of clinical signs of proteinuria.
Implications for clinical management
Despite its limitations, including the retrospective nature, small sample size and methodological variations that could influence the results, this study opens new perspectives for improving clinical decision-making in the diagnosis of renal dysfunction.
These results call for a review of diagnostic practices and the management of patients with renal dysfunction without proteinuria. The systematic integration of renal biopsy into the care pathway could make it possible to detect lesions early, optimize treatment and improve clinical results.
He HY, Feng L, You YK, Yap DYH, Pai P, Guo XH, Ren YP, Li XY. The renal histopathology of nonproteinuric kidney impairment: a three center experience. Clin Exp Med. 2024 Oct 3;24(1):236. doi: 10.1007/s10238-024-01494-x. PMID: 39361090; PMCID: PMC11450049.
