title: Screening for proteinuria in 'at-risk' patients with spinal cord injuries: lessons learnt from failure.
abstract: Spinal cord injury patients may develop proteinuria as a result of glomerulosclerosis due to urosepsis, hydronephrosis, vesicoureteric reflux, and renal calculi. Proteinuria in turn contributes to progression of kidney disease. We report one paraplegic and two tetraplegic patients, who developed recurrent urine infections, urinary calculi, and hydronephrosis. These patients required several urological procedures (nephrostomy, cystoscopy and ureteric stenting, ureteroscopy and lithotripsy, extracorporeal shock wave lithotripsy). These patients had not received antimuscarinic drugs nor had they undergone video-urodynamics. Proteinuria was detected only at a late stage, as testing for proteinuria was not performed during follow-up visits. Urine electrophoresis showed no monoclonal bands in any; Serum glomerular basement membrane antibody screen was negative. Serum neutrophil cytoplasmic antibodies screen by fluorescence was negative. All patients were prescribed Ramipril 2.5 mg daily and there was no further deterioration of renal function. Spinal cord injury patients, who did not receive antimuscarinic drugs to reduce intravesical pressure, are at high risk for developing reflux nephropathy. When such patients develop glomerulosclerosis due to recurrent urosepsis, renal calculi, or hydronephrosis, risk of proteinuria is increased further.
  
  
  CONCLUSIONS
  (1) Screening for proteinuria should be performed regularly in the 'at-risk' patients. (2) In the absence of other renal diseases causing proteinuria, spinal cord injury patients with significant proteinuria may be prescribed angiotensin-converting enzyme inhibitor or angiotensin-II receptor antagonist to slow progression of chronic renal disease and reduce the risk of cardiovascular mortality.
authors: Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Town Lane, Southport PR8 6PN, UK.
authors: Subramanian
authors: S
authors: Vaidyanathan
authors: Department of Renal Medicine, Southport and Formby District General Hospital, Town Lane, Southport PR8 6PN, UK.
authors: Kottarathil Abraham
authors: KA
authors: Abraham
authors: Department of Urology, Southport and Formby District General Hospital, Town Lane, Southport PR8 6PN, UK.
authors: Gurpreet
authors: G
authors: Singh
authors: Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Town Lane, Southport PR8 6PN, UK.
authors: Bakul
authors: B
authors: Soni
authors: Department of Radiology, Southport and Formby District General Hospital, Town Lane, Southport PR8 6PN, UK.
authors: Peter
authors: P
authors: Hughes
keywords: Kidney; Proteinuria; Renal calculi; Spinal cord injury