Abstract
Introduction:Tubular damage is common in glomerular diseases (GD). Glycosuria is a marker of tubular dysfunction and may be used to detect tubular lesion and CKD progression. The aim of this study was to evaluate the prevalence and prognostic value of glycosuria at the time of diagnosis in primary glomerulopathies (PG).Methods: We conducted a 24-month retrospective study in patients diagnosed with PG in our center between 2009 and 2020. We excluded diabetic patients, use of SGLT2 inhibitors, transplant patients, and secondary GD. Patients were divided in two groups according to their glycosuria status at diagnosis.Results:We studied 115 patients. Global prevalence of glycosuria was 10% (n=11) and membranous nephropathy (MN) had the highest prevalence (n=5, 17.9%). We found that patients with glycosuria had higher serum creatinine (2.4 vs. 1.2 mg/dL, p=0.030), higher albuminuria (4.8 vs. 1.9 g/g, p=0.004), and lower serum albumin (2.3 vs. 3.2 g/dL, p=0.021). We did not find association with histological prognostic factors. At the end of follow-up, patients with glycosuria had higher prevalence of the composite outcome of stage 5D CKD or 50% increase in basal SCr (45.5% vs. 17.3%, p=0.037). In patients with MN, results were similar but we were able to find an association of glycosuria with more severe interstitial fibrosis and tubular atrophy (25.0 vs. 0.0 %, p=0.032).Conclusion: Ten percent of our patients with PG have glycosuria. Glycosuria at the time of diagnosis was associated with more severe clinical presentation and worst renal outcome. The association with higher albuminuria suggests that tubular function has an impact on the severity and outcomes of PG.
Highlights
Tubular damage is common in glomerular diseases (GD)
Glucose is freely filtered in the glomerulus and is almost completely reabsorbed in the proximal tubules by the sodium-glucose cotransporters (SGLT)[1]
Categorical variables are expressed as frequencies and continuous variables non-normally distributed as median values with interquartile range (IQR)
Summary
Tubular damage is common in glomerular diseases (GD). Glycosuria is a marker of tubular dysfunction and may be used to detect tubular lesion and CKD progression. In patients with MN, results were similar but we were able to find an association of glycosuria with more severe interstitial fibrosis and tubular atrophy (25.0 vs 0.0 %, p=0.032). Glycosuria at the time of diagnosis was associated with more severe clinical presentation and worst renal outcome. Glycosuria, in euglycemic non-diabetic patients, is a known marker of proximal tubular disfunction[2]. It may be present with other Fanconi Syndrome manifestations as aminoaciduria, hyperuricosuria, hyperphosphaturia, and tubular acidosis[2,3]. Glycosuria might be a valuable marker of prognosis in renal diseases It is an extremely easy and inexpensive test. The vicious cycle mechanisms of CKD progression, with tubular inflammation and expansion of interstitial damage, are responsible for the appearance of tubular dysfunction markers in urinalysis, glycosuria[2,5]
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