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. Take home message: (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.
Highlights
A cross-sectional analyses of Veterans with spinal cord injury and disorders across all VA facilities of USA in 2006.revealed that 1 in 3 Veterans with had chronic kidney disease [1]
Proteinuria in spinal cord injury patients The lesson from these cases is that health professionals should look for proteinuria in spinal cord injury patients with following risk factors: (1) those, who have not been taking anticholinergic drugs and at risk for developing vesicoureteric reflux and reflux nephropathy
(2) Patients, in whom vesicoureteric reflux has been demonstrated in video-urodynamics
Summary
A cross-sectional analyses of Veterans with spinal cord injury and disorders across all VA facilities of USA in 2006.revealed that 1 in 3 Veterans with had chronic kidney disease [1]. Left ureteric stenting was done followed by extracorporeal shock wave lithotripsy of left renal calculus Later, this patient developed stone in left ureter; ureteric stenting was done in another hospital. Right nephrostomy: 0.61 g/L Urine Protein: creatinine ratio: 112.96 mg/mmol. Extracorporeal shock wave lithotripsy of left renal calculus was carried out and follow-up X-ray of kidney revealed complete clearance. Extracorporeal shockwave lithotripsy was performed, which resulted in complete fragmentation of stones in right kidney. In 2009, this patient developed stones in left kidney, and renal calculi were treated by extracorporeal shock wave lithotripsy. After he recovered from this episode of acute infection, extracorporeal shock wave lithotripsy of right renal calculi was carried out. He manages his bladder by penile sheath drainage and intermittent catheterisations. He lives in his home with his family and has been doing well
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