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Glomerular morphometry in reflux nephropathy: functional and radiological correlations

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Abstract

Using computerized digitometry, we investigated the relationships between renal size, glomerular filtration rate (GFR), proteinuria, incidence of segmental and global glomerulosclerosis, glomerular size, hilar arteriolar wall thickness and hyaline deposition in renal biopsies obtained from 24 children and adolescents with reflux nephropathy, of whom only 4 were hypertensive. Agematched controls comprised minimal-change nephrotic syndrome (6) and recurrent haematuria with normal biopsy (13). The mean sectional area of patients' glomeruli was double that of controls. Glomerular size correlated with the amount of proteinuria (measured as protein/creatinine ratios in early morning urine) and inversely with renal size and GFR. Segmental sclerosis, invariably of hilar origin, was observed in 8 patients and the percentage of glomeruli affected correlated strongly with glomerular size and proteinuria. Global sclerosis was found equally in patients and controls, and showed no similar correlations. Compared with controls, patients' hilar arterioles showed increased wall thickness, more intramural hyaline deposits and decreased luminal diameter when related to glomerular size. The proteinuria and glomerular changes are consistent with hyperfiltration, while the previously undescribed hilar vascular changes, which both precede and accompany sclerosis, resemble abnormalities reported experimentally following renal ablation.

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Authors and Affiliations

  1. Department of Nephrology, The Children's Hospital, Ladywood Middleway, B16 8ET, Birmingham, UK

    Shoichi Yoshiara & Richard H. R. White

  2. Department of Pathology, The Children's Hospital, Ladywood Middleway, B16 8ET, Birmingham, UK

    Shoichi Yoshiara & Faro Raafat

  3. Department of Radiology, The Children's Hospital, Ladywood Middleway, B16 8ET, Birmingham, UK

    Nicholas C. Smith & Kishore J. Shah

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  1. Shoichi Yoshiara
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  2. Richard H. R. White
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  5. Kishore J. Shah
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Yoshiara, S., White, R.H.R., Raafat, F. et al. Glomerular morphometry in reflux nephropathy: functional and radiological correlations. Pediatr Nephrol 7, 15–22 (1993). https://doi.org/10.1007/BF00861553

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  • DOI: https://doi.org/10.1007/BF00861553

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