How early renal biopsy has to be performed in children with isolated asymptomatic proteinuria?

摘要

An axiom in nephrology is that the treatment of renal diseases is mostly effective when the renal damage has not yet entered a sclerotic phase, hence the need for an early diagnosis to establish a timely treatment. This is considered particularly valid for the immune-mediated glo-merular diseases. A point of no-return—~2-3 mg/dL of serum creatinine—has been claimed to exist for inflammatory glomerular diseases, like IgA nephropathy [1, 2]. It corresponds to a severe loss of functioning renal mass (~60-70%) and the kidney lesion mostly detected at this point is a severe interstitial fibrosis, which is the monotonous pathology hallmark of conditions with irreversible chronic renal damage. In these cases, proteinuria is mostly due to glomerular hyperfiltration, which further aggravates the tubulointerstitial damage and can be only partially reduced by angiotensin-antagonists [3]. It is clear that the diagnosis should be made long before the detection of these pathology lesions.