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The normal range for the BUN:creatinine ratio (BCR) has not been determined for infants and children. The objectives of this study were to: i) test the hypothesis that the BCR is higher in young children, and ii) establish normal BCR ranges for children of various ages. In this retrospective single-center review, 482 patients evaluated in an ambulatory setting were studied. The mean BCR declined significantly with age (P<0.0001). There was an inverse relationship between BCR and age, body mass index (BMI), and serum creatinine and a direct relationship with BUN and estimated glomerular filtration rate. Based on our findings, we concluded that BCR values in adult patients are inapplic - able to children below 10 years of age. We suggest that BCR greater than 60 in children 10 years of age or younger, and greater than 30 in children older than 10 years be considered abnormal. Application of age-specific pediatric criteria will ensure the proper application of the BCR in evaluating acutely ill children. [ABSTRACT FROM AUTHOR]

Background: Idiopathic membranous nephropathy (IMN) is one of the most common causes of primary nephrotic syndrome in adults. However, it is a relatively rare entity in the pediatric population and there is a paucity of data about the incidence, prognosis, and optimal treatment of IMN in children and adolescents. We conducted this study to evaluate pediatric patients with IMN in order to clarify the presentation, response to therapy, and clinical outcome. Methods: A retrospective chart review was performed on patients identified with biopsy-proven IMN between 1988-2005. Patients with systemic lupus erythematosus or hepatitis-related lesions were excluded. The following data were tabulated: age, gender, ethnicity, presenting clinical and laboratory findings, proteinuria in a first morning urine specimen, estimated glomerular filtration rate (GFRe), histopathology, type and duration of treatment, and clinical status at final evaluation. Results: 13 cases of IMN were identified out of 460 renal biopsies performe for evaluation of primary kidney disease during the study interval. Mean age was 9.6 ± 4.6, gender 6 M:7 F, ethnicity 8 W:2 B:3 H. At the initial visit hematuria was present in 9 patients, edema in 5, nephrotic-range proteinuria in 5, and hypertension in 3. Mean urinary protein:creatinine ratio 3.3 ± 2.5 and all patients had a normal GFRe. Classic glomerular findings of IMN were seen in all renal specimens, with concomitant interstitial changes in 2 cases. Treatment included anangiotensin converting enzyme inhibitor or angiotensin receptor blocker in 11 cases. Most patients were also given immunosuppressive medications - prednisone in 10, a calcineurin inhibitor in 5, and mycophenolate mofetil or azathioprine in 3 patients. At the last follow-up, 42 ± 35 months after the diagnostic biopsy, 7 children were hypertensive and the urine protein:creatinine ratio was 2.3 ± 3.1. The mean GFRe was 127 ± 57 mL/min/m2. Three patients had Chronic Kidney Disease Stage 3, all of whom were also hypertensive. Conclusion: IMN is a rare but serious glomerulopathy in pediatrics. We estimate that it accounts for approximately 3% of renal biopsies. Long-term prognosis is guarded because approximately 50% of patients may have evidence of progressive kidney disease. [ABSTRACT FROM AUTHOR]

Proteinuria is utilized to screen for underlying kidney disease and serves as a marker of disease progression. The aim of this study was to test the hypothesis that patients with proteinuria will have a higher frequency of urine dipstick positive for leukocytes as an index of noninfectious renal inflammation. In this retrospective analysis, 1,099 urine specimens were evaluated from 676 patients. Proteinuria was present in 39% of the samples and leukocyturia in 5.1%. The percentage of urines that were dipstick positive for leukocytes was similar in those specimens with or without proteinuria. However, in patients with proteinuria and concomitant leukocyturia, the mean serum creatinine concentration was higher ( P=0.003) and the calculated GFR was lower ( P=0.01) compared to those without this additional abnormality. These differences were noted despite similar age, gender distribution, and array of underlying diseases in these two groups. Based on these findings, urine dipstick testing for leukocytes as a primary means of screening otherwise healthy children for serious renal disease is of little value. However, in patients with established proteinuria, a positive dipstick result for leukocytes is a simple means of identifying those with more prominent noninfectious renal inflammation, a process which may promote kidney disease progression. This finding may serve as an early marker of the severity of renal injury, regardless of whether the primary process is glomerular or tubular. [ABSTRACT FROM AUTHOR]