Abstract: PUB460
Intriguing Presentation of Proteinuria Associated with Immature Glomeruli in a Child with Horseshoe Kidney
Session Information
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Prasanna, Ganesh, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
- Hiser, Wesley, Pathologists Bio-Medical Laboratories, Coppell, Texas, United States
- Pal, Abhijeet, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
Introduction
Horseshoe kidney, a congenital anomaly resulting from the fusion of the lower poles of both kidneys, affects about 1 in 500 children. While horseshoe kidney has been associated with various glomerulopathies, we report the first instance where evaluation for persistent proteinuria revealed immature glomeruli with segmental sclerosis on renal biopsy.
Case Description
A four-year-old boy presented in 2021 with incidental proteinuria with no other symptoms. He was born at term with no familial history of kidney disease. His blood pressure was normal, and his physical examination was unremarkable. Urinalysis showed proteinuria with urine protein creatinine ratio (UPCR) of 1.1 mg/mg (normal range <0.2 mg/mg), albumin creatinine ratio (ACR) of 0.6 mg/mg, and no hematuria. Serum creatinine was 0.3 mg/dL. Blood counts were within normal limits. Renal ultrasound revealed a horseshoe kidney. Renal biopsy showed forty-six glomeruli, of which six (13%) were immature, which is unusually high for his age. Four immature glomeruli also had segmental sclerosis. Six glomeruli (13%) were globally sclerosed. Remaining were normal with insiginificant foot process effacement. Initially, he was monitored with no therapy. However, due to persisting proteinuria (UPCR 1.11 mg/mg) over a two-year follow-up, losartan was started in January 2024. By April 2024, UPCR had reduced (0.8 mg/mg). The patient remains on follow-up.
Discussion
This is the first report of horseshoe kidney concomitant with proteinuria and immature glomeruli. At first, we opted to survey without treatment, hypothesizing that the proteinuria was due to developmentally abnormal nephrons, whose further scarring may resolve the proteinuria. Moreover, we were reassured by the non-severe degree of proteinuria and the absence of symptoms. But the persisting proteinuria prompted us to start therapy with losartan, which reduced the proteinuria. This case suggests that immature glomeruli might be a benign cause of proteinuria, while also indicating a developmental correlation with the horseshoe kidney.