BENIGN AND PATHOLOGIC ALBUMINURIA: A STUDY OF 600 HOSPITALIZED CASES

Abstract

A practical, rapid and accurate procedure for differentiation of various forms of albuminuria is described. It involves examination of consecutive urinary specimens over 24 hrs. under standard conditions of activity, posture and fluid restriction. A night recumbent specimen serves for a urinary concn. test and Addis count. 600 military inductees, with albuminuria on repeated examination at induction stations, were hospitalized for short periods of study with this procedure. About 25% of all cases of albuminuria were studied. The incidence of albuminuria in young males is estimated at 2% of which about 90% are of the benign types. A revised classification of albuminuria is presented. Benign albuminuria is presented. Benign albuminuria is divided into 2 major groups, transitory and postural, the former being the more common. Many cases of the transitory variety are believed to represent a peculiar reaction pattern to stress and emotional tension. They are frequently recurrent. Clinical observations correlated with known physiologic data, suggest that albuminuria in such cases may follow renal vasoconstriction. In the postural type, albuminuria may be demonstrated regularly, following either the erect position, activity, or lordosis, and in some instances under combined conditions. Clinical evidence incriminating congenital renal defects as the cause of this variety is presented. Persistent albuminuria is the designation for cases with albumin in all specimens, but with normal urinary sediment (Addis count). This condition does not represent a single pathologic entity, but a moderately advanced stage of renal damage, usually from congenital abnormalities and degenerative disease. Some may represent a very latent or "healed*'' phase of glomerulonephritis or pyelonephritis. A high incidence of congenital renal defects was demonstrated by urography in this condition. Chronic glomerulonephritis was relatively infrequent (42 cases). Albuminuria was constant and associated with hematuria, casts, and often with hypertension. More than half of the persons of this group were unaware of the existence of this disease, prior to the routine discovery of albumin at induction examination. Chronic pyelonephritis was noted in 51 cases. Difficulties in diagnosis are emphasized, including variable albuminuria and intermittent pyuria. In advanced stages, with renal impairment, albuminuria becomes constant, and is frequently associated with casts and hypertension (30%). Chronic pyelonephritis may be engrafted upon congenital renal defects. This method has proven useful in the differential diagnosis of various forms of benign and pathologic albuminuria. Consistent results were obtained in many of this group, who were studied on several admissions.