Bianchetti, Mario G

Fossali, Emilio F

Mazzoni, Marta B M

Milani, Gregorio P

Bern Open Repository and Information System (BORIS)

LETTER TO THE EDITORSMultidetector computed tomography in orthostaticproteinuria?Gregorio P. Milani & Marta B. M. Mazzoni &Emilio F. Fossali & Mario G. BianchettiReceived: 5 March 2010 /Accepted: 23 March 2010 /Published online: 13 April 2010# IPNA 2010Sirs,Orthostatic proteinuria is a condition characterized byincreased protein excretion in the upright position, butnormal protein excretion in the supine position, whichaffects up to 5% of adolescents [1]. Anecdotal observationssuggest that orthostatic proteinuria might sometimes reflectincipient renal disease. However, most authoritative reportsstate that this condition is benign, with renal functionremaining normal after as long as 50 years’ follow-up.Furthermore, orthostatic proteinuria resolves spontaneouslyin most patients, being present in about 50% at 10 yearsand 20% at 20 years [1].In most subjects with this form of proteinuria, renalultrasound imaging and Doppler flow scanning revealentrapment of the left renal vein in the fork between theabdominal aorta and the proximal superior mesentericartery close to its origin. It has been therefore postulatedthat partial obstruction to the flow in the left renal vein inthe upright position alters glomerular microcirculation, thusleading to increased protein filtration [2, 3].Very recently, Cho et al. evaluated children andadolescents with orthostatic proteinuria by means of multi-detector computed tomography and noted that both theangle and the distance between the aorta and the superiormesenteric artery were significantly altered in subjects withpostural proteinuria [3]. The sophisticated imaging studiesof the report further support left renal vein entrapment inthe pathogenesis of isolated orthostatic proteinuria.The lifetime cancer mortality risks attributable toradiation from a computed tomography examination areconsiderably higher for children than for adults. It has beenestimated that the lifetime cancer mortality risk attributableto the radiation exposure from a single abdominal computedtomography examination in a 1-year-old child is approxi-mately one in 500 [4].Considering the cancer mortality risk attributable toradiation from an abdominal computed tomography, thebenign nature of postural proteinuria, and its spontaneousresolution, we strongly advise against the use of multi-detector computed tomography in postural proteinuria, assuggested by Cho et al. [3]. No imaging studies or renalultrasound imaging and Doppler flow scanning arecurrently performed at our institutions in children withisolated postural proteinuria.References1. Omoloja AA, Patel H, Ey E, Jackson E (2007) Common renalproblems in pediatric medicine. Curr Probl Pediatr Adolesc HealthCare 37:153–1942. Ragazzi M, Milani G, Edefonti A, Burdick L, Bianchetti MG,Fossali EF (2008) Left renal vein entrapment: a frequent feature inchildren with postural proteinuria. Pediatr Nephrol 23:1837–18393. Cho BS, Suh JS, Hahn WH, Kim SD, Lim JW (2010) Multidetectorcomputed tomography findings and correlations with proteinuria innutcracker syndrome. Pediatr Nephrol 25:469–4754. Bertell R, Ehrle LH, Schmitz-Feuerhake I (2007) Pediatric CTresearch elevates public health concerns: low-dose radiation issuesare highly politicized. Int J Health Serv 37:419–439G. P. Milani :M. B. M. Mazzoni : E. F. FossaliEmergency Unit, Clinica Pediatrica De Marchi,Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico,Milan, ItalyM. G. Bianchetti (*)Department of Pediatrics, Mendrisio and Bellinzona Hospitals,University of Bern,Bern, Switzerlande-mail: mario.bianchetti@pediatrician.chPediatr Nephrol (2010) 25:2369DOI 10.1007/s00467-010-1524-z

Multidetector computed tomography in orthostatic proteinuria?

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Multidetector computed tomography in orthostatic proteinuria?

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