MICROPROTEINURIA AND ENZYMURIA IN CHILDRE N WITH FEVER OF NONRENAL ORIGIN AND WITH PYELONEPHRITIS - A PROSPECTIVE-STUDY IN 180 CHILDREN

In 180 children (87 children belonging to a control group, 68 with fev er of non-renal origin, and 25 with pyelonephritis) albumin and immuno globulin G (markers for glomerular dysfunction), alpha-1-microglobulin and beta-NAG (markers for proximal tubular dysfunction) and apolipopr otein Al (marker of 'postrenal' dysfunction) were measured in second-v oided morning urine. In children with fever of nonrenal origin, glomer ular dysfunction was encountered in 8.8 %, tubular dysfunction in 17.6 % and mixed glomerular-tubular dysfunction in 14.7 % of cases. Among c hildren with pyelonephritis, 28 % revealed glomerular dysfunction and 44 % mixed glomerular-tubular dysfunction, No case of solitary proxima l tubular dysfunction was observed in children with pyelonephritis. Th ere were highly significant differences in presence and expression of glomerular dysfunction between children with fever of non-renal origin and children with pyelonephritis (P<0.0001), whereas with regard to p roximal tubular dysfunction, the differences were only moderately sign ificant (beta-NAG: P<0.01) or of low significance (alpha-1-microglobul in: P<0.05). This may indicate that morphologic changes occur during i nterstitial pyelonephritis due to inflammation of glomeruli, resulting in glomerular dysfunction, while proximal tubular dysfunction may add itionally be due to fever-associated function processes.