A retrospective, case-control study was performed to investigate the risk f
actors that may contribute to the development of proteinuria in patients wi
th chronic spinal cord injury (SCI), During an 18-month period, 31 subjects
with a 24-hour protein excretion of 1.0 g or greater were identified, Thre
e control subjects with SCIs with a 24-hour urinary protein excretion of le
ss than 1.0 g during the same time period were randomly selected for each s
tudy subject with proteinuria. Clinical data, including level and duration
of injury, age, presence of indwelling bladder catheter, number of decubitu
s ulcer procedures, serum albumin and creatinine concentrations, hematocrit
, creatinine clearance, and the presence of hypertension and diabetes melli
tus, were obtained from medical records, Subjects with proteinuria had othe
r evidence of renal dysfunction with greater serum creatinine concentration
s and reduced creatinine clearances, serum albumin concentrations, and hema
tocrits, Proteinuric subjects were older, had a longer duration of injury,
had undergone a greater number of decubitus ulcer procedures, and were more
likely to have hypertension and indwelling bladder catheters. The independ
ent predictors for the development of proteinuria using logistic stepwise m
ultiple linear regression analysis were the use of chronic indwelling bladd
er catheters, number of decubitis ulcer procedures, presence of hypertensio
n, and older age, These data suggest that inflammatory complications associ
ated with complications of chronic SCI, rather than SCI per se, contribute
to the development of proteinuria. SCI patients with proteinuria have more
impaired renal function and increased mortality compared with SCI patients
without proteinuria. (C) 1999 by the National Kidney Foundation, Inc.