A proposed cooperation system between physicians in private practice and hospitals to prevent neglect of poor prognostic cases with mild urinary abnormalities

Abstract

Some outpatients with only mild urinary abnormalities have histologically active lesions. To prevent the progression of these lesions, they should not be overlooked at the initial diagnosis. For this purpose, I propose a new system of diagnostic cooperation between physicians in private practice and hospitals. A 50-year-old male showed proteinuria (_??_), occult blood (_??_), and one granular and red cell cast in the total fields in spot urine samples, a 24 hr urinary protein of 0.17 g, a serum creatinine of 1.2 mg/dl and a mean blood pressure of 112 mmHg at the first examination. Four months after the administration of an ACE-inhibitor, the urinary protein decreased to 0.04 g while the serum creatinine level increased to 1.5mg/dl. Therefore, a biopsy was performed at Kyoto University Hospital. Twenty-one glomeruli were obtained revealing 6 with global sclerosis and 13 proliferative glomeruli, including 3 with crescentic and 4 with adhesive lesions. In addition, interstitial cell infiltration was observed. After treatment for active blomeruli lesions using prednisolone and warfarin, the 24 hr urinary protein decreased to 0 g and serum creatinine to 1.2 mg/dl, Since a correlation between the relative volume of the renal cortical interstitial involvement and the serum creatinine concentration has been reported, the possibility of glomerularinterstitial interaction was considered. Thus, to prevent the neglect of patients with apparently mild disease associated with a poor prognosis, I propose the establishment of a system of diagnostic cooperation consisting of physicians in private practice, general hospitals and central hospitals that can provide appropriate treatment principles and give instructions for patients with mild urinary abnormalities encountered in daily practice.