DR K TAMILSELVAN

Renal Glycosuria

Renal Glycosuria is a rare condition in which the simple sugar glucose is excreted in the urine despite normal or low blood glucose levels. With normal kidney (renal) function, glucose is excreted in the urine only when there are abnormally elevated levels of glucose in the blood. However, in those with renal glycosuria, glucose is abnormally elevated in the urine due to improper functioning of the renal tubules, which are primary components of nephrons, the filtering units of the kidneys.

This is an inherited or acquired defect in proximal tubular glucose reabsorption resulting in glycosuria in the absence hyperglycemia.

History

Medical history offers no clues for either primary or benign renal glucosuria. In cases associated with combined tubular defects or hyperglycemia (ie, diabetes mellitus), history is specific to the disease or syndrome.

Renal glucosuria is first noted on routine urinalysis. In cases of glucosuria associated with tubular disorders, a history of growth failure, polyuria, polydipsia, or dehydration may be noted.

Mutations of the SGLT-2 gene have not been associated with other clinical abnormalities such as hypoglycemia, tendency to develop diabetes mellitus, chronic kidney disease, or higher rates of infection, especially urinary tract infections. Age at diagnosis ranges from childhood to adulthood. Polyuria associated with sodium wasting and/or aminoaciduria has been reported when daily urinary excretion of glucose is high.Low levels of glycosylated hemoglobin (HbA1c) and insulin have been reported.

In a case series of 16 pediatric patients with FRG, Dorum et al reported that growth and development were normal, and the results of kidney function tests and urinary amino acid excretion were also within normal limits.

Symptoms of Renal Glycosuria

Renal glycosuria is an inherited condition that usually doesn’t cause symptoms. When symptoms do occur, they can include:

Benign glycosuria

Familial renal glycosuria

Nondiabetic glycosuria

Primary renal glycosuria

Diabetes renalis

Renal diabetes

Diabetes innocence

Hypophosphatemic rickets

Volume depletion

Short stature

Muscle hypotonia

Cataracts or glaucoma

Kayser-Fleischer rings

Renal glycosuria is defined as glucosuria in the absence of hyperglycemia, meaning serum glucose is less than 140 mg/dL. It’s usually detected during a routine urinalysis.

Other conditions that can cause glycosuria include:

Type 1 and Type 2 diabetes, Gestational diabetes, and Fanconi syndrome.
Symptoms of glycosuria can include:
Extreme thirst or hunger
Dehydration
Peeing more than usual
Fatigue
Unexplained weight loss
Vision discoloration
Slow healing

Diagnosis of Renal Glycosuria

Renal glycosuria is diagnosed by laboratory tests that detect glucose in the urine and normal or low glucose levels in the blood. A healthcare provider may use the following tests:
Urinalysis
A urine sample is sent to a lab, where a technician uses a test strip to measure the glucose levels.
Blood glucose test
A blood sample is sent to a lab for analysis to check for high blood sugar.
A1C test
A blood sample is taken from a finger prick or blood draw to measure average blood sugar levels over the past three months.
diabetes mellitus part:- Part 5 – Glucose in urine …
Renal glycosuria is an uncommon kidney condition that occurs when glucose is excreted in the urine, even though blood glucose levels are normal or low. It usually doesn’t cause symptoms or serious consequences, and no treatment is required.
After a diagnosis of renal glycosuria, a healthcare provider may perform genetic testing to determine the risk of family members having the condition.

Treatment for Renal glycosuria

It depends on the cause and may include:
Lifestyle changes: Eating more fresh fruits and vegetables, whole grains, and lean proteins, and exercising regularly
Medications: Taking oral or injectable medications for type 2 diabetes, or insulin for type 1 diabetes and some people with type 2 diabetes
Antidiabetic agents: Taking antidiabetic agents like dapagliflozin or canagliflozin
Hydration: Drinking electrolyte solutions frequently
Avoiding nephrotoxic medications: Avoiding medications that are known to cause glycosuria as a side effect
Benign renal glucosuria is a self-limiting process that usually doesn’t require special medical care. Most people with renal glycosuria don’t have symptoms, but serious symptoms like dehydration or ketosis can occur in rare cases. If left untreated, glycosuria can lead to extreme thirst, hunger, frequent urination, or accidental urination.

Prognosis

The prognosis is excellent with no recorded mortality and the only morbidity being polyuria and enuresis and later a mild growth and pubertal maturation delay observed during a follow-up period of 30 years.

Morbidity/mortality
Renal glucosuria is a benign condition, affected individuals do not have any complaints, and only very rarely a propensity to hypovolemia and hypoglycemia has been described. However, morbidity is significant in Fanconi syndrome, Lowe syndrome, and cystinosis (see Differentials).

Complications
FRG is an entity considered to be a benign condition, more a phenotype than a disease. Some of the following have been reported with this condition:

Polyuria and enuresis and later a mild growth and pubertal maturation
Episodic dehydration and ketosis during pregnancy and starvation
Presence of several autoantibodies without clinical evidence of autoimmune disease
An increased incidence of urinary tract infections
Activation of the renin-angiotensin-aldosterone system, secondary to natriuresis and possible extracellular volume depletion
Hypercalciuria
Selective aminoaciduria

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