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PubMed2003

Involvement of renal ACE activity in proteinuria-associated renal damage in untreated and treated adriamycin nephrotic rats.

Proteinuria is assumed to play a pathogenetic role in progressive renal damage. Angiotensin-converting enzyme (ACE) inhibition reduces proteinuria and provides renoprotection. This suggests that ACE activity might play a pathogenetic role in the development of proteinuria-induced renal structural damage. We investigated this hypothesis in untreated and treated established adriamycin nephrosis, a model of proteinuria-induced renal damage. In a time-course experiment, the development of renal structural damage in untreated adriamycin nephrotic rats was paralleled by a significant rise in renal ACE activity. Moreover, on cross-sectional analysis, a consistent positive correlation between renal, but not plasma, ACE activity and proteinuria, focal glomerulosclerosis and interstitial injury was present. Notably, these associations were present, not only in the untreated condition, but also during intervention with either ACE inhibition or AT(1)-receptor antagonism. Interestingly, we found that higher renal ACE activity is associated with more severe renal damage for a given amount of proteinuria, suggesting that renal ACE activity may be either a permissive or a promoting factor in the processes by which proteinuria eventually leads to renal structural damage. This relationship was abolished by renin-angiotensin system (RAS)-blockade, suggesting that RAS-mediated effects are involved in the relationship between renal ACE activity and proteinuria-induced renal damage. In conclusion, in untreated as well as treated adriamycin nephrotic rats, renal ACE activity is closely associated with renal outcome. This association appears to be independent of the specific mode of blockade of the RAS. Renal ACE activity is a consistent marker of individual differences in proteinuria-associated renal damage: further studies are needed to investigate a possible pathogenetic role in renal damage.

Angiotensin Receptor Antagonists↗
PubMed1995

Blood pressure control, proteinuria, and the progression of renal disease. The Modification of Diet in Renal Disease Study.

OBJECTIVE: To examine the relations among proteinuria, prescribed and achieved blood pressure, and decline in glomerular filtration rate in the Modification of Diet in Renal Disease Study. DESIGN: 2 randomized trials in patients with chronic renal diseases of diverse cause. SETTING: 15 outpatient nephrology practices at university hospitals. PATIENTS: 840 patients, of whom 585 were in study A (glomerular filtration rate, 25 to 55 mliters/min.1.73 m2) and 255 were in study B (glomerular filtration rate, 13 to 24 mliters/min.1.73 m2). Diabetic patients who required insulin were excluded. INTERVENTIONS: Patients were randomly assigned to a usual blood pressure goal (target mean arterial pressure, < or = 107 mm Hg for patients < or = 60 years of age and < or = 113 mm Hg for patients > or = 61 years of age) or a low blood pressure goal (target mean arterial pressure, < or = 92 mm Hg for patients < or = 60 years of age and < or = 98 mm Hg for patients > or = 61 years of age). MAIN OUTCOME MEASURES: Rate of decline in glomerular filtration rate and change in proteinuria during follow-up. RESULTS: The low blood pressure goal had a greater beneficial effect in persons with higher baseline proteinuria in both study A (P = 0.02) and study B (P = 0.01). Glomerular filtration rate declined faster in patients with higher achieved blood pressure during follow-up in both study A (r = -0.20; P < 0.001) and study B (r = -0.34; P < 0.001), and these correlations were stronger in persons with higher baseline proteinuria (P < 0.001 in study A; P < 0.01 in study B). In study A, the association between decline in glomerular filtration rate and achieved follow-up blood pressure was nonlinear (P = 0.011) and was stronger at higher mean arterial pressure. In both studies, the low blood pressure goal significantly reduced proteinuria during the first 4 months after randomization. This, in turn, correlated with a slower subsequent decline in glomerular filtration rate. CONCLUSIONS: Our study supports the concept that proteinuria is an independent risk factor for the progression of renal disease. For patients with proteinuria of more than 1 g/d, we suggest a target blood pressure of less than 92 mm Hg (125/75 mm Hg). For patients with proteinuria of 0.25 to 1.0 g/d, a target mean arterial pressure of less than 98 mm Hg (about 130/80 mm Hg) may be advisable. The extent to which lowering blood pressure reduces proteinuria may be a measure of the effectiveness of this therapy in slowing the progression of renal disease.

Adolescent↗
PubMed2003

Proteinuria in aviation personnel: waiver policy in the U.S. Navy.

BACKGROUND: Proteinuria is a condition occasionally detected both in applicants for military pilot training and in experienced pilots. Medical personnel involved in the care of either group require a standardized policy for the evaluation and aeromedical disposition of proteinuria for these personnel. METHODS: A literature search was conducted to obtain current information and prognostic data on proteinuria in the general medical literature. Generally accepted waiver principles were then examined to determine if proteinuria should be waivered in aviation personnel. Other agency policies regarding proteinuria in aviation personnel were examined. The biomedical database records at the Naval Aerospace Medical Institute (NAMI) were searched to discover the U.S. Navy's experience in the evaluation and disposition of aviation personnel with proteinuria. RESULTS: A review of the general medical literature revealed general categories of proteinuria (dependent on protein excretion amount and symptomatology) and the presence or absence of systemic disease that correlated well with prognostic data. These categories provided useful criteria to develop an aeromedical policy that was consistent with previous (informal) NAMI policies, generally accepted waiver principles, and the existing policies of other agencies. Using the above results, a recommended policy for aviation personnel with proteinuria was presented. CONCLUSIONS: A recommended policy for the evaluation and aeromedical disposition of aviation personnel with proteinuria was developed for both applicants for U.S. Navy aviation duty as well as in those already serving within the U.S. Navy aviation community.

Aerospace Medicine↗
PubMed1989

Age-related nephropathy and proteinuria in rats with intact kidneys exposed to diets with different protein content.

Tubulointerstitial damage and glomerular sclerosis are findings commonly observed in the experimental models of adriamycin and puromycin aminonucleoside nephrosis. It has been suggested that in such models proteinuria might be an important mediator of tubulo-interstitial damage which in turn may determine the progression of the disease favoring the development of glomerulosclerosis. The objective of the present investigation was to establish the temporal relationship between proteinuria, tubulo-interstitial damage and glomerulosclerosis in aging rats with intact kidneys exposed to diets with different protein content. There were six groups of rats studied. Animals of groups 1, 5, and 6 (N = 10) were fed diets containing 20, 35, and 6% protein, respectively, for 20 months and sacrificed at the end of the experimental period. Rats in groups 3 and 4 (N = 6) exhibited marked and mild proteinuria, respectively, after 14 months of maintenance on standard diet, and followed for two additional months after the onset of proteinuria with the aim of evaluating the pattern of renal damage after a relatively short period of proteinuria. Rats in group 2 (N = 10) were fed standard diet and sacrificed before (5 months) and at the onset of proteinuria (10 months). Protein excretion and plasma creatinine were measured for each animal every month. Pathologic examination was performed by light and electron microscopy. At the onset of proteinuria neither renal structural nor functional abnormalities were detected. After 20 months, rats fed standard diet developed tubulo-interstitial damage (score: 1.29 +/- 1.05) and focal glomerular sclerosis (percentage of glomeruli with focal segmental glomerular sclerosis: 16.70 +/- 16.40). A significant correlation was found between the degree of tubulo-interstitial damage and the percentage of glomeruli with focal glomerular sclerosis (r = 0.99, p less than 0.01). Development of tubulo-interstitial damage and focal glomerular sclerosis were correlated with heavy and sustained proteinuria. The high protein diet significantly worsened proteinuria (at month 20: 247.08 +/- 101.73 mg/day), tubulo-interstitial changes (score: 1.99 +/- 0.70), focal glomerular sclerosis (percentage of glomeruli with focal segmental glomerular sclerosis: 21.50 +/- 9.44) and was associated with deteriorating renal function (at month 20, plasma creatinine: 1.20 +/- 0.50 mg/dl).(ABSTRACT TRUNCATED AT 400 WORDS)

Aging↗
PubMed1995

[Electrophoretic profile of proteinuria in normal pregnancy and in gestational hypertension].

The aim of this study was the determination of the electrophoretic patterns and evaluation of the proteinuria type in the normal pregnancy and in women with gestational hypertension with or without pathological proteinuria, using high performance electrophoresis in SDS-polyacrylamide as analytical tool. The study was done with patients from the General Hospital of the Ministry of Health in Durango, México. Three groups were formed; one included normal pregnant women (n = 13); the second one was formed by patients with gestational hypertension without pathological proteinuria (n = 25); the third group was formed by patients with gestational hypertension and pathological proteinuria (n = 12). The electrophoretic pattern in the three groups showed high and low molecular weight proteins, corresponding to mixed proteinuria (glomerular and tubular). The samples from the group of hypertension of pregnancy with pathological proteinuria showed greater IgG and transferrin content. It is concluded that physiological proteinuria in the normal pregnancy and pathological proteinuria in gestational hypertension differ quantitatively in an absolute and relative manner. The analytical method employed in this study is useful in the evaluation of renal compromise in diseases coursing with proteinuria.

Adolescent↗
PubMed1995

Proteinuria in patients with sleep apnea.

BACKGROUND: Proteinuria severe enough to be in the nephrotic range has been noted on occasion in patients with obstructive sleep apnea (OSA), but it is not known what factors are related to the severity of proteinuria in these patients. This study was conducted to determine if the severity of proteinuria is related to the number of apneas. METHODS: The level of proteinuria was determined by the dipstick method in 407 patients in whom OSA had been diagnosed. The apnea-hypopnea index (AHI) was calculated in each patient after all-night polysomnography. Sleep apnea was defined as the presence of at least 30 apneas during a 6- to 8-hour monitoring period and an AHI greater than 15. RESULTS: The apnea-hypopnea index in patients without proteinuria was similar to that of patients with 1+ to 3+ proteinuria. However, the AHI was significantly greater in the 9 patients with 4+ proteinuria. CONCLUSIONS: While severe proteinuria in OSA occurs in patients with a higher rate of sleep apneas, the lesser degree of proteinuria cannot be explained by AHI alone. Other factors that determine the severity of the disease, such as hypoxemia, merit further investigation.

Adult↗
PubMed1996

A long-term follow-up study of asymptomatic hematuria and/or proteinuria in adults.

Between January 1, 1983 and December 31, 1992, 805 patients with asymptomatic proteinuria and/or hematuria were selected in the mass screening of 56,269 adults. We conducted prospective long-term follow-up studies of these patients and evaluated their clinical findings and renal histology. They were divided into three groups according to the first dipstick urinalysis findings: 478 patients with pure hematuria (H), 150 patients with concomitant hematuria and proteinuria (H & P), and 177 patients with proteinuria (P). The mean follow-up period was 5.80 +/- 4.42 years. Of the 478 patients with H, a specific cause of hematuria was found in 46 (9.6%), the remaining 432 (90.4%) patients were diagnosed as having asymptomatic hematuria (ASH). During the follow-up period, in the ASH patients, hematuria disappeared in 44.2%, 43.7% had persistent microhematuria without proteinuria, and 10.6% manifested proteinuria, none of the patients showed renal insufficiency. Of the 150 patients with H & P, 134 were diagnosed as having asymptomatic H & P. During the follow-up period, the hematuria and proteinuria disappeared in 16.4% of these patients, the proteinuria disappeared in 8.2%, and 14.9% of the patients showed renal insufficiency. Of the 177 patients with P, 151 were diagnosed has having asymptomatic P. During the follow-up period, proteinuria disappeared in 23.2%, and 10.6% showed renal insufficiency. Renal biopsy was performed in 151 patients in the study population who had a moderate degree of proteinuria; 68.2% of these patients had IgA nephropathy, 12.6% had non-IgA mesangial proliferative GN, 6.0% had membranous nephropathy, 5.3% had minimal change, and 2.6% had focal and segmental glomerular sclerosis. This study of the mass screening of urinalysis in asymptomatic adults showed that although the patients with pure hematuria did not exhibit renal insufficiency, 10.6% of these patients were proteinuric during the follow-up period. Therefore, careful observation and management are needed in these patients.

Adolescent↗
PubMed2000

The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus.

BACKGROUND: Despite the numerous studies on the relation of albuminuria with increased risk of all-cause mortality in type 2 diabetes mellitus, it remains uncertain whether microalbuminuria and/or gross proteinuria are independent risk factors for cardiovascular mortality. Moreover, the association of albuminuria with cardiovascular mortality in people with type 2 diabetes mellitus has not been well described in US populations. OBJECTIVE: To estimate the relative risks (RRs) for the associations of microalbuminuria and gross proteinuria with cardiovascular disease mortality among persons with older-onset diabetes mellitus. METHODS: We conducted a prospective cohort study of 840 people with older-onset diabetes mellitus who provided urine samples in the 1984-1986 examination of a population-based study of diabetic persons. The presence of microalbuminuria was determined by an agglutination inhibition assay and gross proteinuria by a reagent strip. The main outcome was time to mortality from cardiovascular disease, as determined from death certificates. RESULTS: Of the 840 older-onset diabetic persons, 54.8% had normoalbuminuria, while 24.8% had microalbuminuria and 20.5% had gross proteinuria. During the 12-year follow-up (6127 person-years), we identified 364 deaths from cardiovascular disease. Compared with persons with normoalbuminuria, those with microalbuminuria and gross proteinuria had significantly higher risks of cardiovascular mortality. The RR as controlled for age, sex, glycemic control, insulin use, alcohol intake, physical activity, cardiovascular disease history, antihypertensive use, and retinopathy severity, was 1.84 (95% confidence interval [CI], 1.42-2.40) for those with microalbuminuria and 2.61 (95% CI, 1.99-3.43) for those with gross proteinuria. Further adjustment for other factors did not change the relations we found. When the end point used was mortality from coronary heart disease, stroke, or all causes, the increased risks were significant for both microalbuminuria (adjusted RRs [95% CIs], 1.96 [1.42-2.72], 2.20 [1.29-3.75], and 1.68 [1.35-2.09], respectively) and gross proteinuria (adjusted RRs [95% CIs], 2.73 [1.95-3.81], 2.33 [1.28-4.24], and 2.47 [1.97-3.10], respectively). CONCLUSIONS: Results from our population-based study strongly suggest that both microalbuminuria and gross proteinuria were significantly associated with subsequent mortality from all causes and from cardiovascular, cerebrovascular, and coronary heart diseases. These associations were independent of known cardiovascular risk factors and diabetes-related variables.

Aged↗
PubMed2005

Direct, progressive association of cardiovascular risk factors with incident proteinuria: results from the Korea Medical Insurance Corporation (KMIC) study.

BACKGROUND: Proteinuria is a major risk factor for the progression of kidney disease and the development of cardiovascular disease. Little is known, however, about risk factors for incident proteinuria. METHODS: We conducted a 10-year prospective cohort study of 104,523 Korean men and 52,854 women, aged 35 to 59 years, who attended Korea Medical Insurance Corporation health examinations and who did not have proteinuria at baseline. Incident proteinuria was assessed at biennial examinations during the next 10 years. We performed Cox proportional hazards analyses. RESULTS: During 10 years of follow-up, proteinuria developed in 3951 men (3.8%) and 1527 women (2.9%). The adjusted relative risk (RR) of proteinuria associated with diabetes was 3.27 (95% confidence interval [CI], 2.98-3.58) in men and 2.60 (95% CI, 1.98-3.43) in women; with body mass index (calculated as weight in kilograms divided by the square of height in meters), it was 1.43 (95% CI, 1.35-1.50) in men and 1.45 (95% CI, 1.35-1.55) in women per 5-U increment. Compared with subjects with serum cholesterol levels of less than 200 mg/dL (< 5.18 mmol/L), the adjusted RRs associated with serum cholesterol levels of 200 to 239 mg/dL (5.18-6.19 mmol/L) and 240 mg/dL or more (> or = 6.22 mmol/L) were 1.13 (95% CI, 1.05-1.21) and 1.40 (95% CI, 1.27-1.54), respectively, in men and 1.14 (95% CI, 1.01-1.28) and 1.22 (95% CI, 1.00-1.37), respectively, in women. Persons with stages 1 and 2 hypertension had a greater adjusted RR of incident proteinuria compared with those with normal blood pressure (1.62 [95% CI, 1.47-1.79] and 2.06 [95% CI, 1.81-2.34], respectively, in men and 1.37 [95% CI, 1.14-1.65] and 2.10 [95% CI, 1.59-2.76], respectively, in women). CONCLUSIONS: Fasting glucose and cholesterol levels, body mass index, and blood pressure were direct and independent predictors of incident proteinuria in Korean adults. These associations were present even at low levels of exposure, emphasizing the importance of early detection and management of these modifiable risk factors.

Adult↗
PubMed1993

Determinants of end-stage renal disease in Pima Indians with type 2 (non-insulin-dependent) diabetes mellitus and proteinuria.

To identify factors related to the development of end-stage renal disease after the onset of proteinuria, its incidence was determined in 364 Pima Indians aged 35 years or older with Type 2 (non-insulin-dependent) diabetes mellitus and proteinuria (protein-to-creatinine ratio > or = 0.5 g/g). Of these 364 subjects, 95 (36 men, 59 women) developed end-stage renal disease. The cumulative incidence was 40% 10 years after and 61% 15 years after the onset of proteinuria. The incidence of end-stage renal disease was significantly related to the duration of diabetes, the duration of proteinuria, higher 2-h plasma glucose concentration, type of diabetes treatment, and the presence of retinopathy at the time of recognition of the proteinuria, but not to age, sex, or blood pressure. Duration of proteinuria influenced the risk of end-stage renal disease, contingent, however, upon the duration of diabetes at the onset of proteinuria. The higher cumulative incidence of end-stage renal disease 15 years after the onset of proteinuria in Pima Indians (61%) than in Caucasians from Rochester, Minnesota (17%) may be attributable, in part, to the younger age of onset of Type 2 diabetes in Pima Indians than in Caucasians, to ethnic differences in susceptibility to renal disease, or to lower death rates among the Pima Indians from competing causes of death, such as coronary heart disease.

Adult↗
PubMed1986

Penicillamine-induced proteinuria: risk factors.

Twenty-six of 300 patients (9%) with rheumatoid arthritis (RA) developed penicillamine-induced proteinuria. The mean daily dose and duration of therapy at onset of proteinuria were 591 mg and 9 months, respectively, while the mean duration of proteinuria was 5.5 months. However, six patients developed proteinuria at 250 mg/d and six after 9 months of therapy. Twelve patients were successfully either restarted (five) or maintained (seven) on penicillamine with resolution of proteinuria. No permanent renal impairment occurred. Positive risk factors included the presence of HLA-B8 and DR3 and prior gold-induced proteinuria. Patients with prior gold-induced proteinuria should be observed more carefully, but tissue typing is not recommended as proteinuria is reversible. Furthermore, penicillamine can be restarted or maintained in these patients if the RA has responded favorably to the drug.

Adult↗
PubMed1981

Characterization of the proteinuria induced by prolonged oral administration of cadmium in female rats.

Female Sprague-Dawley rats were given 200 ppm cadmium (Cd) in the drinking water for 11 months. Total proteinuria and the concentrations of Cd in blood, urine, liver and kidney cortex were determined monthly. The proteinuria was characterized by Sephadex G-75 chromatography and by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. From the 8th month of treatment, the Cd concentration in the kidney cortex levels off at a value of about 250 microgram/g wet wt and this phenomenon coincides with the occurrence of proteinuria. The proteinuria was characterized by an increased urinary excretion of high molecular weight (HMW) proteins, particularly gamma-globulins. Aminoaciduria also increased which suggests the existence of a slight tubular dysfunction. The renal dysfunction induced by chronic oral administration of Cd seems different from that observed in a previous study in which Cd was administered by the i.p. route (1 mg Cd/kg, 5 times a week for 2 months). For the same level of Cd in the kidney cortex the proteinuria induced by i.p. injection of Cd was usually of mixed type and in some cases of the tubular type. The development of this proteinuria was coincident with the levelling off of Cd concentration in the kidney cortex and in the liver. The saturation of liver by Cd is very likely at the origin of he extensive tubular lesion and of the mixed type proteinuria observed in the i.p. experiment. These results demonstrate the importance of mode of Cd administration on the nature of the Cd-induced proteinuria in animal. They support also our proposal that both low and HMW proteins should be determined in urine for the early detection of renal damage occurring in man chronically exposed to cadmium.

Administration, Oral↗
PubMed2004

Ramipril in the treatment of hypertension and proteinuria in children with chronic kidney diseases.

BACKGROUND: Angiotensin-converting enzyme inhibitors are the drugs of choice in renal hypertension. The efficacy and safety of ramipril in adults has been proved; however, data on effectiveness of ramipril in children are few. The aim of the present study was to investigate the effect of ramipril on blood pressure (BP) and proteinuria in children with chronic kidney diseases. METHODS: A total of 31 children (median age 11.3 years, range 1.9-19.8 years) with various chronic nephropathies and hypertension or proteinuria were prospectively treated with ramipril for 6 months. Blood pressure was evaluated using ambulatory BP monitoring and hypertension was defined as mean BP equal to or greater than the 95th percentile for healthy children. Proteinuria was defined as protein excretion > or =100 mg/m(2)/24 h. The starting dose of ramipril was 1.5 mg/m(2)/24 h once daily. In 27 children it was given as monotherapy. RESULTS: The median decrease in ambulatory BP was 11 mm Hg for daytime systolic, 10 mm Hg for daytime and nighttime diastolic, and 8 mm Hg for nighttime systolic BP. Hypertension normalized in 55% of the children. Proteinuria decreased in 84% of the children with pathologic proteinuria; the median decrease was 51%. A positive correlation was found between initial proteinuria and change of proteinuria (r = 0.95, P <.001). Glomerular filtration rate and serum potassium level did not change significantly. One child developed a cough that was believed to be related to ramipril. CONCLUSIONS: Ramipril is an effective and safe drug in children with chronic kidney diseases associated with hypertension, proteinuria, or both.

Adolescent↗
PubMedDate not supplied

Is sirolimus responsible for proteinuria?

Sirolimus (SRL) is suspected to induce proteinuria. We retrospectively studied proteinuria in a population of liver (n = 29) and kidney transplant (n = 30) recipients switched to SRL with progressive diminution or withdrawal of calcineurin inhibitors (CNI). We also observed estimated glomerular filtration rate (GFR), modification of treatment with antiproteinuric drugs, and changes in concentration of SRL. Collection of data started 3 months before SRL introduction at a mean follow-up of 21 months. Following SRL introduction, proteinuria was not detected in the 28 liver transplant patients, and was stable in the two others. In the kidney transplant group, proteinuria did not occur in 12 patients, remained stable in three, and was slightly increased in 14 (0.57 +/- 0.93 g/d vs 1.83 +/- 1.26 g/d). For all patients, eGFR remained stable; there was no difference in management of antiproteinuric drugs. As suspected, cyclosporin (CsA) and tacrolimus (FK) serum concentrations were decreased. We observed a significant correlation between the variation of proteinuria and the variation of serum concentration of CsA or FK (respectively, P = .001 and P = .007). On the other hand, we did not find any correlation between variation in proteinuria and concentration of SRL. This retrospective study suggests that in our cohort of liver transplant patients without previous renal damage, SRL did not provoke proteinuria. On the other hand, the slight aggravation of proteinuria in a subgroup of kidney transplant patients seems to be linked to the hemodynamic renal effects due to CNI withdrawal.

Colforsin↗
PubMed2001

The natural history of immunoglobulin a nephropathy among patients with hematuria and minimal proteinuria.

PURPOSE: To determine the natural history of immunoglobulin (Ig) A nephropathy among patients who presented with hematuria and minimal proteinuria, and factors associated with the development of adverse clinical events, such as proteinuria. SUBJECTS AND METHODS: In Hong Kong, all patients who present with isolated hematuria are referred for renal biopsy after urologic diseases are ruled out. We reviewed the clinical course of 72 consecutive patients with histologically confirmed IgA nephropathy who presented with hematuria and minimal proteinuria (0.4 g/day or less). All patients were normotensive and had normal renal function at presentation. Adverse events were defined as proteinuria greater than 1 g per day, hypertension, or impaired renal function (serum creatinine level 120 micromol/L or estimated creatinine clearance < 70 mL per minute). RESULTS: The mean (+/- SD) age at presentation was 27 +/- 8 years; 56 (78%) were female. Nine patients (13%) had grade 2 histologic lesions. During a median follow-up of 7 years, 32 patients (44%) developed adverse events: 24 (33%) developed proteinuria of 1 g per day or more, 19 (26%) became hypertensive, and 5 (7%) developed impaired renal function. Another 30 patients (42%) had persistently abnormal urinalysis examinations. Only 10 patients (14%) had complete resolution of hematuria. The median time for progression from proteinuria (> l g/day) to renal impairment was 84 months (range 56 to 132). In a multivariate analysis, age at presentation (relative risk [RR] per 10 years of age = 2.0; 95% confidence interval [CI], 1.2 to 3.4) and histologic grade (grade 2 versus grade 1, RR = 4.5; 95% CI, 1.7 to 12) were independent predictors of developing an adverse event. CONCLUSIONS: IgA nephropathy that presents with hematuria and minimal proteinuria is usually a progressive disease. Life-long follow-up with regular monitoring of blood pressure and proteinuria is recommended.

Adolescent↗
PubMed1990

Quantitation of proteinuria with urinary protein/creatinine ratios and random testing with dipsticks in nephrotic children.

We examined the relative feasibility of using random urinary dipstick testing and urinary protein/creatinine ratios in the quantitation of proteinuria. Sixty-four children with relapsing nephrotic syndrome, ranging in age from 1 1/2 to 16 years, contributed 145 timed urine collections and 150 random specimens, which were analyzed by urinary protein dipstick, quantitation of protein and creatinine, or both. Total protein excretion was expressed as grams per surface area per day and the urinary protein/creatinine ratio as milligrams of protein per milligram of creatinine. Degrees of proteinuria were designated as physiologic (less than 0.1 gm/m2/day), intermediate (greater than 0.1 and less than 1.0 gm/m2/day), or nephrotic (greater than 1.0 gm/m2/day). The log regression analysis of the 24-hour urinary protein/creatinine ratio (y) and total protein excretion (x) was highly significant (r = 0.97; p less than 0.001). The upper and lower confidence limits of the urinary protein/creatinine ratio (1.0 and 0.1, respectively) closely approximated the designations for nephrotic and physiologic proteinuria, respectively. These values were therefore used to classify degrees of proteinuria by the urine protein/creatinine ratio. The validity of these tests was assessed by sensitivity, specificity, and predictive value, and compared with that of random testing by urinary dipstick. The urinary protein/creatinine ratio offered good reliability as a test for classifying degrees of proteinuria and accurately predicting nephrotic and physiologic proteinuria. The random dipstick testing was reliable only when results were distinctly positive and when sensitivity and specificity were low. The error in the total protein excretion value that was imposed by collection errors with high and low variations in the creatinine value (57% of samples) was largely corrected by normalization of the data by log transformation. When controlled for creatinine excretion, linear regression analysis allowed calculation of total protein excretion (TP) from the urinary protein/creatinine ratio (U P/Cr) by the following equation: TP (gm/m2/day) = 0.63 (U P/Cr) at all levels of proteinuria. The random urinary protein/creatinine ratio appeared to offer the most sensitive test for classification of proteinuria in children with nephrosis, with the advantages of ease and expediency not afforded by the 24-hour urine quantitation.

Adolescent↗
PubMed2000

Renal disease in women with severe preeclampsia or gestational proteinuria.

OBJECTIVE: To identify women with severe preeclampsia or severe gestational proteinuria at high risk of having underlying renal disease. METHODS: Between 1980 and 1999, 86 Japanese women who had severe hypertension, severe proteinuria, or both during pregnancy had postpartum needle biopsies of their kidneys. Diagnoses before biopsies were severe preeclampsia in 74 women and severe gestational proteinuria in 12. We compared clinical characteristics, such as antepartum hematuria and postpartum proteinuria, and maternal and neonatal outcomes with regard to presence of renal disease. RESULTS: Nineteen of 86 women (22.1%, 95% confidence interval [CI] 13.9%, 32. 3%) were diagnosed with underlying renal disease. Immunoglobulin A nephropathy was present in 12. Women with renal disease had a significantly earlier onset of proteinuria than those without (median 11 versus 32 weeks' gestation, P <.001). Eighteen of 19 women with renal disease had proteinuria, hypertension, or both before 30 weeks' gestation. Ten of 12 women with severe gestational proteinuria (83.3%, 95% CI 51.6%, 97.9%) had underlying renal disease. Eight of the 19 women had antepartum hematuria, and seven had elevated serum immunoglobulin A levels. In women with severe preeclampsia, onset before 30 weeks' gestation was the best predictor of underlying renal disease (odds ratio 34.1, 95% CI 3.8, 304.5). Women with renal disease had lower rates of severe hypertension (nine of 19 versus 59 of 67, P <.01) and small-for-gestational-age infants (four of 19 versus 34 of 67, P <.05) than those without renal disease. CONCLUSION: Women who had gestational proteinuria or preeclampsia before 30 weeks' gestation were more likely to have had underlying renal disease.

Adult↗
PubMed2000

Evaluation of a simple, random urine test for prospective analysis of proteinuria in Type 2 diabetes: a six year follow-up study.

AIM: To assess the usefulness of an estimated proteinuria (EPE) using the protein to creatinine ratio (P/C ratio) in a random urine sample for follow-up evaluation of kidney function in diabetic patients. RESEARCH DESIGNS AND METHODS: 410 newly registered Type 2 diabetic patients had annual follow-up for 6 years (M:F 263:147). EPE was calculated by estimation of P/C ratio in random urine sample. Based on the EPE they were divided into those with normal protein excretion (<100 mg/dl), mild proteinuria (100 to <500 mg/dl) and nephropathy (persistent proteinuria >500mg/dl) cases. The study subjects were divided into 4 groups based on the proteinuria status at follow-up. Anthropometry, measurement of blood pressure and retinopathy were carried out for all study subjects. RESULTS: at the baseline, 342 (83.4%) had normal protein excretion, 53 (12.9%) had mild proteinuria and 15 (3.7%) had nephropathy. At the follow-up the respective numbers were 276 (67.3%), 64 (15.6%) and 70(17%). During the study period nephropathy developed in 55 (13.4%) and mild proteinuria in 11 (2.7%). Nephropathy developed in 32 (6.7%) subjects in the non-proteinuria group and in 23 (43.4%) of the mild proteinuric subjects. Conversion to nephropathy was greater in the latter group (chi(2)=41.6, P<0.0001). Nephropathy cases had higher duration of diabetes at the baseline (8.8+/-6.4 years) and at follow-up (7.1+/-6.0 years) and higher prevalence of hypertension when compared with non-proteinuric group (60 and 43.5% compared with 11.1%, P<0.01). New cases of hypertension were detected in 32.8% of proteinuric and 0.7% of normal protein excretion subjects (chi(2)=32. 24, P=0.0001). During the follow-up 55 of the 70 nephropathy subjects (78.6%) developed retinopathy compared with ten out of the 276 subjects with normal protein excretion (3.6%) (chi(2)=200.6, P=0. 0001). CONCLUSION: EPE is useful in serial evaluation of kidney function. The risk conferred by hypertension, mild proteinuria and duration of diabetes in producing nephropathy are also highlighted. EPE could be used in developing countries to assess the renal function on a follow-up basis.

Cholesterol↗