Association of renal hyperfiltration with incident proteinuria - A nationwide registry study

Lee, Seung Min; Park, Ju Young; Park, Min Su; Park, Jong Heon; Park, Minseon; Yoon, Hyung‐Jin

doi:10.1371/journal.pone.0195784

Cited by 9 publications

(5 citation statements)

References 41 publications

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“…Cox regression analysis after adjusting for possible confounding variables including age, sex, BMI, diabetes, hypertension, and so on showed that the relative risk of incident proteinuria during a median follow-up period of 46 months was 1.571-fold higher in the RHF group compared with that in the no RHF group. This is comparable with a recent report also showing an increased risk of incident proteinuria in an analysis of Korean Nationwide health screening data over 11,559,520 adults [15]. Interestingly, this association was only observed in male subjects.…”

Section: Discussionsupporting

confidence: 90%

Renal hyperfiltration as a risk factor for chronic kidney disease: A health checkup cohort study

Yang

Kim

et al. 2020

PLoS ONE

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Introduction Renal hyperfiltration (RHF) has been found to be an independent predictor of adverse cardiovascular outcome. However, it remains uncertain whether it is precursor of chronic kidney disease (CKD) in a healthy population. Materials and methods To determine relative risks and identify the predictor of incident proteinuria and decline of estimated glomerular filtration rate (eGFR) in subjects with RHF. A total of 55,992 subjects aged �20 years who underwent health checkup during 2004-2017 were included. Among them, 16,946 subjects who completed at least two health checkups were analyzed. Results A total of 949 (5.6%) subjects developed proteinuria and 98 (0.6%) subjects showed � 30% of eGFR decline. The risk of incident proteinuria was significantly higher in those with RHF (RR: 1.644; 95% CI: 1.064-2.541). Those with RHF showed 8.720 fold (95% CI: 4.205-18.081) increased risk for �30% decline. ESR, CRP, and monocyte count showed reversed J shaped curve according to the increase of eGFR. The adjusted mean of monocyte count was significantly higher in participants with eGFR �90ml/min/1.73m 2 or < 60ml/min/1.73m 2 compared to that in patients with eGFR 75-89ml/min/1.73m 2. Compared to subjects with the lowest tertile of monocyte and no RHF, those with the highest tertile of monocyte count in the RHF group had 3.314-fold (95% CI: 1.893-5.802) higher risk of incident proteinuria and 3.822-fold (95% CI, 1.327-11.006) risk of 30% eGFR decline. Conclusions RHF had significantly increased risk of developing proteinuria and CKD in healthy subjects. Higher monocyte count might be used as a predictor of CKD in subjects with RHF.

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Section: Discussionsupporting

confidence: 90%

Renal hyperfiltration as a risk factor for chronic kidney disease: A health checkup cohort study

Yang

Kim

et al. 2020

PLoS ONE

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“…Another important observation was the weak correlation between measured 24 h creatinine clearance and the estimated GFR using the 2021 CKD-EPI Creatinine (145 ± 44 mL/min vs. 104 ± 14 mL/min/1.73 m 2 ) in our patient population, which supports findings from recent studies suggesting this equation might underestimate GFR in patients with obesity [20]. As expected, both proteinuria and albuminuria were higher in patients with higher creatinine clearances [21,22]. Several factors have been shown to contribute to increased albumin excretion in patients with obesity [4,23,24].…”

Section: Discussionsupporting

confidence: 88%

Renal Dysfunction Phenotypes in Patients Undergoing Obesity Surgery

Pereira

Braga

et al. 2023

Biomolecules

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Obesity surgery candidates are at an increased risk of kidney injury, but pre-operative evaluation usually neglects kidney function assessment. This study aimed to identify renal dysfunction in candidates for bariatric surgery. To reduce the sources of bias, subjects with diabetes, prediabetes under metformin treatment, neoplastic or inflammatory diseases were excluded. Patients’ (n = 192) average body mass index was 41.7 ± 5.4 kg/m2. Among these, 51% (n = 94) had creatinine clearance over 140 mL/min, 22.4% (n = 43) had proteinuria over 150 mg/day and 14.6% (n = 28) albuminuria over 30 mg/day. A creatinine clearance higher than 140 mL/min was associated with higher levels of proteinuria and albuminuria. Univariate analysis identified sex, glycated hemoglobin, uric acid, HDL and VLDL cholesterol as being associated with albuminuria, but not with proteinuria. On multivariate analysis, glycated hemoglobin and creatinine clearance as continuous variables were significantly associated with albuminuria. In summary, in our patient population prediabetes, lipid abnormalities and hyperuricemia were associated with albuminuria, but not with proteinuria, suggesting different disease mechanisms might be implicated. Data suggest that in obesity-associated kidney disease, tubulointerstitial injury precedes glomerulopathy. A significant proportion of obesity surgery candidates present clinically relevant albuminuria and proteinuria along with renal hyperfiltration, suggesting that routine pre-operative assessment of these parameters should be considered.

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“…Laboratory analyses of these particular individuals also show increased total protein in 24-h-urine (> 200 mg/day), which agrees with the spectroscopy findings. The relationship between RHf and urinary albumin and protein excretion has been demonstrated in the literature 57 , 58 . Although the albumin excretion of all participants was in normal range (< 30 mg/day) in our study, it is observed that there is a statistically significant difference between those with or without RHf.…”

Section: Resultsmentioning

confidence: 93%

Urinalysis of individuals with renal hyperfiltration using ATR-FTIR spectroscopy

Kurultak

Sarıgül

Kodal

et al. 2022

Sci Rep

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Abnormal increased glomerular filtration rate (GFR), otherwise known as renal hyperfiltration (RHf), is associated with an increased risk of chronic kidney disease and cardiovascular mortality. Although it is not considered as a disease alone in medicine today, early detection of RHf is essential to reducing risk in a timely manner. However, detecting RHf is a challenge since it does not have a practical biochemical marker that can be followed or quantified. In this study, we tested the ability of ATR-FTIR spectroscopy to distinguish 17 individuals with RHf (hyperfiltraters; RHf (+)), from 20 who have normal GFR (normofiltraters; RHf(−)), using urine samples. Spectra collected from hyperfiltraters were significantly different from the control group at positions 1621, 1390, 1346, 933 and 783/cm. Intensity changes at these positions could be followed directly from the absorbance spectra without the need for pre-processing. They were tentatively attributed to urea, citrate, creatinine, phosphate groups, and uric acid, respectively. Using principal component analysis (PCA), major peaks of the second derivative forms for the classification of two groups were determined. Peaks at 1540, 1492, 1390, 1200, 1000 and 840/cm were significantly different between the two groups. Statistical analysis showed that the spectra of normofiltraters are similar; however, those of hyperfiltraters show diversity at multiple positions that can be observed both from the absorbance spectra and the second derivative profiles. This observation implies that RHf can simultaneously affect the excretion of many substances, and that a spectroscopic analysis of urine can be used as a rapid and non-invasive pre-screening tool.

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Association of renal hyperfiltration with incident proteinuria - A nationwide registry study

Cited by 9 publications

References 41 publications

Renal hyperfiltration as a risk factor for chronic kidney disease: A health checkup cohort study

Renal hyperfiltration as a risk factor for chronic kidney disease: A health checkup cohort study

Renal Dysfunction Phenotypes in Patients Undergoing Obesity Surgery

Urinalysis of individuals with renal hyperfiltration using ATR-FTIR spectroscopy

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