Management of Glomerular Proteinuria

Wilmer, William A.; Rovin, Brad H.; Hébert, Caroline; Rao, Sunil V.; Kumor, Karen M.; Hebert, Lee A.

doi:10.1097/01.asn.0000100145.27188.33

Cited by 189 publications

(132 citation statements)

References 163 publications

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“…A ratio of 0.9:1.1 suggests a complete 24-hour urine collection because both estimated and measured creatinine clearances are roughly equal. 22 Although in many cases the timed urine collection is incomplete, measurement of UACR and UPCR from this urine collection is still helpful and may be more accurate than a spot urine specimen.…”

Section: Box 1 Patient Instructions For 24-hr Urine Collectionmentioning

confidence: 99%

Primary Care Approach to Proteinuria

Naderi

Reilly²

2008

The Journal of the American Board of Family Medicine

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Proteinuria is a common finding in primary care practice. Most adolescents who are diagnosed with proteinuria through screening urinalysis do not have renal disease, and the proteinuria will usually resolve on repeat testing. In contrast, proteinuria is suggestive of kidney disease in patients with diabetes mellitus, hypertension, primary renal disease, or other systemic illnesses. Quantification of proteinuria can be used longitudinally to monitor therapeutic effects of treatment of the underlying disease.

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Section: Box 1 Patient Instructions For 24-hr Urine Collectionmentioning

confidence: 99%

Primary Care Approach to Proteinuria

Naderi

Reilly²

2008

The Journal of the American Board of Family Medicine

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“…Moreover, the drug used and its dose also contribute to the clinical effectiveness of ACEIs. Although the benefits of ACEIs are believed to be a property of the drug class, differences exist between ACEIs that could influence their efficacy 30. In humans, it was suggested that using higher doses of ACEIs increases their antiproteinuric and renoprotective effects30 and this could also be the case in dogs.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Effects of a Therapeutic Renal Diet to Control Proteinuria in Proteinuric Non‐Azotemic Dogs Treated with Benazepril

Cortadellas

Talavera

Palacio

2013

Veterinary Internal Medicne

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BackgroundAngiotensin‐converting enzyme inhibitors (ACEIs) are currently used to control proteinuria in dogs with chronic kidney disease. Renal diets (RDs) have beneficial effects in the management of azotemic dogs, but its role in proteinuric non‐azotemic (PNAz) dogs has been poorly documented.HypothesisAdministration of a RD to PNAz dogs treated with benazepril (Be) improves proteinuria control compared with the administration of a maintenance diet (MD).AnimalsTwenty‐two PNAz (urine protein/creatinine ratio [UPC] >1) dogs.MethodsRandomized open label clinical trial design. Dogs were assigned to group‐MD (5.5 g protein/100 kcal ME)/Be or to group‐RD (3.7 g protein/100 kcal ME)/Be group during 60 days. Dogs with serum albumin (Alb) <2 g/dL received aspirin (1 mg/kg/12 hours). A physical examination, systolic blood pressure (SBP) measurement, complete blood count (CBC), biochemistry panel, urinalysis, and UPC were performed at day 0 (D0) and day 60 (D60).ResultsAt D0, there were no significant differences between groups in the evaluated variables. During the study, logUPC (geometric mean (95% CI) and SBP (mean±SD mmHg) significantly decreased (paired t‐test, P = 0.001) in Group‐RD (logUPCD0 = 3.16[1.9–5.25]; UPCD60 = 1.20 [0.59–2.45]; SBPD0 = 160 ± 17.2; SBPD60 = 151 ± 15.8), but not in Group‐MD (UPCD0 = 3.63[2.69–4.9]; UPCD60 = 2.14 [0.76–6.17]; SBPD0 = 158 ± 14.7; SBPD60 = 153 ± 11.5). However, RM‐ANOVA test did not confirm that changes were consequence of dietary modification. Weight and Alb concentration did not change significantly in any group.Conclusion and Clinical RelevanceThe administration of a RD to PNAz dogs treated with Be might help to control proteinuria and SBP compared with the administration of a MD, without inducing clinically detectable malnutrition, but more studies are warranted.

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“…There is considerable evidence that proteinuria itself is nephrotoxic, particularly nonselective proteinuria (reviewed in references [30,31]). In this study, we estimated the magnitude of nonselective proteinuria as P-C ratio Ϫ A-C ratio.…”

Section: Resultsmentioning

confidence: 99%

“…minuria to monitor SLE GN status is the substantially greater cost of the microalbumin assay compared with the proteinuria assay (30). In light of all of these concerns, we suggest that monitoring SLE GN by routine microalbuminuria assay is not warranted at this time.…”

Section: Figure 2 Relationship Between P-c Ratio and The Proportion mentioning

confidence: 99%

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Relationship between Albuminuria and Total Proteinuria in Systemic Lupus Erythematosus Nephritis

Birmingham¹,

Rovin²,

Shidham³

et al. 2008

Clinical Journal of the American Society of Nephrology

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Background and objectives: Albuminuria is regarded a sensitive measure of progression of glomerular disease. This study was undertaken in patients who had systemic lupus erythematosus glomerulonephritis (n ‫؍‬ 57) and were followed in the Ohio SLE Study to determine whether measuring albuminuria offered clinical advantages over that of total proteinuria. Design, setting, participants, & measurements: Twenty-four-hour urine collections (n ‫؍‬ 127) were obtained at baseline and annually for measurement of microalbumin, total protein, and creatinine.Results: There was a strong linear relationship between microalbumin-creatinine and protein-creatinine ratios over the entire range of protein-creatinine ratios; however, in the protein-creatinine ratio range 0.0 to 0.3, as the protein-creatinine ratio increased, the microalbumin-protein ratio increased much more than the protein-creatinine ratio. Also, the greater the protein-creatinine ratio, the greater was the evidence for nonselective proteinuria (protein-creatinine ratio ؊ microalbumincreatinine ratio).Conclusions: For the diagnosis of proteinuria renal flare, measuring albuminuria offers no advantage over measuring total proteinuria because changes in protein-creatinine and microalbumin-creatinine ratios are highly correlated over the designated ranges for systemic lupus erythematosus glomerulonephritis proteinuric flares. In those with normal-range proteinuria, subsequent changes in microalbumin-protein ratio might be a better forecaster of renal flare than changes in proteincreatinine or microalbumin-creatinine ratio. High protein-creatinine ratios are associated with evidence of nonselective proteinuria, which may increase the nephrotoxicity of proteinuria. Thus, using high-threshold criteria for systemic lupus erythematosus flare (allowing greater proteinuria increase before flare is declared) may expose the kidney to greater nephrotoxicity than using the low-threshold criteria for systemic lupus erythematosus flare.

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Management of Glomerular Proteinuria

Abstract: Abstract. It is widely accepted that proteinuria reduction is an appropriate therapeutic goal in chronic proteinuric kidney disease. Based on large randomized controlled clinical trials (RCT), ACE inhibitor (ACEI) and angiotensin receptor blocker (ARB)

Cited by 189 publications

References 163 publications

Primary Care Approach to Proteinuria

Primary Care Approach to Proteinuria

Evaluation of the Effects of a Therapeutic Renal Diet to Control Proteinuria in Proteinuric Non‐Azotemic Dogs Treated with Benazepril

Relationship between Albuminuria and Total Proteinuria in Systemic Lupus Erythematosus Nephritis

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