The Significance of Trace Proteinuria

Komatsu

et al. 2011

Tohoku J. Exp. Med.

Diabetes and chronic kidney disease (CKD) which are risk facters of cardiovascular disease, are increasing global public health problems. Microalbuminuria is an early sign of progressive cardiovascular and renal disease in individuals with or without diabetes. Screening for microalbuminuria and early treatment are recommended for patients with increased cardiovascular and renal risk factors. However, the procedure used to measure urinary albumin is expensive. Alternatively, the measurement of total urinary protein is simple and inexpensive. Thus, we aimed to establish a method that could predict the presence of microalbuminuria by measuring the total protein-to-creatinine ratio. Spot urine samples were obtained from 150 patients with diabetes mellitus, and the total protein-to-creatinine ratio and the albumin-to-creatinine ratio (ACR) were measured. There was a significant positive correlation between the protein-to-creatinine ratio and the ACR (r = 0.95). The presence of albuminuria (both micro-and macroalbuminuria) could be predicted from the value of the protein-to-creatinine ratio in more than 90% of patients. A receiveroperating characteristic curve analysis revealed that the protein-to-creatinine ratio had a sensitivity and a specificity of 90.8% and 91.9%, respectively, for the detection of albuminuria and a cutoff value of 0.091 g/g creatinine. These results suggest that screening for microalbuminuria can be replaced by the detection of the protein-to-creatinine ratio, which may be cost-effective for patients with cardiovascular risks as well as for the general population.

Section: Discussionsupporting

confidence: 77%

Establishment of a Method to Detect Microalbuminuria by Measuring the Total Urinary Protein-to-Creatinine Ratio in Diabetic Patients

Komatsu

et al. 2011

Tohoku J. Exp. Med.

“…Moreover, a survey undertaken in Okinawa after 17 years of follow-up indicates that individuals with dipstick-positive proteinuria are at increased risk of developing CKD, in fact in proportion to the severity of proteinuria [28]. Sam et al [29] have demonstrated that trace dipstick proteinuria usually means microalbuminuria. Indeed, in their survey, a negative urinalysis for proteinuria excluded microalbuminuria in 87% and proteinuria in 78% of cases.…”

Section: Discussionmentioning

confidence: 99%

Screening for Proteinuria and Chronic Kidney Disease Risk Factors in Kinshasa: A World Kidney Day 2007 Study

et al. 2008

Background: Although screening programs for chronic kidney disease (CKD) may be of great value, these programs are not yet implemented in the Democratic Republic of Congo. This study focused on proteinuria and examined its prevalence in terms of the number needed to screen for the different risk factors of CKD. Such knowledge would guide the utility of population screening to prevent end-stage renal disease. Methods: A cross-sectional survey was conducted in Kinshasa on the Second World Kidney Day. A sample of 3,018 subjects was interviewed and the following measurements were performed: blood pressure, body mass index, glycemia and urine protein. Logistic regression analysis was used to identify determinants of proteinuria. Results: The prevalence of proteinuria was 17.1% (95% CI 15.8–18.6). Other CKD risk factors identified were: hypertension, diabetes mellitus, obesity and metabolic syndrome. To identify 1 case of proteinuria, one would need to screen 4 persons with diabetes, 5 persons with hypertension, 4 subjects having metabolic syndrome, 5 persons aged ≥72 years and 9 persons without any of the conditions mentioned above. Age, overweight and diabetes were the strongest factors associated with proteinuria. Conclusions: This study indicates that proteinuria and traditional risk factors for CKD are very prevalent in Kinshasa. Realistic policies to stem these conditions should be a public health priority.

Journal of the American Society of Nephrology

“…A related issue is that determination of proteinuria was based on a single random dipstick urinalysis rather than repeated quantitative measures such as urinary albumin to creatinine ratio. Because we did not have information on microalbuminuria, we used trace (rather than 1ϩ) proteinuria to define CKD in patients with mildly reduced GFR, recognizing that this probably increased sensitivity for earlier forms of diabetic nephropathy while reducing specificity for other types of CKD (35,36). For these reasons, some patients may have been misclassified with respect to CKD status.…”

Section: Discussionmentioning

confidence: 99%

Effect of Pravastatin in People with Diabetes and Chronic Kidney Disease

Tonelli¹,

Keech²,

Shepherd³

et al. 2005

153

Although diabetes is a major cause of chronic kidney disease (CKD), limited data describe the cardiovascular benefit of hydroxymethyl glutaryl CoA reductase inhibitors (statins) in people with both of these conditions. This study sought to determine whether pravastatin reduced the incidence of first or recurrent cardiovascular events in people with non-dialysisdependent CKD and concomitant diabetes, using data from three randomized trials of pravastatin 40 mg daily versus placebo. CKD was defined by estimated GFR <60 or 60 to 89.9 ml/min per 1.73 m 2 with proteinuria. Of 19,737 patients, 4099 (20.8%) had CKD but not diabetes at baseline, 873 (4.4%) had diabetes but not CKD, and 571 (2.9%) had both conditions. The primary composite outcome was time to myocardial infarction, coronary death, or percutaneous/surgical coronary revascularization. Median follow-up was 64 mo. After adjustment for trial and random treatment assignment, the incidence of the primary outcome was lowest in individuals with neither CKD nor diabetes (15.2%), intermediate in individuals with only CKD (18.6%) or only diabetes (21.3%), and highest in individuals with both characteristics (27.0%). Pravastatin reduced the relative likelihood of the primary outcome to a similar extent in subgroups defined by the presence or absence of CKD and diabetes. For example, pravastatin was associated with a significant reduction in the relative risk of the primary outcome by 25% in patients with CKD and concomitant diabetes and by 24% in individuals with neither characteristic. However, the absolute reduction in the risk of the primary outcome as a result of pravastatin use was highest in patients with both CKD and diabetes (6.4%) and lowest in individuals with neither characteristic (3.5%). In conclusion, stage 2 or early stage 3 CKD and diabetes both are associated with higher cardiovascular risk, and pravastatin reduces cardiovascular event rates in people with neither, one, or both characteristics. Given the high absolute benefit of pravastatin in patient with diabetes and stage 2 or early stage 3 CKD, this population in particular should be targeted for widespread use of statins. Additional studies are needed to determine whether these benefits apply to patients with more severe CKD, and recruitment to such studies should be given high priority.