Transient Proteinuria in Emergency Medical Admissions

Reuben, David B.; Wachtel, Tom J.; Brown, Peter C.; Driscoll, James L.

doi:10.1056/nejm198204293061706

Cited by 39 publications

(14 citation statements)

References 6 publications

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“…This is understandable in the context of an acute illness, where some degree of proteinuria is frequently present [15], but in stable patients seen in a clinic, trace protein needs to be interpreted in the light of the recent emphasis on diagnosing renal disease at an early stage and preventing its progression [5, 16]. In our present study, conducted on a clinic population comprising a variety of patients but mostly referred for the evaluation of hypertension, we found that a trace protein reading from a randomly collected urine sample had a high predictability in diagnosing microalbuminuria as determined by radioimmunoassay.…”

Section: Discussionmentioning

confidence: 99%

The Significance of Trace Proteinuria

et al. 2003

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Background: The clinical significance of a trace protein reading on urinalysis is unclear, and such a result is often ignored by the clinician. Methods: We examined 185 samples of urine with trace proteinuria by both Chemstrips and sulfosalicylic acid testing, and compared the results with those of urinary albumin and total protein concentrations. Results: Taking for the purposes of this study an arbitrary upper limit of normal of 20 mg/l for albumin and 100 mg/l for total protein concentration, we found abnormal albumin excretion in 87% and abnormal total protein excretion in 88% of trace samples. In this study, a negative urinalysis for protein excluded microalbuminuria in 87% and proteinuria in 78% of cases. Conclusion: Qualitative testing for protein by urinalysis has a high sensitivity and specificity for diagnosing or ruling out microalbuminuria. Trace proteinuria usually means microalbuminuria; negative proteinuria tends to rule it out.

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Section: Discussionmentioning

confidence: 99%

The Significance of Trace Proteinuria

et al. 2003

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“…At least 2 studies have reported development of proteinuria during acute decompensated HF that was reversible after treatment. 17,38 However, well-designed prospective studies are required to assess the contributions of structural kidney disease, hemodynamic factors, and neurohormonal factors to the development of proteinuria in patients with HF.…”

Section: Proteinuria and Heart Failurementioning

confidence: 99%

Proteinuria, Chronic Kidney Disease, and the Effect of an Angiotensin Receptor Blocker in Addition to an Angiotensin-Converting Enzyme Inhibitor in Patients With Moderate to Severe Heart Failure

Anand

Bishu

Rector³

et al. 2009

Circulation

122

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Background— Chronic kidney disease (CKD) is an established risk factor for poor outcomes in heart failure (HF). Whether proteinuria provides additional prognostic information is not known. Renin-angiotensin blockade medications improve outcomes in HF but are underutilized in HF patients with renal dysfunction because of safety concerns and a lack of evidence of their effectiveness. Methods and Results— In the Valsartan in Heart Failure Trial (Val-HeFT), 5010 patients with class II, III, or IV heart failure were randomly assigned to receive valsartan or placebo. The 2 primary outcomes were death and first morbid event, defined as death, sudden death with resuscitation, hospitalization for HF, or administration of intravenous inotropic or vasodilator drugs for 4 hours or more without hospitalization. The study cohort was divided into subgroups according to the presence of CKD (estimated glomerular filtration rate <60 mL · min −1 · 1.73 m −2 ) and proteinuria (positive dipstick). Multivariable Cox proportional hazards regression models were used to examine the relationships between study outcomes and proteinuria, including its interaction with CKD. The interaction between valsartan and CKD was also tested. The effect of valsartan on estimated glomerular filtration rate was estimated by generalized linear models, including tests of interactions between treatment and CKD. At baseline, CKD was found in 58% and dipstick-positive proteinuria in 8% of patients. Dipstick-positive proteinuria was independently associated with mortality (hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.01 to 1.62, P =0.05) and first morbid event (HR 1.28, 95% CI 1.06 to 1.55, P =0.01). The increased risk of death associated with dipstick-positive proteinuria was similar for those with and without CKD (HR 1.26, 95% CI 0.96 to 1.66 versus HR 1.37, 95% CI 0.83 to 2.26; P =0.94), as was the hazard for first morbid event (HR 1.26, 95% CI 1.01 to 1.57 versus HR 1.42, 95% CI 0.98 to 2.07; P =0.71). Valsartan reduced estimated glomerular filtration rate compared with placebo to a similar extent ( P =0.52) in the subgroups with CKD (mean reduction −3.6 mL · min −1 · 1.73 m −2 ) and without CKD (mean reduction −4.0 mL · min −1 · 1.73 m −2 ) and by −3.8 mL · min −1 · 1.73 m −2 in both groups combined. The beneficial effect of valsartan on first morbid events was similar in those with and without CKD (HR 0.86, 95% CI 0.74 to 0.99 versus HR 0.91, 95% CI 0.73 to 1.12; P =0.23) and was significant in the subgroup with CKD. The effect of valsartan on mortality did not differ in patients with and without CKD (HR 1.01, 95% CI 0.85 to 1.20 versus HR 0.91, 95% CI 0.69 to 1.25; P =0.08). Conclusions— CKD was common and dipstick-positive proteinuria was infrequent in this sample of patients with HF. After controlling for other risk factors, including CKD, the relatively small subgroup with dipstick-positive proteinuria did have worse outcomes. Valsartan reduced the estimated glomerular filtration rate by the same amount in patients with and without CKD and reduced the risk of the first morbid event in patients with CKD, which suggests its beneficial effects in patients with HF and CKD.

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“…2 Protein analysis is more sensitive, 13 but microscopy is more specific for recognition of renal disease because proteinuria can result from many nonrenal causes. 14 ' 15 In addition, measurements of urinary proteins are subject to marked intraindividual variation. 16 Therefore, morphologic methods still are important in detection and follow-up of renal disease.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Sysmex UF-100 Urine Flow CytometervsChamber Counting of Supravitally Stained Specimens and Conventional Bacterial Cultures

et al. 1999

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A b s t r a c tWe evaluated the Sysmex UF-100 urine flow cytometer (TOA Medical Electronics, Kobe, Japan) The development of automated blood cell analyzers has prompted several attempts to produce similar devices for urinalysis. The first commercially available instruments were the Yellow IRIS (International Remote Imaging Systems, Chatsworth, CA) in the United States' and the Sysmex UA series (TOA Medical Electronics, Kobe, Japan) in Japan. 2Demands for a higher level of automation and satisfactory differentiation of specific urine particles have been the driving forces for improvement.We evaluated a second-generation urine flow cytometer, the Sysmex UF-100 (TOA Medical Electronics) by comparing its performance with chamber counting of Sternheimerstained noncentrifuged specimens and with conventional bacterial cultures on cystine-lactose-electrolyte-deficient (CLED) agar plates. Routine reflectometric test strip measurements and morphologic analyses based on the Finnish recommendations 3 were also performed for comparison. The characterization of formed elements with the UF-100 analyzer is based on flow cytometry of particles doublestained for DNA and membranes; particle identification involves measurement of forward-scattered light intensity and fluorescent light intensity, and the widths of these signals. Conductivity of the sample is measured before it enters the flow cell to adjust a constant electrical current in the flow cell for the impedance measurement. The final differentiation is accomplished with multiparametric algorithms (adaptive cluster analysis). A quantitative report is given for RBCs, WBCs, (large) epithelial cells, bacteria, and casts. Additional information flags are provided to indicate the presence of inclusional casts (granular or cellular casts),

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Transient Proteinuria in Emergency Medical Admissions

Cited by 39 publications

References 6 publications

The Significance of Trace Proteinuria

The Significance of Trace Proteinuria

Proteinuria, Chronic Kidney Disease, and the Effect of an Angiotensin Receptor Blocker in Addition to an Angiotensin-Converting Enzyme Inhibitor in Patients With Moderate to Severe Heart Failure

Evaluation of Sysmex UF-100 Urine Flow CytometervsChamber Counting of Supravitally Stained Specimens and Conventional Bacterial Cultures

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