Albuminuria, Proteinuria, and Urinary Albumin to Protein Ratio in Chronic Kidney Disease

Wu, Men-Tai; Lam, King-Kwan; Lee, Wen‐Chin; Hsu, Kao-Tai; Wu, Chien-Hsing; Cheng, Ben-Chung; Ng, Hwee-Yeong; Chi, Po-Jui; Lee, Yueh‐Ting; Lee, Chien-Te

doi:10.1002/jcla.21487

Cited by 41 publications

(40 citation statements)

References 21 publications

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“…In contrast, another study reported that PCR was more sensitive (compared with ACR) as a screening test when proteinuria was <0.5 g/d and <1.0 g/d. (20) Consistent with our findings, many studies among CKD and non-CKD populations have shown strong correlations between ACR and PCR (14, 17–19). Yet, the recently published KDIGO guidelines strongly advocate for measurement of ACR (over PCR), partly due to limitations in measurement of PCR including substantial sample-to-sample variations in the quantity and composition of proteins and between-laboratory variations (10).…”

Section: Discussionsupporting

confidence: 91%

“…Some studies have found albuminuria to be superior (13), some have shown total proteinuria to be better (14), while still others have found both measures to be equivalent predictors of outcomes such as end-stage renal disease (ESRD) and mortality (15, 16). Additionally, while some studies among CKD and non-CKD populations have shown strong correlations between albuminuria and total proteinuria (14, 17–19), others have not (20). …”

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confidence: 99%

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Comparison of Associations of Urine Protein-Creatinine Ratio Versus Albumin-Creatinine Ratio With Complications of CKD: A Cross-sectional Analysis

Fisher

Hsu

Vittinghoff

et al. 2013

American Journal of Kidney Diseases

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Background Urine albumin-creatinine ratio (ACR) and protein-creatinine ratio (PCR) are important markers of kidney damage and are utilized for prognosis in persons with chronic kidney disease (CKD). Despite how commonly these measurements are done in clinical practice, relatively few studies have directly compared the performance of these two measures with regard to associations with clinical outcomes, which may inform clinicians about which measure of urinary protein excretion is best. We studied the association of ACR and PCR with common complications of CKD. Study Design Cross-sectional study. Setting & Participants 3,481 participants with CKD in the Chronic Renal Insufficiency Cohort (CRIC) study. Predictors ACR and PCR. Outcomes We examined the association between ACR and PCR with measures of common CKD complications: serum hemoglobin, bicarbonate, parathyroid hormone, phosphorus, potassium and albumin. Measurements Restricted cubic spline analyses adjusted for estimated glomerular filtration rate (eGFR; calculated by the MDRD [Modification of Diet in Renal Disease] Study Equation) were performed to study the continuous association with our predictors with each outcome. Results Mean eGFR was 43 ± 13 (SD) ml/min/1.73 m2 and median levels of PCR and ACR were 140 and 46 mg/g, respectively. In continuous analyses adjusted for eGFR, higher ACR and PCR were comparable and both were associated with lower levels of serum hemoglobin, bicarbonate, and albumin and higher levels of parathyroid hormone, phosphorus, and potassium. Across all outcomes, the associations of ACR and PCR were comparable with only small, absolute differences in the outcome measure. Similar associations were seen in patients with diabetes mellitus. Limitations Participants largely had moderate CKD with low levels of ACR and PCR, so results may not be generalizable to all CKD populations. Conclusions In persons with CKD, ACR and PCR are relatively comparable in their associations with common complications of CKD. Thus routine measurement of PCR may provide similar information as ACR in managing immediate complications of CKD.

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

Comparison of Associations of Urine Protein-Creatinine Ratio Versus Albumin-Creatinine Ratio With Complications of CKD: A Cross-sectional Analysis

Fisher

Hsu

Vittinghoff

et al. 2013

American Journal of Kidney Diseases

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“…We used only a dipstick test to measure proteinuria. Twenty-four hour urine collections should be used to measure its constituents and albumin-to-creatinine ratios to quantify proteinuria better, confirm its prevalence,31 verify the prognostic importance and determine its incidence.…”

Section: Discussionmentioning

confidence: 99%

Proteinuria as a Risk Factor for Mortality in Patients with Colorectal Cancer

et al. 2013

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PurposeWe investigated the effects of proteinuria and renal insufficiency on all-cause mortality in patients with colorectal cancer, with special emphasis on cancer staging and cancer-related deaths.Materials and MethodsWe retrospectively studied a cohort of patients with colorectal cancer. In protocol 1, patients were classified into four groups based on the operability of cancer and proteinuria: group 1, early-stage cancer patients (colorectal cancer stage ≤3) without proteinuria; group 2, early-stage cancer patients with proteinuria; group 3, advanced-stage cancer patients without proteinuria (colorectal cancer stage=4); and group 4, advanced-stage cancer patients with proteinuria. In protocol 2, patients were classified into four similar groups based on cancer staging and renal insufficiency (eGFR <60 mL/min/1.73 m2). Between January 1, 1998 and December 31, 2009, 3379 patients were enrolled in this cohort and followed until May 1, 2012 or until death.ResultsThe number of patients with proteinuria was 495 (14.6%). The prevalence of proteinuria was higher in advanced-stage cancer (n=151, 22.3%) than in early-stage cancer patients (n=344, 12.7%). After adjusting for age, gender and other clinical variables, the proteinuric, early-stage cancer group was shown to be associated with an adjusted hazard ratio of 1.67 and a 95% confidence interval of 1.38-2.01, compared with non-proteinuric early-stage cancer patients. However, renal insufficiency was not associated with colorectal cancer mortality.ConclusionProteinuria is an important risk factor for cancer mortality, especially in relatively early colorectal cancer.

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“…1-3 Recent analysis revealed that much of continuing increase in number of patients with CKD is seen in obese hypertensive patients. 4 Various animal models have been employed to gain more insight into the pathogenesis of CKD associated with obesity hypertension. One of the validated models is the obese Zucker rat (OZR).…”

Section: Introductionmentioning

confidence: 99%

Angiotensin II Type 2–Receptor Agonist C21 Reduces Proteinuria and Oxidative Stress in Kidney of High-Salt–Fed Obese Zucker Rats

2016

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Oxidative and nitrosative stress have been implicated in high sodium diet (HSD)-related hypertensive renal injury. In the present study we investigated AT2R-mediated renoprotection in obese Zucker rats fed HSD. Obese Zucker rats were fed normal sodium-diet (NSD) or HSD 4%, for 14 days, with/without AT2R agonist C21, delivered subcutaneously via osmotic pump, 1 mg/kg/day. Compared to NSD controls, HSD rats exhibited increase in cortical NADPH oxidase activity, urinary H2O2 and 8-isoprostanes, which were associated with severe glomerulosclerosis, interstitial fibrosis, decline in estimated glomerular filtration rate (eGFR), and an increase in urinary leak and activity of N-acetyl-β-D-glucosaminidase, a lysosomal enzyme and a marker of tubular damage. These changes were improved by C21 treatment. Cortical expression of endothelial nitric oxide synthase (eNOS), p-eNOS (Ser1177) and plasma nitrites were reduced after HSD intake while nitrosative stress (3-nitrotyrosine) and enzymatic defense (superoxide dismutase-to-catalase activity) remained unaltered. Albeit, C21 preserved plasma nitrites in HSD-fed OZR. C21 treatment reduced protein-to-creatinine (uPcr), albumin-to-creatinine (uAcr) as well as fractional excretion of protein (FEpro) and albumin (FEalb) in HSD-fed OZR, which is independent of changes in protein recycling receptors, megalin and cubilin. HSD intake also altered renal excretory and reabsorptive capacity as evident by elevated plasma urea nitrogen-to-creatinine (UN-to-cr) and fractional excretion of urea nitrogen (FEUN), and reduced urine-to-plasma creatinine (UPcr), which were modestly, but insignificantly, improved by C21 treatment. Together results demonstrate that AT2R activation protects against HSD-induced kidney damage in obesity plausibly by reducing NOX activity and rescuing nitrites.

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Albuminuria, Proteinuria, and Urinary Albumin to Protein Ratio in Chronic Kidney Disease

Abstract: There was a significant association between UACR and UPCR in patients with CKD. Characteristics of patients, renal function, and co-morbidities all affected UACR, UPCR, and UAPR.

Cited by 41 publications

References 21 publications

Comparison of Associations of Urine Protein-Creatinine Ratio Versus Albumin-Creatinine Ratio With Complications of CKD: A Cross-sectional Analysis

Comparison of Associations of Urine Protein-Creatinine Ratio Versus Albumin-Creatinine Ratio With Complications of CKD: A Cross-sectional Analysis

Proteinuria as a Risk Factor for Mortality in Patients with Colorectal Cancer

Angiotensin II Type 2–Receptor Agonist C21 Reduces Proteinuria and Oxidative Stress in Kidney of High-Salt–Fed Obese Zucker Rats

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