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Journal of the American Medical... May 2023Screening for chronic kidney disease (CKD) requires an estimated glomerular filtration rate (eGFR, mL/min/1.73 m2) from a blood sample and a proteinuria level from a...
OBJECTIVE
Screening for chronic kidney disease (CKD) requires an estimated glomerular filtration rate (eGFR, mL/min/1.73 m2) from a blood sample and a proteinuria level from a urinalysis. We developed machine-learning models to detect CKD without blood collection, predicting an eGFR less than 60 (eGFR60 model) or 45 (eGFR45 model) using a urine dipstick test.
MATERIALS AND METHODS
The electronic health record data (n = 220 018) obtained from university hospitals were used for XGBoost-derived model construction. The model variables were age, sex, and 10 measurements from the urine dipstick test. The models were validated using health checkup center data (n = 74 380) and nationwide public data (KNHANES data, n = 62 945) for the general population in Korea.
RESULTS
The models comprised 7 features, including age, sex, and 5 urine dipstick measurements (protein, blood, glucose, pH, and specific gravity). The internal and external areas under the curve (AUCs) of the eGFR60 model were 0.90 or higher, and a higher AUC for the eGFR45 model was obtained. For the eGFR60 model on KNHANES data, the sensitivity was 0.93 or 0.80, and the specificity was 0.86 or 0.85 in ages less than 65 with proteinuria (nondiabetes or diabetes, respectively). Nonproteinuric CKD could be detected in nondiabetic patients under the age of 65 with a sensitivity of 0.88 and specificity of 0.71.
DISCUSSION AND CONCLUSIONS
The model performance differed across subgroups by age, proteinuria, and diabetes. The CKD progression risk can be assessed with the eGFR models using the levels of eGFR decrease and proteinuria. The machine-learning-enhanced urine-dipstick test can become a point-of-care test to promote public health by screening CKD and ranking its risk of progression.
Topics: Humans; Creatinine; Urinalysis; Proteinuria; Renal Insufficiency, Chronic; Glomerular Filtration Rate; Diabetes Mellitus
PubMed: 37027837
DOI: 10.1093/jamia/ocad051 -
The Journal of International Medical... Apr 2020To evaluate the association between proteinuria and maternal and neonatal outcomes in pregnant women with pre-eclampsia. (Observational Study)
Observational Study
OBJECTIVES
To evaluate the association between proteinuria and maternal and neonatal outcomes in pregnant women with pre-eclampsia.
METHODS
This retrospective study included patients beyond 20 weeks of gestation diagnosed with pre-eclampsia, who were admitted to Suzhou Municipal Hospital between December 2013 and December 2015. Demographic and clinical data were extracted from clinical records, including age, body mass index, newborn weight and Apgar score. Pre-eclampsia risk factors and perinatal outcomes were analysed.
RESULTS
A total of 407 patients were enrolled, of whom, 402 with pre-eclampsia were included in the final analyses, divided into two groups: patients with proteinuria ( = 364 [90.55%]) and patients without proteinuria ( = 38 [9.45%]). Newborn 5-min Apgar scores were statistically lower in the proteinuria group versus the group without proteinuria (9.77 versus 9.95). Compared with patients without proteinuria, patients with proteinuria had a significantly higher rate of births before 37 weeks of gestation (50.80% versus 31.60%), but the incidence of preterm membrane rupture was significantly lower (3.8% versus 13.2%).
CONCLUSION
Proteinuria may be associated with adverse maternal and neonatal outcomes in cases of pre-eclampsia.
Topics: Adult; Apgar Score; Body Mass Index; Female; Humans; Infant, Newborn; Middle Aged; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Proteinuria; Retrospective Studies; Risk Factors
PubMed: 32339047
DOI: 10.1177/0300060520908114 -
Pediatric Nephrology (Berlin, Germany) Apr 2023Cubilin is one of the receptor proteins responsible for reabsorption of albumin in proximal tubules and is encoded by the CUBN gene. We aimed to evaluate clinical and...
BACKGROUND
Cubilin is one of the receptor proteins responsible for reabsorption of albumin in proximal tubules and is encoded by the CUBN gene. We aimed to evaluate clinical and genetic characterization of six patients with proteinuria who had CUBN mutations.
METHODS
Patients' characteristics, serum creatinine, albumin, vitamin B levels, urine analysis, spot urine protein/creatinine, microalbumin/creatinine, beta-2 microglobulin/creatinine ratios, estimated glomerular filtration rates (eGFR), treatments, kidney biopsies, and genetic analyses were evaluated.
RESULTS
Six patients (2 female, 4 male) with an incidental finding of proteinuria were evaluated. Mean admission age and follow-up time were 7.3 ± 2.9 and 6.5 ± 5.6 years, respectively. Serum albumin, creatinine, and eGFR were normal; urine analysis revealed no hematuria, and C3, C4, ANA, and anti-DNA were negative; kidney ultrasonography was normal for all patients. Urine protein/creatinine was 0.9 ± 0.3 mg/mg, and microalbumin was high in all patients. Serum vitamin B was low in two patients and normal in four. Kidney biopsy was performed in four patients, three demonstrated normal light microscopy, and there was one focal segmental glomerulosclerosis (FSGS). Genetic tests revealed four homozygous and two compound heterozygous mutations in the C-terminal part of cubilin. All patients had normal eGFR and still had non-nephrotic range proteinuria at last visit.
CONCLUSIONS
CUBN gene mutations should be considered in patients with isolated non-nephrotic range proteinuria and normal kidney function. Diagnosing these patients, who are thought to have a better prognosis, is important in terms of avoiding unnecessary treatment and predicting prognosis. CUBN gene mutations may also present as FSGS which extends the spectrum of renal manifestation of these patients. A higher resolution version of the Graphical abstract is available as Supplementary information.
Topics: Humans; Male; Child; Female; Glomerulosclerosis, Focal Segmental; Creatinine; Proteinuria; Receptors, Cell Surface; Albumins; Vitamins
PubMed: 36112210
DOI: 10.1007/s00467-022-05730-y -
Nutrients Mar 2023Previous cohort studies have reported conflicting associations between alcohol consumption and chronic kidney disease, characterized by proteinuria and low glomerular... (Meta-Analysis)
Meta-Analysis Review
A Dose-Dependent Association between Alcohol Consumption and Incidence of Proteinuria and Low Glomerular Filtration Rate: A Systematic Review and Meta-Analysis of Cohort Studies.
Previous cohort studies have reported conflicting associations between alcohol consumption and chronic kidney disease, characterized by proteinuria and low glomerular filtration rate (GFR). This systematic review, which included 14,634,940 participants from 11 cohort studies, assessed a dose-dependent association of alcohol consumption and incidence of proteinuria and low estimated GFR (eGFR) of <60 mL/min/1.73 m. Compared with non-drinkers, the incidence of proteinuria was lower in drinkers with alcohol consumption of ≤12.0 g/day (relative risk 0.87 [95% confidence interval 0.83, 0.92]), but higher in drinkers with alcohol consumption of 36.1-60.0 g/day (1.09 [1.03, 1.15]), suggesting a J-shaped association between alcohol consumption and the incidence of proteinuria. Incidence of low eGFR was lower in drinkers with alcohol consumption of ≤12.0 and 12.1-36.0 than in non-drinkers (≤12.0, 12.1-36.0, and 36.1-60.0 g/day: 0.93 [0.90, 0.95], 0.82 [0.78, 0.86], and 0.89 [0.77, 1.03], respectively), suggesting that drinkers were at lower risk of low eGFR. In conclusion, compared with non-drinkers, mild drinkers were at lower risk of proteinuria and low eGFR, whereas heavy drinkers had a higher risk of proteinuria but a lower risk of low eGFR. The clinical impact of high alcohol consumption should be assessed in well-designed studies.
Topics: Humans; Glomerular Filtration Rate; Incidence; Risk Factors; Alcohol Drinking; Cohort Studies; Proteinuria
PubMed: 37049433
DOI: 10.3390/nu15071592 -
Pediatric Nephrology (Berlin, Germany) Feb 2024Proteinuria remission is the most significant predictive factor for kidney outcome in childhood IgA nephropathy (c-IgAN). Even if proteinuria remission can be obtained,...
BACKGROUND
Proteinuria remission is the most significant predictive factor for kidney outcome in childhood IgA nephropathy (c-IgAN). Even if proteinuria remission can be obtained, some patients have recurrence of proteinuria in the long-term.
METHODS
This is a retrospective analysis of 312 cases of proteinuria remission among 538 consecutive children with biopsy-proven IgAN from 1976 to 2013. To elucidate the incidence and factors related to recurrence of proteinuria in c-IgAN, we compare clinical and pathological findings between patients with and without recurrence of proteinuria.
RESULTS
Among 312 patients with remission of proteinuria, 91 (29.2%) had recurrence of proteinuria within the observation period (median 8 years). Using a multivariate Cox regression analysis, significant factors associated with recurrence of proteinuria were onset age (HR 1.13 [95%CI: 1.05-1.22], P = 0.002) and presence of hematuria after proteinuria remission (HR 2.11 [95%CI: 1.30-3.45], P = 0.003). The Kaplan-Meier analysis showed significant differences in CKD G3a-G5-free survival between the patients with no-recurrence of proteinuria, recurrence of proteinuria and non-proteinuria remission (P < 0.0001, log-rank test). Kidney survival was 100% in no-recurrence of proteinuria, 92.2% in recurrence of proteinuria, and 65.6% in non-proteinuria remission at 15 years. Cox analyses adjusted by proteinuria remission showed that recurrence of proteinuria (HR 03.10e [95%CI: NA], P = 0.003) was a significant factor associated with progression to CKD G3a-G5 in all patients with c-IgAN.
CONCLUSIONS
Approximately 30% of patients with proteinuria remission had recurrence of proteinuria regardless of treatment. Both remission and recurrence of proteinuria are significant prognostic factors for kidney outcome. A higher resolution version of the Graphical abstract is available as Supplementary information.
Topics: Child; Humans; Glomerulonephritis, IGA; Retrospective Studies; Immunoglobulin A; Proteinuria; Kidney Failure, Chronic
PubMed: 37594578
DOI: 10.1007/s00467-023-06116-4 -
Human Psychopharmacology Mar 2022The aim of this study was to investigate the effect of lithium treatment on renal function and to determine influencing factors. In addition, the utility of spot urine...
OBJECTIVE
The aim of this study was to investigate the effect of lithium treatment on renal function and to determine influencing factors. In addition, the utility of spot urine protein/creatinine ratio in detection of lithium induced nephropathy was also investigated.
METHODS
Serum concentrations of lithium, blood urea nitrogen (BUN), creatinine, estimated glomerular filtration rate (eGFR), and urinalysis including protein/creatinine ratio were measured in 375 patients using lithium.
RESULTS
Patients taking lithium for ≥8 years had higher BUN, creatinine levels, percentage of proteinuria, percentages of stage 2 and 3 chronic kidney disease (CKD); lower urine density and eGFR compared to patients taking lithium <8 years. Urine density was lower in groups with >0.8 and 0.6-0.8 mmol/L lithium level than <0.6 mmol/L. Predictors of CKD were serum level of lithium, dose of lithium, cumulative duration of lithium use, age at onset of illness, and caffeine consumption.
CONCLUSIONS
Detrimental effects of lithium on renal functions were detected after lithium use for ≥8 years. Proteinuria measured by spot urine protein/creatinine ratio can be detected even when eGFR is >90 ml/min/1.73 m . Spot urine protein/creatinine ratio, which is a cost-effective and practical laboratory test, can be used to monitor lithium-treated patients.
Topics: Creatinine; Glomerular Filtration Rate; Humans; Kidney; Lithium Compounds; Proteinuria
PubMed: 34541707
DOI: 10.1002/hup.2812 -
The Pediatric Infectious Disease Journal Mar 2024We aimed to determine the prevalence and severity of glomerular and tubular renal dysfunction by means of urinalysis in infants and toddlers with congenital...
BACKGROUND
We aimed to determine the prevalence and severity of glomerular and tubular renal dysfunction by means of urinalysis in infants and toddlers with congenital cytomegalovirus infection (cCMV) and their association with cCMV disease, viruria and antiviral treatment.
METHODS
This cross-sectional study was done using the Spanish Registry of Congenital Cytomegalovirus Infection. First-morning urine samples were collected from January 2016 to December 2018 from patients <5 years old enrolled in Spanish Registry of Congenital Cytomegalovirus Infection. Samples were excluded in case of fever or other signs or symptoms consistent with acute infection, bacteriuria or bacterial growth in urine culture. Urinary protein/creatinine and albumin/creatinine ratios, urinary beta-2-microglobulin levels, hematuria and CMV viruria were determined. A 0.4 cutoff in the urinary albumin/protein ratio was used to define tubular (<0.4) or glomerular (>0.4) proteinuria. Signs and symptoms of cCMV at birth, the use of antivirals and cCMV-associated sequelae at last available follow-up were obtained from Spanish Registry of Congenital Cytomegalovirus Infection.
RESULTS
Seventy-seven patients (37 females, 48.1%; median [interquartile range] age: 14.0 [4.4-36.2] months) were included. Symptom-free elevated urinary protein/creatinine and albumin/creatinine ratios were observed in 37.5% and 41.9% of patients, respectively, with tubular proteinuria prevailing (88.3%) over glomerular proteinuria (11.6%). Proteinuria in the nephrotic range was not observed in any patients. In multivariate analysis, female gender was the only risk factor for tubular proteinuria (adjusted odds ratio = 3.339, 95% confidence interval: 1.086-10.268; P = 0.035). cCMV disease at birth, long-term sequelae, viruria or the use of antivirals were not associated with urinalysis findings.
CONCLUSIONS
Mild nonsymptomatic tubular proteinuria affects approximately 40% of infants and toddlers with mostly symptomatic cCMV in the first 5 years of life.
Topics: Infant, Newborn; Infant; Humans; Female; Adolescent; Child, Preschool; Cross-Sectional Studies; Cytomegalovirus; Creatinine; Cytomegalovirus Infections; Proteinuria; Antiviral Agents; Kidney; Albumins
PubMed: 38063508
DOI: 10.1097/INF.0000000000004176 -
Giornale Italiano Di Nefrologia :... Jun 2021Proteinuria is a well-known marker of renal damage and, at the same time, an important factor in the progression of chronic kidney disease itself. The scientific... (Review)
Review
Proteinuria is a well-known marker of renal damage and, at the same time, an important factor in the progression of chronic kidney disease itself. The scientific community has always sought to investigate and provide answers on how nutritional therapy can influence and modify proteinuria and therefore limit its impact on progression to end-stage renal disease. However, despite the importance of the topic, the studies rarely take the form of randomized and controlled trials; in any case, they are often limited to protein intake only, conducted on very heterogeneous populations and, finally, they rarely indicate the precise values of proteinuria. The aim of this work is to explore the different nutritional approaches and their implications in the pathological conditions associated with proteinuria.
Topics: Biomarkers; Disease Progression; Humans; Kidney; Kidney Failure, Chronic; Proteinuria; Renal Insufficiency, Chronic
PubMed: 34169693
DOI: No ID Found -
Transplantation Proceedings Jun 2022Living donor kidney transplant represents the best treatment option for patients with end-stage kidney disease; however, it has been associated with possible risks to...
BACKGROUND
Living donor kidney transplant represents the best treatment option for patients with end-stage kidney disease; however, it has been associated with possible risks to the donor. Our aim was to evaluate the impact of kidney donation in the donor's estimated glomerular filtration rate (eGFR), blood pressure, and proteinuria and related risk factors.
PATIENTS AND METHODS
A single-center, retrospective study, including all living donors who underwent nephrectomy between January 2000 and December 2019, was performed. Demographic, clinical, and laboratory data were collected. Risk factors for a decrease in eGFR >30 mL/min/1.73 m one year after donation were assessed.
RESULTS
Eighty-six donors were included with a mean age of 46.7 ± 9.07 years. The mean follow-up was 105.6 ± 65.4 months, and 35 patients (41%) had more than 10 years of follow-up. No significant difference was found in proteinuria or body mass index (P > .1) before and after the donation. The prevalence of hypertension was higher after kidney donation (9.3% vs 22.1%; P < .001). A mean reduction in the eGFR in the first year of 37 ± 12 mL/min/1.73 m, followed by stabilization in the following years, was observed. The only variable that was significantly associated with a decline in GFR >30 mL/min/1.73 m was a lower predonation eGFR, with a cutoff value established at 100 mL/min/1.73 m for our sample.
DISCUSSION
Living donor nephrectomy appears to be an acceptably safe intervention. Predonation eGFR influences the adaptative response after nephrectomy; however, other variables did not have an impact on long-term outcome in our population.
Topics: Adult; Glomerular Filtration Rate; Humans; Kidney; Living Donors; Middle Aged; Nephrectomy; Proteinuria; Retrospective Studies
PubMed: 35599204
DOI: 10.1016/j.transproceed.2022.04.009 -
The Journal of Clinical Endocrinology... Jan 2021Hypothyroidism is associated with reversible decline in kidney function as measured by estimated glomerular filtration rate (eGFR). eGFR and proteinuria are the most... (Observational Study)
Observational Study
CONTEXT
Hypothyroidism is associated with reversible decline in kidney function as measured by estimated glomerular filtration rate (eGFR). eGFR and proteinuria are the most important markers for clinical assessment of kidney function. Though hypothyroidism is associated with proteinuria in cross-sectional data, the impact of treatment on proteinuria is unknown.
OBJECTIVE
This study explores the effect of thyroid hormone replacement therapy on eGFR and 24-hour urine protein excretion in patients with severe primary hypothyroidism.
DESIGN AND PARTICIPANTS
This study was a prospective, observational cohort study in adults with severe primary hypothyroidism (serum thyrotropin [TSH] > 50 µIU/mL). Individuals with preexisting or past kidney disease, kidney or urinary tract abnormalities, calculi or surgery, diabetes mellitus, or hypertension were excluded. The participants received thyroid hormone replacement therapy. Thyroid functions, eGFR, 24-hour urine protein excretion, and biochemical parameters were measured at baseline and 3 months.
SETTING
This study took place at a single center, a tertiary care referral and teaching hospital.
RESULTS
Of 44 enrolled participants, 43 completed 3 months of follow-up. At 3 months, serum TSH levels decreased and thyroxine levels increased (P < .001 for both). Significant increases in eGFR (mean difference, 18.25 ± 19.49 mL/min/1.73 m2; 95% CI, 12.25 to 24.25, P < .001) and declines in 24-hour urine protein excretion (mean difference, -68.39 ± 125.89 mg/day; 95% CI, -107.14 to -29.65, P = .001) were observed. Serum cholesterol and low-density lipoprotein levels also significantly decreased (P < .001).
CONCLUSIONS
Thyroid hormone replacement therapy in patients with severe primary hypothyroidism improves eGFR and decreases 24-hour urine protein excretion, thereby suggesting reversible alterations.
Topics: Adult; Cohort Studies; Cross-Sectional Studies; Female; Follow-Up Studies; Glomerular Filtration Rate; Hormone Replacement Therapy; Humans; Hypothyroidism; India; Kidney; Male; Middle Aged; Prospective Studies; Proteinuria; Renal Insufficiency, Chronic; Severity of Illness Index; Thyroxine
PubMed: 33245744
DOI: 10.1210/clinem/dgaa871