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American Family Physician Sep 2010Proteinuria is common in children and may represent a benign condition or a serious underlying renal disease or systemic disorder. Proteinuria may occur secondary to...
Proteinuria is common in children and may represent a benign condition or a serious underlying renal disease or systemic disorder. Proteinuria may occur secondary to glomerular or tubular dysfunction. Although a 24-hour urine protein excretion test is usually recommended, it may be impractical in children. A spot, first-morning urine test for protein/creatinine ratio can be useful in this situation. Proteinuria is usually benign, in the form of transient or orthostatic proteinuria. Persistent proteinuria may be associated with more serious renal diseases. Clinical features from the history, physical examination, and laboratory tests help determine the cause of proteinuria. Treatment should be directed at the underlying cause. Patients with active urinary sediments, persistent and gross hematuria, hypertension, hypocomplementemia, renal insufficiency with depressed glomerular filtration rate, or signs and symptoms suggestive of vasculitic disease may require a renal biopsy and referral to a pediatric nephrologist.
Topics: Adolescent; Biomarkers; Child; Child, Preschool; Creatinine; Diagnosis, Differential; Glomerular Filtration Rate; Humans; Infant; Kidney Diseases; Kidney Glomerulus; Proteinuria; Urinalysis
PubMed: 20842993
DOI: No ID Found -
Nutrients Apr 2021Sodium effects on proteinuria are debated. This observational, cross-sectional, population-based study investigated relationships to proteinuria and albuminuria of... (Observational Study)
Observational Study
Sodium effects on proteinuria are debated. This observational, cross-sectional, population-based study investigated relationships to proteinuria and albuminuria of sodium intake assessed as urinary sodium/creatinine ratio (NaCR). In 482 men and 454 women aged 35-94 years from the Moli-sani study, data were collected for the following: urinary NaCR (independent variable); urinary total proteins/creatinine ratio (PCR, mg/g), urinary albumin/creatinine ratio (ACR, mg/g), and urinary non-albumin-proteins/creatinine ratio (calculated as PCR minus ACR) (dependent variables). High values were defined as PCR ≥ 150 mg/g, ACR ≥ 30 mg/g, and urinary non-albumin-proteins/creatinine ratio ≥ 120 mg/g. Urinary variables were measured in first-void morning urine. Skewed variables were log-transformed in analyses. The covariates list included sex, age, energy intake, body mass index, waist/hip ratio, estimated urinary creatinine excretion, smoking, systolic pressure, diastolic pressure, diabetes, history of cardiovascular disease, reported treatment with antihypertensive drug, inhibitor or blocker of the renin-angiotensin system, diuretic, and log-transformed data of total physical activity, leisure physical activity, alcohol intake, and urinary ratios of urea nitrogen, potassium, and phosphorus to creatinine. In multivariable linear regression, standardized beta coefficients of urinary NaCR were positive with PCR (women and men = 0.280 and 0.242, 95% confidence interval = 0.17/0.39 and 0.13/0.35, < 0.001), ACR (0.310 and 0.265, 0.20/0.42 and 0.16/0.38, < 0.001), and urinary non-albumin-proteins/creatinine ratio (0.247 and 0.209, 0.14/0.36 and 0.09/0.33, < 0.001). In multivariable logistic regression, higher quintile of urinary NaCR associated with odds ratio of 1.81 for high PCR (1.55/2.12, < 0.001), 0.51 of 1.62 for high ACR (1.35/1.95, < 0.001), and of 1.84 for high urinary non-albumin proteins/creatinine ratio (1.58/2.16, < 0.001). Findings were consistent in subgroups. Data indicate independent positive associations of an index of sodium intake with proteinuria and albuminuria in the population.
Topics: Adult; Aged; Aged, 80 and over; Creatinine; Cross-Sectional Studies; Female; Humans; Italy; Male; Middle Aged; Proteinuria; Sodium, Dietary
PubMed: 33920400
DOI: 10.3390/nu13041255 -
Journal of Obstetrics and Gynaecology :... Dec 2023Proteinuria during pregnancy is closely related to the occurrence of adverse pregnancy outcomes. One hundred and forty-two women with proteinuria during pregnancy and...
Proteinuria during pregnancy is closely related to the occurrence of adverse pregnancy outcomes. One hundred and forty-two women with proteinuria during pregnancy and followed between January 2018 and December 2020 were evaluated. Based on the 24-h proteinuria value, they were divided as mild ( = 76, 300-1000 mg/day), moderate ( = 39, 1000-3500 mg/day) and severe ( = 27, >3500 mg/day) proteinuria. The rates of prematurity, low birth weight and neonatal asphyxia were significantly higher in the severe proteinuria group than in the mild and moderate groups, while the rates of foetal growth restriction and neonatal intensive care unit admission were significantly higher in the severe compared with the mild proteinuria group (all < .05). Logistic regression analysis showed that moderate proteinuria (OR = 97.2, 95%CI: 7.1-1334.2, = .001) and severe proteinuria (OR = 34.0, 95%CI: 1.6-711.0, = .023) were associated with adverse perinatal outcomes. Compared with mild proteinuria, moderate and severe proteinuria are associated with adverse pregnancy outcomes in perinatal infants.Impact Statement The production of proteinuria is closely related to the filtration function of the glomerulus, the reabsorption and secretion function of the renal tubules. For women with normal renal function before pregnancy, such physiological changes are less likely to cause adverse symptoms; however, for women with chronic kidney disease before pregnancy, especially those with significantly impaired renal function, the kidneys often cannot compensate for these physiological changes, which can lead to serious complications for both mother and infant. In our study, logistic regression analysis showed that the severity of proteinuria was independently associated with adverse perinatal outcomes. The ROC curve showed that 24-h proteinuria had a predictive value for adverse perinatal outcomes. Therefore, for patients with urine protein quantification ≥0.3 g/24 h, regular 24-h urine protein quantification during pregnancy could help predict adverse perinatal outcomes and improve prognosis. Proteinuria quantification can be used as one of the factors predicting adverse pregnancy outcomes. Thus, monitoring of urinary protein quantification in women during pregnancy should be strengthened for early detection of renal impairment, then interventions be used to improve maternal and infant outcomes.
Topics: Pregnancy; Infant, Newborn; Infant; Female; Humans; Pre-Eclampsia; Retrospective Studies; Pregnancy Outcome; Infant, Premature; Proteinuria
PubMed: 36178502
DOI: 10.1080/01443615.2022.2126299 -
Journal of the Indian Medical... Feb 2011World Kidney Day is observed on March 10 every year and in 2011 the 6th annual event is going to be celebrated under the joint sponsorers - International Society of... (Review)
Review
World Kidney Day is observed on March 10 every year and in 2011 the 6th annual event is going to be celebrated under the joint sponsorers - International Society of Nephrology and the International Federation of Kidney Foundations. The presence of chronic kidney disease significantly increases the risk of a cardiovascular event in both diabetes and hypertension. Proteinuria is always a marker of kidney disease. The time to development of a cardiovascular event is accelerated significantly by the presence of proteinuria at all levels of glomerular filtration rate. It is suggested that renal-targeted interventions designed to reduce proteinuria and slow progression of chronic renal disease can reduce cardiovascular disease. The biomarkers of chronic kidney disease (proteinuria, eGFR) are easy and relatively inexpensive to detect and one of these, proteinuria emerges early in the generalised vascular disease.
Topics: Cardiovascular Diseases; Chronic Disease; Global Health; Humans; Kidney Diseases; Proteinuria; Risk Factors
PubMed: 21888170
DOI: No ID Found -
Journal of the American Society of... Aug 2020
Topics: Albumins; Albuminuria; Creatinine; Humans; Proteinuria
PubMed: 32737208
DOI: 10.1681/ASN.2020050707 -
American Journal of Nephrology 2005Proteinuria, nearly a universal finding in progressive kidney disease, has been the subject of frequent recent analyses in the renal literature. Proteinuria is a... (Review)
Review
BACKGROUND/AIMS
Proteinuria, nearly a universal finding in progressive kidney disease, has been the subject of frequent recent analyses in the renal literature. Proteinuria is a hallmark of diabetic nephropathy: microalbuminuria is the principal early predictor for progression of diabetic glomerulopathy, and proteinuria may be viewed as a measure of the severity and promoter of progression of nephropathy.
METHODS
This article critically reviews for the first time the full scope of diabetic proteinuria--complex molecular mechanisms, natural history, and analysis of treatment trials--in order to address the validity of 'the proteinuria hypothesis', i.e., that diabetic proteinuria is a modifiable determinant of renal progression. This hypothesis is analyzed in detail, including recent studies on the primary therapy of diabetic nephropathy, renin-angiotensin blockade.
RESULTS
As fully developed, this hypothesis consists of three postulates: that higher amounts of proteinuria predict progressive loss of function, that proteinuria reduction correlates with slowing progression, and that proteinuria is a surrogate endpoint for clinical trials. The latter postulate has not before been adequately linked to growing information about the first two postulates as they apply to diabetic kidney disease.
CONCLUSION
While diabetic nephropathy is a disease model for the potential use of proteinuria as a surrogate marker for renal progression, this shift in perspective will require prospective data from additional clinical trials, particularly of non-renin-angiotensin blocking drugs, to be complete.
Topics: Diabetic Nephropathies; Disease Progression; Humans; Predictive Value of Tests; Proteinuria
PubMed: 15746541
DOI: 10.1159/000084286 -
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 -
Kidney International Sep 2007Heparanase is an endo-beta(1-4)-D-glucuronidase that degrades heparan sulfate (HS) polysaccharide side chains. The role of heparanase in metastasis, angiogenesis, and... (Review)
Review
Heparanase is an endo-beta(1-4)-D-glucuronidase that degrades heparan sulfate (HS) polysaccharide side chains. The role of heparanase in metastasis, angiogenesis, and inflammation has been established. Recent data suggest a role for heparanase in several proteinuric diseases and an increased glomerular heparanase expression is associated with loss of HS in the glomerular basement membrane (GBM). Furthermore, an increase in heparanase activity was detected in urine from proteinuric patients. Mice with transgenic heparanase overexpression developed mild proteinuria. Glomerular heparanase activity is proposed to lead to loss of HS in the GBM and proteinuria. Because the primary role of GBM HS for charge-selective permeability has been questioned recently, heparanase may induce or enhance proteinuria by (i) changes in the glomerular cell-GBM interactions, due to loss of HS; (ii) release of HS-bound factors and HS fragments in glomeruli; or (iii) intracellular signaling by binding of heparanase to glomerular cells. Which of these mechanisms is prevailing requires further research. The precise mechanisms leading to increased heparanase expression in the different glomerular cell types remain elusive, but may involve hyperglycemia, angiotensin II, aldosterone, and reactive oxygen species. This review focuses on the role of heparanase in HS degradation in proteinuric diseases and the possibility/feasibility of heparanase inhibitors, such as heparin(oids), as treatment options.
Topics: Glucuronidase; Heparitin Sulfate; Humans; Kidney Glomerulus; Proteinuria
PubMed: 17519955
DOI: 10.1038/sj.ki.5002337 -
Chemotherapy 2014We performed a systematic review and meta-analysis of the risk of proteinuria associated with ramucirumab. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
We performed a systematic review and meta-analysis of the risk of proteinuria associated with ramucirumab.
METHODS
Eligible studies included randomized phase II and III trials of patients with solid tumors on ramucirumab, describing events of all-grade and high-grade proteinuria.
RESULTS
Our search strategy yielded 170 potentially relevant citations from PubMed/Medline, CENTRAL Cochrane database, ASCO and ESMO meeting libraries. After exclusion of ineligible studies, a total of 11 clinical trials were considered eligible for the meta-analysis. The relative risk (RR) of all-grade proteinuria was 3.31 (95% CI 2.48-4.42; p < 0.00001). Moreover, the RR of high-grade proteinuria was 5.28 (95% CI 2.32-12.01; p < 0.0001).
CONCLUSIONS
Our meta-analysis has demonstrated that ramucirumab use is associated with an increased risk of all-grade and high-grade proteinuria. Early detection strategies should be employed in those patients to prevent the progression to more sinister renal disease.
Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Agents; Clinical Trials as Topic; Humans; Neoplasms; Proteinuria; Treatment Outcome; Ramucirumab
PubMed: 26302785
DOI: 10.1159/000437253 -
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