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Table 1.  

Studies Evaluating the Association Between Proteinuria and Cardiovascular Disease

Table 2.  

Therapeutic Strategies for Reduction of Cardiovascular and Renal Risk in Patients With Proteinuria Based on the KDOQI Guidelines

Box 1.  

Classification of Proteinuria

Box 2.  

Screening for Proteinuria

CME

Cardiovascular Implications of Proteinuria: An Indicator of Chronic Kidney Disease

  • Authors: Varun Agrawal, MD; Victor Marinescu, MD, PhD; Mohit Agarwal, MD; Peter A. McCullough, MD, MPH, FACC, FACP, FCCP
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Target Audience and Goal Statement

This activity is intended for primary care physicians, nephrologists, endocrinologists, cardiologists, and other physicians who care for patients with proteinuria.

The goal of this activity is to describe the relationship between proteinuria and cardiovascular disease.

Upon completion of this activity, participants will be able to:

  1. Describe the procedure of screening for proteinuria
  2. Identify the effect of inhibitors of the renin-angiotensin-aldosterone system on cardiovascular outcomes among patients with proteinuria
  3. Describe the relationship between proteinuria and dyslipidemia
  4. List treatment goals for patients with proteinuria


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Author(s)

  • Varun Agrawal, MD

    Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan

    Disclosures

    Disclosure: Varun Agrawal, MD, has disclosed no relevant financial relationships.

  • Victor Marinescu, MD, PhD

    Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan

    Disclosures

    Disclosure: Victor Marinescu, MD, PhD, has disclosed no relevant financial relationships.

  • Mohit Agarwal, MD

    Department of Hospitalist Medicine, Marion General Hospital, Marion, Ohio

    Disclosures

    Disclosure: Mohit Agarwal, MD, has disclosed no relevant financial relationships.

  • Peter A. McCullough, MD, MPH, FACC, FACP, FCCP

    Divisions of Cardiology, Nutrition, and Preventive Medicine, William Beaumont Hospital, Royal Oak, Michigan

    Disclosures

    Disclosure: Peter A. McCullough, MD, MPH, FACC, FACP, FCCP, has disclosed no relevant financial relationships.

CME Author(s)

  • Charles P. Vega, MD

    Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine

    Disclosures

    Disclosure: Charles P. Vega, MD, FAAFP, has disclosed that he has served as an advisor or consultant to Novartis, Inc.

Editor

  • Bryony Mearns, PhD

    Editor, Nature Reviews Cardiology

    Disclosures

    Disclosure: Bryony Mearns, PhD, has disclosed no relevant financial relationships.


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  • This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Nature Publishing Group.

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CME

Cardiovascular Implications of Proteinuria: An Indicator of Chronic Kidney Disease: Measurement of Proteinuria

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Measurement of Proteinuria

Measuring the amount of protein in urine allows for identification of persons at increased risk for CVD (discussed later in this review), progression of CKD, and monitoring of the efficacy of therapy aimed at reduction of proteinuria. Routine screening for proteinuria in the general population, however, is not cost-effective.[6] The Kidney Disease outcomes Quality initiative guidelines[7] recommend that 'individuals at increased risk of developing chronic kidney disease should undergo testing for markers of kidney damage', such as proteinuria ( Box 2 ).

The gold standard for measuring proteinuria is 24 h urine protein excretion; however, this measurement is cumbersome and subject to error owing to improper collection. Untimed (spot) urine sample is a more practical alternative to detect and measure proteinuria. Although first morning void specimens are preferred, random urine specimens are also acceptable. Kidney Disease outcomes Quality initiative guidelines[7] recommend screening for proteinuria with standard urine dipsticks. Urine dipstick measurements have high specificity (97–100%) but low sensitivity (32–46%), with the possibility of false negative results from dilute urine.[8] Patients who test positive on the dipstick should have their result confirmed with a quantitative measurement that includes spot urine protein:creatinine or albumin:creatinine ratios. These spot urine measurements correlate well with the gold-standard, 24 h protein quantitation.[7] Variability in the level of urine protein in an individual, from diet, activity or time of collection, is a serious limitation of the spot urine tests (standard deviation up to 40–50% of the mean).[7] Repeat urine studies should thus be performed when abnormal results are obtained.