Studies Evaluating the Association Between Proteinuria and Cardiovascular Disease
Therapeutic Strategies for Reduction of Cardiovascular and Renal Risk in Patients With Proteinuria Based on the KDOQI Guidelines
Classification of Proteinuria
Screening for Proteinuria
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.
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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.