Assessment of Proteinuria in Patients with Chronic Kidney Disease Albuminuria and Non-Albumin Proteinuria
Article Sidebar
Main Article Content
Abstract
Background: Chronic Kidney Disease (CKD) is a global health concern characterized by a gradual loss of kidney function over time. It is often associated with an increased risk of cardiovascular disease and other complications. Proteinuria, the presence of abnormal quantities of protein in the urine, is a key indicator of kidney damage in CKD. Among the types of proteinuria, albuminuria (excessive albumin in the urine) is particularly significant. This study aims to delve into the prevalence and implications of both albuminuria and non-albumin proteinuria (NAP) in CKD patients, offering insights into their diagnostic and prognostic value.
Objective: To evaluate the prevalence and association of albuminuria and NAP in CKD patients.
Methods: Conducted at Pakistan Emirates Military Hospital, Rawalpindi, from March to September 2023, this prospective study included 385 CKD patients. Convenience sampling was utilized. Participants underwent medical history reviews, clinical evaluations, blood tests, and provided three morning urine samples. The study defined albuminuria as a urine albumin to creatinine ratio (uACR) of ≥3 mg/mmol in at least two out of three samples. Isolated NAP was indicated by a urine protein to creatinine ratio (uPCR) of ≥17 mg/mmol in two out of three samples and uACR <3 mg/mmol in all samples.
Results: In this study of 385 CKD patients, 54.5% (210 individuals) were male, and 45.5% (175) were female. Proteinuria of albuminuria was observed in 24.6% of patients. Specifically, 76 patients (19.7%) had abnormal uACR levels in their initial test. On follow-up tests, 65 patients (16.8%) showed albuminuria based on at least two out of three positive uACR measurements. The study also found that 55 patients (14.2%) had a mixed profile of albuminuria and NAP, while 20 patients (5.1%) exhibited isolated albuminuria. Moreover, 135 individuals (35%) had 'high normal' albuminuria (uACR 1-3 mg/mmol).
Conclusion: The study concluded that albuminuria is distinctly associated with CKD. While albuminuria can be initially detected with one uACR sample, accurate quantification requires three measurements.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004 Sep 23;351(13):1296-305.
Tangri N, Stevens LA, Griffith J, Tighiouart H, Djurdjev O, Naimark D, Levin A, Levey AS. A predictive model for progression of chronic kidney disease to kidney failure. JAMA. 2011 Apr 20;305(15):1553-9.
Methven S, Traynor JP, Hair MD, O’Reilly DS, Deighan CJ, MacGregor MS. Stratifying risk in chronic kidney disease: an observational study of UK guidelines for measuring total proteinuria and albuminuria. QJM. 2011 Aug 1;104(8):663-70.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004 Sep 23;351(13):1296-305.
Jafar TH, Stark PC, Schmid CH, Landa M, Maschio G, Marcantoni C, De Jong PE, De Zeeuw D, Shahinfar S, Ruggenenti P, Remuzzi G. Proteinuria as a modifiable risk factor for the progression of non-diabetic renal disease. Kidney Int. 2001 Sep 1;60(3):1131-40.
Methven S, MacGregor MS, Traynor JP, O’Reilly DS, Deighan CJ. Assessing proteinuria in chronic kidney disease: protein–creatinine ratio versus albumin–creatinine ratio. Nephrol Dial Transplant. 2010 Sep 1;25(9):2991-6.
Methven S, MacGregor MS, Traynor JP, Hair M, O'Reilly DS, Deighan CJ. Comparison of urinary albumin and urinary total protein as predictors of patient outcomes in CKD. Am J Kidney Dis. 2011 Jan 1;57(1):21-8.
Hallan S, Astor B, Romundstad S, Aasarød K, Kvenild K, Coresh J. Association of kidney function and albuminuria with cardiovascular mortality in older vs younger individuals: The HUNT II Study. Arch Intern Med. 2007 Dec 10;167(22):2490-6.
Nitsch D, Grams M, Sang Y, Black C, Cirillo M, Djurdjev O, Iseki K, Jassal SK, Kimm H, Kronenberg F, Øien CM. Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis. BMJ. 2013 Jan 29;346.
Methven S, MacGregor MS, Traynor JP, Hair M, O'Reilly DS, Deighan CJ. Comparison of urinary albumin and urinary total protein as predictors of patient outcomes in CKD. Am J Kidney Dis. 2011 Jan 1;57(1):21-8.
Smith ER, Cai MM, McMahon LP, Wright DA, Holt SG. The value of simultaneous measurements of urinary albumin and total protein in proteinuric patients. Nephrol Dial Transplant. 2012 Apr 1;27(4):1534-41.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004 Sep 23;351(13):1296-305.
Tangri N, Stevens LA, Griffith J, Tighiouart H, Djurdjev O, Naimark D, Levin A, Levey AS. A predictive model for progression of chronic kidney disease to kidney failure. JAMA. 2011 Apr 20;305(15):1553-9.
Fraser SD, Roderick PJ, McIntyre NJ, Harris S, McIntyre C, Fluck R, Taal MW. Assessment of proteinuria in patients with chronic kidney disease stage 3: albuminuria and non-albumin proteinuria. PLoS One. 2014 May 27;9(5):e98261.
Hong DS, Oh IH, Park JS, Lee CH, Kang CM, Kim GH. Evaluation of urinary indices for albuminuria and proteinuria in patients with chronic kidney disease. Kidney Blood Press Res. 2016 Apr 29;41(3):258-66.
Fisher H, Hsu CY, Vittinghoff E, Lin F, Bansal N. Comparison of associations of urine protein-creatinine ratio versus albumin-creatinine ratio with complications of CKD: a cross-sectional analysis. Am J Kidney Dis. 2013 Dec 1;62(6):1102-8.
Methven S, Traynor JP, Hair MD, O’Reilly DS, Deighan CJ, MacGregor MS. Stratifying risk in chronic kidney disease: an observational study of UK guidelines for measuring total proteinuria and albuminuria. QJM. 2011 Aug 1;104(8):663-70.
Menon V, Greene TO, Wang X, Pereira AA, Marcovina SM, Beck GJ, Kusek JW, Collins AJ, Levey AS, Sarnak MJ. C-reactive protein and albumin as predictors of all-cause and cardiovascular mortality in chronic kidney disease. Kidney Int. 2005 Aug 1;68(2):766-72.
Tonelli M, Sacks F, Pfeffer M, Jhangri GS, Curhan G. Biomarkers of inflammation and progression of chronic kidney disease. Kidney Int. 2005 Jul 1;68(1):237-45.
Mahemuti N, Zou J, Liu C, Xiao Z, Liang F, Yang X. Urinary Albumin-to-Creatinine Ratio in Normal Range, Cardiovascular Health, and All-Cause Mortality. JAMA Netw Open. 2023;6(12):e2348333. doi:10.1001/jamanetworkopen.2023.48333