Proteinuria in Chronic Kidney Disease and its Management
Keywords:chronic kidney disease, diabetic kidney disease, proteinuria, microalbuminuria, macroalbuminuria
Proteinuria is a marker of kidney damage and an important risk factor for progression of chronic kidney disease as well as cardiovascular morbidity and mortality. Albumin is the principal component of proteinuria in glomerular disease. The presence of persistent albumin in the urine is a clear sign of glomerular abnormality. Microalbuminuria describes the urinary excretion of small amounts of albumin which identifies the very early stage of diabetic kidney disease. The albumin creatinine ratio is the preferred method of detecting microalbuminuria. There is strong evidence that treatment in the early stages of chronic kidney disease reduces progression of kidney damage. The levels of proteinuria in both diabetic and non-diabetic kidney disease at which management should be addressed have been reviewed. This article also reviews the interventions recommended for early stages of chronic kidney disease to reduce the risk of progression to end stage kidney failure. Angiotensin converting enzyme inhibitors and angiotensin 2 receptor blockers are more effective in reducing proteinuria and retarding the progression of kidney disease in comparison to other therapies which lower systemic blood pressure to a similar degree.
Medicine Today 2013 Vol.25(1): 36-41