Proteinuria predictive value

The relationship between the urinary protein excretion UPE initially achieved after steroid therapy and the long-term renal outcome of IgA nephropathy IgAN has not been clarified. The spline model was used to define the threshold UPE predicting renal survival.

Thirteen patients 9. The online version of this article doi Although proteinuria has been considered one of the most important predictors of renal outcome [ 2 — 6 ], few studies have clarified what degree of proteinuria at an early phase after initial treatment predicts renal survival.

Donadio et al. However, they did not define the proteinuria level predicting a favorable renal outcome. Among the many clinical trials demonstrating the efficacy of steroid therapy for IgAN [ 8 — 10 ], a randomized controlled trial by Pozzi et al. Another 24 patients who were recruited into a prospective randomized controlled trial were also excluded.

971 country code time now

Finally, the data obtained from patients were analyzed to elucidate the renal outcome. The patients were followed up until April or the last day of serum creatinine measurement before April Clinical remission was defined as the disappearance of both proteinuria and hematuria.

The estimated glomerular filtration rate eGFR was calculated by the Japanese eGFR equation based on age, sex and serum creatinine [ 13 ].

Smoking status was defined according to a report by Yamamoto et al. The 6-month steroid therapy was previously reported by Pozzi et al. The patients were administered angiotensin-converting enzyme inhibitors or angiotensin receptor blockers RAAS inhibitors and antiplatelet agents as needed.

All renal biopsy specimens were processed routinely for light microscopy. Pathological variables were evaluated according to the Oxford classification [ 16 ]. Categorical variables were expressed in percentages and compared using the chi-squared test.

Second, using the highest decile as the referred category, the relative hazard ratios HRs adjusted by the baseline eGFR were plotted according to the specified median values of each decile. Third, quadratic splines were fitted to the relative HR with knots.

Content Preview

The spline model is considered to be a smooth function that is sensitive to changes in the relationship between a predictor variable and an outcome across the range of the predictor [ 18 ]. The UPE was log-transformed for the spline analyses. The result of the threshold analysis was additionally ascertained by a receiver operating curve ROC analysis.

Renal survival was analyzed using the Kaplan—Meier method. In addition, it was analyzed in multivariate Cox regression models to explore the independent prognostic value of predictors.

Proteinuria

Different relevant multivariate models were tested, obeying the standard statistical rules. The median initial proteinuria was 1. During a median follow-up of 3. One hundred and eighteen patients As shown in Fig. The lines in the middle and those delimiting the boxes indicate the median, 25th and 75th percentile values, respectively.

Dots indicate outliers. Risk ratio for the endpoint associated with the UPE at the 1-year follow-up. The degree of proteinuria was log transformed.Persistent proteinuria with an inactive urine sediment is likely marker of chronic kidney disease CKD in dogs and cats.

You think meaning

Proteinuria is a general term that describes the presence of any type of protein in the urine, such as albumin, globulins, and Bence Jones proteins. Proteinuria of renal origin results from two major mechanisms: the first is a loss of selective glomerular filtration resulting in an increased amount of plasma protein in the filtrate; the second is an impaired resorption of the filtered protein. Albumin is the predominate protein in urine in dogs and cats in both health and renal disease.

Many laboratories confirm positive reactions for protein on the dipstick test with the sulfosalicylic acid SSA turbidimetric test. The dipstick colorimetric test for proteinuria is inexpensive, easy to use, and primarily measures albumin, but sensitivity and specificity are relatively low. False-positive results are also common in both species with the dipstick but occur more frequently in cats than in dogs. In addition to albumin, the SSA test can detect globulins and Bence Jones proteins to a greater extent than the dipstick test.

False-positive results may occur if the urine contains radiographic contrast agents, penicillin, cephalosporins, sulfisoxazole, or thymol a urine preservativeand for other, unknown reasons. The protein content may also be overestimated with the SSA test if uncentrifuged, turbid urine is analyzed. Because of the relatively poor specificity of conventional dipstick analysis, many reference laboratories will confirm a positive dipstick test result for proteinuria using the SSA test.

When both tests are performed simultaneously they should be interpreted in series both tests should be positive in order to consider the sample positive for albuminuriarather than in parallel fashion, to increase specificity. For feline urine samples, both routine-screening tests dipstick and SSA performed poorly and appear to be of minimal diagnostic value due to an unacceptable high number of false-positives.

The sensitivity and specificity of the dipstick and SSA tests for detection of albuminuria has also been evaluated in cats with CKD.

Severe lupus nephritis: the predictive value of a ≥ 50% reduction in proteinuria at 6 months

In the case of a negative urine dipstick result the addition of the SSA test added little diagnostic value. Proteinuria detected by these semi-quantitative, screening methods has historically been interpreted in light of the urine specific gravity and urine sediment. In addition, a positive dipstick reading for protein in the presence of hematuria or pyuria was often attributed to urinary tract hemorrhage or inflammation. However, in both situations this interpretation may not be correct.

Given the limits of the conventional dipstick test sensitivity, any positive result for protein regardless of urine concentration may be abnormal except in the case of false-positive results.

Likewise, hematuria and pyuria have an inconsistent effect on urine albumin concentrations: not all dogs with microscopic hematuria and pyuria have albuminuria. Albuminuria can be measured by quantitative immunoassays at reference laboratories Antech Diagnostics and Heska Corporation. Urine albumin concentrations can be adjusted for differences in urine concentration by dividing by urine creatinine concentrations. Alternatively, urine can be diluted to a standard concentration by using the urine specific gravity e.

In one study of dogs, normalizing urine albumin concentrations to a 1. Interpretation and follow-up of MA testing is critical. Like other tests for proteinuria, MA tests can be affected by lower urinary tract inflammation and therefore assessment of patient history and urine sediment changes is important. A negative MA result is a useful finding because it obviates any concern about albuminuria until the next testing interval.Metrics details. Proteinuria is well recognised as a marker of chronic kidney disease CKDas a risk factor for progression of CKD among those with known CKD, and as a risk factor for cardiovascular events and death among both the general and CKD populations.

Which measure of proteinuria is most predictive of renal events remains uncertain. We conducted a prospective study with proteinuric CKD and kidney transplant recipients attending an outpatient clinic of a tertiary care hospital in Australia. Secondary outcomes were each component of the composite outcome. The multivariable analysis showed strong evidence of an association between each log-transformed proteinuria measurement and the primary composite outcome.

However, which measure best predicted the outcomes individually is less certain. Peer Review reports. Proteinuria is an established marker of kidney damage, a risk factor for progression of chronic kidney disease CKD and a potent risk factor for cardiovascular events and mortality amongst the diabetic and non-diabetic population [ 12 ]. Precise measurements of proteinuria allow the clinician to identify patients at risk of CKD progression and to monitor response to treatment.

Major clinical practice guidelines now recommend using a spot urine albumin-to-creatinine ratio UACR as first-line in the evaluation of proteinuria for the diagnosis of CKD and monitoring response to treatment [ 3456 ].

Previously considered the gold standard, there has been an increasing movement to forgo the timed h protein excretion as the test of choice to quantify proteinuria due to the inconvenience and inaccuracies associated with the test [ 78 ]. In contrast, studies of patients with glomerular diseases have shown only modest correlations between UPCR compared to h protein excretion [ 910 ] however; these studies did not evaluate long-term outcomes.

Underpinning such guidelines, studies of morning spot UACR have shown to be the superior method for predicting renal events compared with h protein and albumin excretion in patients with diabetic nephropathy [ 11 ]. Therefore, which measure of proteinuria remains most predictive of renal events remains a key question and has not been definitively answered.

We sought to determine the relationship between the three most common lab-based measurements of proteinuria spot UPCR, UACR and h urinary total protein excretion and clinical outcomes over five years in a cohort of CKD patients at a tertiary care hospital. We conducted this single-centre prospective longitudinal study at a metropolitan tertiary care teaching hospital in Sydney, Australia. In summary, medically stable CKD patients were instructed at baseline to perform a h urine collection and to collect multiple spot untimed urine samples over the h period.

At the time of the urine collection, participants also underwent a blood test to determine haemoglobin, urea and serum creatinine. Patients were followed up in the clinic at an interval determined by their caring physician.

We followed this cohort of patients for five years to determine their clinical status. We only included patients in the study if the results for all three baseline measures of proteinuria were available and the patient had at least one follow-up visit. We obtained the following baseline variables at recruitment: age, sex, ethnicity, cause of CKD, eGFR, serum creatinine, kidney transplant status, angiotensin converter enzyme inhibitor or angiotensin receptor blocker use, history of diabetes mellitus DM defined as a previous diagnosis of DM, use of oral hypoglycaemic agent or insulinhypertension defined by a history of diagnosed hypertension or the use of antihypertensive medications and smoking history.

We chose a composite outcome as the primary outcome, after balancing the consideration of statistical precision, with the clinical significance of the composite outcome [ 14 ].When the immune system attacks the kidney it becomes inflamed, a process known as lupus nephritis, one of the most severe complications in SLE patients that can lead to long-term damage, kidney failure and death.

There is no approved drug treatment for lupus nephritis. In order to conduct proper lupus nephritis trials, it is necessary to establish which response measures are the most predictive in terms of good long-term kidney function. The research team analyzed data available from 76 patients in the Euro-Lupus Nephritis Trial, who had 3, 6, or 12 months measurements of proteinuria, serum Cr and urinary RBC, with a minimum follow-up period of 7 years.

The specificity and sensitivity of each biomarker was determined. The research team concluded that the level of proteinuria at 12 months is the best single predictor of long-term renal outcome in patients with lupus nephritis. Researchers also suggest that since urinary RBCs have a poor predictive value, they should not be considered as a response measure in clinical trials for lupus nephritis.

Vote count: 0. No votes so far! Be the first to rate this post. Print This Page. How useful was this post? Click on a star to rate it! As you found this post useful Follow us on social media! We are sorry that this post was not useful for you! Let us improve this post! Tell us how we can improve this post? Submit Feedback. We use cookies to enhance your experience on our website.

Gta 5 ip grabber

Privacy Policy Accept.Either your web browser doesn't support Javascript or it is currently turned off. In the latter case, please turn on Javascript support in your web browser and reload this page. The relationship between the urinary protein excretion UPE initially achieved after steroid therapy and the long-term renal outcome of IgA nephropathy IgAN has not been clarified.

proteinuria predictive value

The spline model was used to define the threshold UPE predicting renal survival. Thirteen patients 9. The online version of this article doi Although proteinuria has been considered one of the most important predictors of renal outcome [ 2 — 6 ], few studies have clarified what degree of proteinuria at an early phase after initial treatment predicts renal survival.

Donadio et al. However, they did not define the proteinuria level predicting a favorable renal outcome. Among the many clinical trials demonstrating the efficacy of steroid therapy for IgAN [ 8 — 10 ], a randomized controlled trial by Pozzi et al.

Another 24 patients who were recruited into a prospective randomized controlled trial were also excluded. Finally, the data obtained from patients were analyzed to elucidate the renal outcome. The patients were followed up until April or the last day of serum creatinine measurement before April Clinical remission was defined as the disappearance of both proteinuria and hematuria.

The estimated glomerular filtration rate eGFR was calculated by the Japanese eGFR equation based on age, sex and serum creatinine [ 13 ]. Smoking status was defined according to a report by Yamamoto et al. The 6-month steroid therapy was previously reported by Pozzi et al. The patients were administered angiotensin-converting enzyme inhibitors or angiotensin receptor blockers RAAS inhibitors and antiplatelet agents as needed.

All renal biopsy specimens were processed routinely for light microscopy. Pathological variables were evaluated according to the Oxford classification [ 16 ].

Black peacoat womens

Categorical variables were expressed in percentages and compared using the chi-squared test. Second, using the highest decile as the referred category, the relative hazard ratios HRs adjusted by the baseline eGFR were plotted according to the specified median values of each decile.Professional Reference articles are designed for health professionals to use.

You may find the Proteinuria article more useful, or one of our other health articles. NICE has issued rapid update guidelines in relation to many of these. This guidance is changing frequently. Proteinuria is associated with cardiovascular and renal disease and is a predictor of end organ damage in patients with hypertension. Detection of an increase in protein excretion is known to have both diagnostic and prognostic value in the initial detection and confirmation of renal disease.

Microalbuminuria Microalbuminuria is protein between 30 and mg per 24 hours.

proteinuria predictive value

This may occur with diabetes and is discussed in its own article. Standard dipsticks will show negative with microalbuminuria. Bence-Jones protein As may occur with multiple myeloma, this may also be undetectable on standard dipstick testing. These are the light chains of immunoglobulins. Proteinuria is usually asymptomatic, although patients may complain of some 'frothiness' of their urine.

Heavy and persistent proteinuria results in hypo-albuminaemia. This may produce ankle swelling, abdominal pain and breathlessness.

Proteinuria

Patients with asymptomatic proteinuria usually have no signs, but in more severe cases such as with nephrotic syndrome there may be oedema, asciteshydroceles and pleural effusions as a result of decreased oncotic pressure. The nephrotic syndrome consists of proteinuria, hypoalbuminaemia and oedema.

There may also be symptoms and signs relating to the underlying cause. Below this level the conversion is non-linear.

proteinuria predictive value

Proteinuria in excess of 3. This usually indicates glomerular disease. Any associated hypertension should be treated aggressively, preferably including an ACE inhibitor or, if there are side-effects, an angiotensin-II receptor antagonist. The presence of any the following increases the likelihood of significant renal disease, and indicates that further investigation or referral to a specialist is appropriate:.

The possible results of hypoalbuminaemia have been mentioned.The datasets used and analysed for the current study are available from the corresponding author on reasonable request. Proteinuria is well recognised as a marker of chronic kidney disease CKDas a risk factor for progression of CKD among those with known CKD, and as a risk factor for cardiovascular events and death among both the general and CKD populations.

Which measure of proteinuria is most predictive of renal events remains uncertain. We conducted a prospective study with proteinuric CKD and kidney transplant recipients attending an outpatient clinic of a tertiary care hospital in Australia.

Secondary outcomes were each component of the composite outcome. The multivariable analysis showed strong evidence of an association between each log-transformed proteinuria measurement and the primary composite outcome. However, which measure best predicted the outcomes individually is less certain. Proteinuria is an established marker of kidney damage, a risk factor for progression of chronic kidney disease CKD and a potent risk factor for cardiovascular events and mortality amongst the diabetic and non-diabetic population [ 12 ].

Precise measurements of proteinuria allow the clinician to identify patients at risk of CKD progression and to monitor response to treatment. Major clinical practice guidelines now recommend using a spot urine albumin-to-creatinine ratio UACR as first-line in the evaluation of proteinuria for the diagnosis of CKD and monitoring response to treatment [ 3 — 6 ]. Previously considered the gold standard, there has been an increasing movement to forgo the timed h protein excretion as the test of choice to quantify proteinuria due to the inconvenience and inaccuracies associated with the test [ 78 ].

In contrast, studies of patients with glomerular diseases have shown only modest correlations between UPCR compared to h protein excretion [ 910 ] however; these studies did not evaluate long-term outcomes. Underpinning such guidelines, studies of morning spot UACR have shown to be the superior method for predicting renal events compared with h protein and albumin excretion in patients with diabetic nephropathy [ 11 ]. Therefore, which measure of proteinuria remains most predictive of renal events remains a key question and has not been definitively answered.

We sought to determine the relationship between the three most common lab-based measurements of proteinuria spot UPCR, UACR and h urinary total protein excretion and clinical outcomes over five years in a cohort of CKD patients at a tertiary care hospital.

We conducted this single-centre prospective longitudinal study at a metropolitan tertiary care teaching hospital in Sydney, Australia. In summary, medically stable CKD patients were instructed at baseline to perform a h urine collection and to collect multiple spot untimed urine samples over the h period. At the time of the urine collection, participants also underwent a blood test to determine haemoglobin, urea and serum creatinine.

Patients were followed up in the clinic at an interval determined by their caring physician. We followed this cohort of patients for five years to determine their clinical status. We only included patients in the study if the results for all three baseline measures of proteinuria were available and the patient had at least one follow-up visit.

We obtained the following baseline variables at recruitment: age, sex, ethnicity, cause of CKD, eGFR, serum creatinine, kidney transplant status, angiotensin converter enzyme inhibitor or angiotensin receptor blocker use, history of diabetes mellitus DM defined as a previous diagnosis of DM, use of oral hypoglycaemic agent or insulinhypertension defined by a history of diagnosed hypertension or the use of antihypertensive medications and smoking history.

We chose a composite outcome as the primary outcome, after balancing the consideration of statistical precision, with the clinical significance of the composite outcome [ 14 ]. The first author and data assistant manually searched the electronic medical record database of the local area health district, supplemented by the Australian and New Zealand Dialysis and Transplant Registry ANZDATA to obtain dates of death, dialysis commencement and patient disposition at five years.

The Sydney Local Area Health district ethics committee approved the study protocol no. For descriptive statistics, we reported normally distributed continuous variables as means standard deviation [SD] and skewed continuous variables as medians interquartile range [IQR].

For categorical data, we reported absolute numbers and percentages.

Biostatistics - Negative and Positive Predictive Values

We performed a Cox proportional hazards model for the primary composite and individual secondary outcomes. Because the data for the predictor variables UPCR, UACR and h total protein excretion were highly skewed, we performed log-transformations on these variables. We excluded cases with missing predictor or outcome variables in the analysis. The C-statistic is a measure of predictive power where 0.

For the Cox model, we first performed a univariable analysis using the predictor variables. For the multivariable models, we added variables that were known risk factors for progression of CKD including age, baseline eGFR, hypertension and diabetes mellitus and any predictor variable with a p -value of less than 0.

To check whether the association between the predictor variables and the primary outcome was modified by whether the patient had a functioning transplant at the time of study enrolment, we created an interaction term between each of the predictor variables and the transplant status.

We checked the proportional hazard assumption of each model by plotting the Schoenfield residuals against time.


Comments

Leave a Reply

Your email address will not be published. Required fields are marked *