Relationship between albuminuria and total proteinuria in systemic lupus erythematosus nephritis: Diagnostic and therapeutic implications

被引:31
作者
Birmingham, Daniel J. [1 ]
Rovin, Brad H. [1 ]
Shidham, Ganesh [1 ]
Bissell, Michael [2 ]
Nagaraja, Haikady N. [3 ]
Hebert, Lee A. [1 ]
机构
[1] Ohio State Univ, Med Ctr, Dept Internal Med, Columbus, OH 43210 USA
[2] Ohio State Univ, Med Ctr, Dept Pathol, Columbus, OH 43210 USA
[3] Ohio State Univ, Med Ctr, Dept Stat, Columbus, OH 43210 USA
来源
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2008年 / 3卷 / 04期
关键词
D O I
10.2215/CJN.04761107
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background and objectives: Albuminuria is regarded a sensitive measure of progression of glomerular disease. This study was undertaken in patients who had systemic lupus erythematosus glomerulonephritis (n = 57) and were followed in the Ohio SLE Study to determine whether measuring albuminuria offered clinical advantages over that of total proteinuria. Design, setting, participants, & measurements: Twenty-four-hour urine collections (n = 127) were obtained at baseline and annually for measurement of microalbumin, total protein, and creatinine. Results: There was a strong linear relationship between microalbumin-creatinine and protein-creatinine ratios over the entire range of protein-creatinine ratios; however, in the protein-creatinine ratio range 0.0 to 0.3, as the protein-creatinine ratio increased, the micro albumin-protein ratio increased much more than the protein-creatinine ratio. Also, the greater the protein-creatinine ratio, the greater was the evidence for nonselective proteinuria (protein-creatinine ratio - microalbumin-creatinine ratio). Conclusions: For the diagnosis of proteinuria renal flare, measuring albuminuria offers no advantage over measuring total proteinuria because changes in protein-creatinine and microalbumin-creatinine ratios are highly correlated over the designated ranges for systemic lupus erythematosus glomerulonephritis proteinuric flares. In those with normal-range proteinuria, subsequent changes in microalbumin-protein ratio might be a better forecaster of renal flare than changes in protein-creatinine or microalbumin-creatinine ratio. High protein-creatinine ratios are associated with evidence of nonselective proteinuria, which may increase the nephrotoxicity of proteinuria. Thus, using high-threshold criteria for systemic lupus erythematosus flare (allowing greater proteinuria increase before flare is declared) may expose the kidney to greater nephrotoxicity than using the low-threshold criteria for systemic lupus erythematosus flare.
引用
收藏
页码:1028 / 1033
页数:6
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