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      Proteinuria—take a closer look!

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          Abstract

          Proteinuria is a hallmark of kidney disease. Therefore, measurement of urine protein content plays a central role in any diagnostic work-up for kidney disease. In many cases, proteinuria analysis is restricted to the measurement of total protein content knowing that very high levels of proteinuria (nephrotic proteinuria) are characteristic of glomerular disease. Still, proteinuria can also be a manifestation of impaired tubular protein reabsorption or even be physiological. This review will discuss the physiology of renal protein handling and give guidance on a more sophisticated analysis of proteinuria differentiating albumin, low-molecular weight proteins and immunoglobulins. These non-invasive tests are available in most routine clinical laboratories and may guide the clinician in the diagnostic process before ordering far more expensive (molecular genetic testing) and/or invasive (kidney biopsy) diagnostics.

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          Change in albuminuria as a surrogate endpoint for progression of kidney disease: a meta-analysis of treatment effects in randomised clinical trials

          Hiddo J. L. Heerspink, Tom Greene, Hocine Tighiouart … (2019)
          Change in albuminuria has strong biological plausibility as a surrogate endpoint for progression of chronic kidney disease, but empirical evidence to support its validity is lacking. We aimed to determine the association between treatment effects on early changes in albuminuria and treatment effects on clinical endpoints and surrograte endpoints, to inform the use of albuminuria as a surrogate endpoint in future randomised controlled trials.
          Article 0 comments Cited 149 times – based on 0 reviews     Review now
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            Change in albuminuria and subsequent risk of end-stage kidney disease: an individual participant-level consortium meta-analysis of observational studies

            Josef Coresh, Hiddo J. L. Heerspink, Yingying Sang … (2019)
            Change in albuminuria as a surrogate endpoint for progression of chronic kidney disease is strongly supported by biological plausibility, but empirical evidence to support its validity in epidemiological studies is lacking. We aimed to assess the consistency of the association between change in albuminuria and risk of end-stage kidney disease in a large individual participant-level meta-analysis of observational studies.
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              Cystatin C in prediction of acute kidney injury: a systemic review and meta-analysis.

              Baolong Lu, Xiaoyan Sheng, Ni Jin … (2011)
              Cystatin C (CysC) has been proposed as a filtration marker for the early detection of acute kidney injury (AKI); however, a wide range of its predictive accuracy has been reported. Meta-analysis of diagnostic test studies. Various clinical settings of AKI, including patients after cardiac surgery, pediatric patients, and critically ill patients. Computerized search of PubMed, Current Contents, CINAHL, and EMBASE from inception until November 15, 2010, was performed to identify potentially relevant articles. Inclusion criteria were studies investigating the diagnostic accuracy of CysC level to predict AKI. There were no language restrictions in the search. Increasing or increased serum CysC level or urinary CysC excretion. The outcome was the development of AKI, primarily based on serum creatinine level (definition varied across studies). We analyzed data from 19 studies and 11 countries involving 3,336 patients. Of these studies, 13 could be included in the meta-analysis. Across all settings, the diagnostic OR for serum CysC level to predict AKI was 27.7 (95% CI, 12.8-59.8), with sensitivity and specificity of 0.86 and 0.82, respectively. The area under the receiver operating characteristic curve (AUROC) of serum CysC levelto predict AKI was 0.87 (95% CI, 0.81-0.93). In an analysis excluding studies that did not clearly define the measurement time point, early serum CysC (within 24 hours after renal insult or intensive care unit admission) remained of diagnostic value. For the diagnostic value of urinary CysC excretion, the diagnostic OR was 3.10 (95% CI, 2.00-4.81), with sensitivity and specificity of0.61 and 0.67, respectively. TheAUROC of urinary CysC excretion to predict AKI was 0.67 (95% CI, 0.63-0.71) [corrected]. Variation in criteria for definitions of index and reference tests, absence of measured glomerular filtration rate in most studies. Serum CysC appears to be a good biomarker in the prediction of AKI, whereas urinary CysC excretion has only moderate diagnostic value. Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                Arend Bökenkamp:
                ORCID: http://orcid.org/0000-0002-3492-2252
                a.bokenkamp@amsterdamumc.nl
                Journal
                Journal ID (nlm-ta): Pediatr Nephrol
                Journal ID (iso-abbrev): Pediatr. Nephrol
                Title: Pediatric Nephrology (Berlin, Germany)
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0931-041X
                ISSN (Electronic): 1432-198X
                Publication date (Electronic): 10 January 2020
                Publication date PMC-release: 10 January 2020
                Publication date (Print): 2020
                Volume: 35
                Issue: 4
                Pages: 533-541
                Affiliations
                GRID grid.12380.38, ISNI 0000 0004 1754 9227, Department of Pediatric Nephrology, Emma Children’s Hospital, , Amsterdam University Medical Center, Vrije Universiteit, ; De Boelelaan 1112, NL-1081 HV Amsterdam, The Netherlands
                Author information
                http://orcid.org/0000-0002-3492-2252
                Article
                Publisher ID: 4454
                DOI: 10.1007/s00467-019-04454-w
                PMC ID: 7056687
                PubMed ID: 31925536
                SO-VID: fcf7fb04-6ef7-445e-8e33-0f47ddff275e
                Copyright © © The Author(s) 2020
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 10 September 2019
                Date revision received : 10 September 2019
                Date accepted : 19 September 2019
                Funding
                Funded by: Amsterdam UMC (VU University Amsterdam)
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © IPNA 2020

                ScienceOpen disciplines: Nephrology
                Keywords: proteinuria ,low molecular weight proteins,tubulointerstitial disease,glomerular disease,acute kidney injury,selectivity
                Data availability:
                ScienceOpen disciplines: Nephrology
                Keywords: proteinuria , low molecular weight proteins, tubulointerstitial disease, glomerular disease, acute kidney injury, selectivity

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