Proteinuria and eGFR can be prognostic in kidney disease

January 01, 0001

Proteinuria and eGFR can be prognostic in kidney disease

Low values of estimated glomerular filtration rate (eGFR) predispose to acute kidney injury, and proteinuria is a marker of kidney disease. The researchers from Canada aimed to investigate how eGFR and proteinuria jointly modified the risks of acute kidney injury and subsequent adverse clinical outcomes. They did a cohort study of 920 985 adults residing in Alberta, Canada, between 2002 and 2007. Participants not needing chronic dialysis at baseline and with at least one outpatient measurement of both serum creatinine concentration and proteinuria (urine dipstick or albumin-creatinine ratio) were included.

During median follow-up of 35 months 6520 (0.7%) participants were admitted with acute kidney injury. In those with eGFR 60 mL/min per 1.73 m2 or greater, the adjusted risk of admission with this disorder was about 4 times higher in those with heavy proteinuria measured by dipstick (rate ratio 4.4 vs no proteinuria). The adjusted rates of admission with acute kidney injury and kidney injury needing dialysis remained high in participants with heavy dipstick proteinuria for all values of eGFR. The adjusted rates of death and the composite renal outcome were also high in participants admitted with acute kidney injury, although the rise associated with this injury was attenuated in those with low baseline eGFR and heavy proteinuria.

The researchers concluded: "These findings suggest that information on proteinuria and eGFR should be used together when identifying people at risk of acute kidney injury, and that an episode of acute kidney injury provides further long- term prognostic information in addition to eGFR and proteinuria."

This is very measurable in the general practice setting. It is worth thinking of kidneys as renal disease can be ‘silent’.

For the full abstract, click here.

The Lancet published online 22 November 2010
© 2010 Elsevier Limited
Glomerular filtration rate, proteinuria, and the incidence and consequences of acute kidney injury: a cohort study. Matthew T James, Brenda R Hemmelgarn, Natasha Wiebe et al for the Alberta Kidney Disease Network. Correspondence to Marcello Tonelli: [email protected]

Category: U. Urinary System. Keywords: glomerular filtration rate, proteinuria, acute kidney injury, cohort study, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 14 December 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.