Proteinuria, renal impairment, and death

doi:10.1136/bmj.332.7555.1402

BMJ 2006;332:1402-1403 (17 June), doi:10.1136/bmj.332.7555.1402

Editorial

Proteinuria, renal impairment, and death

If reducing proteinuria improves cardiovascular outcomes, urinedipstick testing will become crucial in hypertension

The first 150 words of the full text of this article appear below.

It has been known for many years that patients with chronickidney disease have a significantly increased risk of cardiovascularmorbidity and mortality. Many studies have shown that, in renalfailure, increasing proteinuria and worse renal function areassociated with more rapid progression and a higher incidenceof cardiovascular events. Does the same hold true for patientswith relatively minor degrees of renal impairment and low levelsof proteinuria, even microalbuminuria? Is the combination especiallyimportant? And does this affect the management of patients?

First some technicalities. Proteinuria usually refers to proteinthat is detectable in urine with conventional urine dipsticks,and the amount of protein can vary from 300 mg to several gramsa day. Proteinuria can be quantified reliably and easily byusing spot urine protein: creatinine ratios, where normal issaid to be < 20 mg/mmol (but see below). Just to confusethe issue, diabetologists have . . . [Full text of this article]

Jeremy Levy, consultant nephrologist

West London Renal and Transplant Centre, Hammersmith Hospital, London W12 0HS
(j.levy@imperial.ac.uk)

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