Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0033687 (proteinuria)
 24,015 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We tested patients' urines for albumin, protein, and creatinine by quantitative and dipstick methods. The concentrations of these analytes were established by quantitative, cuvet-based chemistry methods that we assumed gave the "correct" values. There was good to excellent agreement of the dipstick results with the quantitative methods for the above three analytes. We found many patients who excreted pathological amounts of albumin and/or protein who did not have a diagnosis of kidney disease or other likely causes of proteinuria, suggesting that albuminuria and/or proteinuria were underdiagnosed in our group of patients. Those with cardiovascular disease, kidney disease, or diabetes showed the greatest predictive value of a positive test for albumin or protein by dipstick. Dipstick testing for albumin, protein, and creatinine had good or excellent agreement with quantitative methods. The dipstick tests were easy to use, simple, and low in cost, and can serve well for point-of-care testing.
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PMID:Albuminuria and proteinuria in hospitalized patients as measured by quantitative and dipstick methods. 1157 57

In the last few decades, clinical and experimental data have established microalbuminuria/proteinuria as an independent risk factor for renal disease and for progression of renal disease in patients with diabetes and in those with essential hypertension. Reduction of proteinuria with the use of angiotensin-converting enzyme inhibitors has been shown in clinical trials to delay or stabilize the rate of progression of renal disease. This effect appears to be independent of any effect on blood pressure control. In conjunction with other therapeutic interventions such as dietary modification and control of serum lipids, it appears that for at least a subgroup of patients, it is possible to delay or prevent progression of kidney failure. More recently, evidence has accumulated that establishes microalbuminuria/proteinuria as an independent risk factor for cardiovascular morbidity and mortality even in those without other clinical evidence of kidney disease. There is frequently a clustering of risk factors in these individuals that includes insulin resistance, salt-sensitivity, hypertension, and dyslipidemia. The mechanism of this relationship of proteinuria and cardiovascular disease is unclear, but the presence of proteinuria as a marker for cardiovascular disease has important implications for the identification and treatment of individuals at risk.
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PMID:Proteinuria and cardiovascular disease. 1157 14

The Objective of this study was to determine whether peak expiratory flow rate is a predictor of complications of diabetes. Peak expiratory flow rate was measured at the 10-year follow-up (third examination) of a cohort of persons with younger-onset diabetes. The relationships of progression of diabetic retinopathy by two steps, progression to proliferative retinopathy and of incidences of macular edema, sore or ulcers on feet or ankles, lower extremity amputation, proteinuria, and cardiovascular disease 4 years after this examination with respect to peak expiratory flow rate were evaluated. Study procedures including measurements of blood pressure, height and weight, grading of fundus photographs, peak expiratory flow rate, urinalysis, and medical history were performed according to standard protocols. Peak expiratory flow rate was not associated in univariate analyses with progression of retinopathy, incidences of proliferative retinopathy, macular edema or lower extremity amputation, sores or ulcers on feet or ankles, gross proteinuria, or self-reported cardiovascular disease. However, when using multivariable models to include the effects of other risk factors, peak expiratory flow rate was significantly associated with the combined incidences of sores or ulcers on feet and ankles, or lower extremity amputations (OR=0.61, 95% CI 0.42-0.88). These data suggest that peak expiratory flow rate is a predictor of subsequent complications in the lower extremities in those with long duration of younger-onset diabetes. Evaluating this association in an incipient cohort would illuminate whether the relationship we found is likely to be causal.
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PMID:Is peak expiratory flow rate a predictor of complications in diabetes? The Wisconsin Epidemiologic Study of Diabetic Retinopathy. 1171 23

Rapidly accumulating clinical data have repeatedly demonstrated not only the critical importance of even small increases in blood pressure as a pathophysiologic factor in the development of cardiovascular disease, particularly in individuals with diabetes mellitus, but also the therapeutic necessity of more aggressive blood pressure reduction and the achievement of progressively lower blood pressure targets in reducing cardiovascular event rates. JNC VI has defined optimal blood pressure as <or=120/80 mm Hg, and Stage 1 hypertension as >or=140/80 mm Hg. Target blood pressures are now <or=130/80 mm Hg in patients with diabetes and <125/75 mm Hg for patients with hypertensive renal disease with proteinuria of >1 gm/24 hours. Achieving such target pressures is increasingly difficult, particularly in diabetic patients with chronic renal disease, who require complex multidrug antihypertensive regimens. This review attempts to provide some suggestions for constructing such antihypertensive regimens, and provides considerations for the appropriate use of diuretics and the most effective drug combinations. Factors potentially contributing to drug resistant hypertension include such problems as failure to maximize drug dosing, suboptimal diuretic use, noncompliance, and possible confounding effects of such concomitant medications as nonsteroidal and anti-inflammatory drugs or decongestants. The issues underlying drug-resistant hypertension are listed, together with strategies for overcoming this problem.
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PMID:Beyond the usual strategies for blood pressure reduction: therapeutic considerations and combination therapies. 1172 56

Clinical data have established microalbuminuria/proteinuria as an independent risk factor for the development and progression of renal disease in patients with either diabetes or essential hypertension. Decreased kidney function is associated with increased cardiovascular risk, even at modest reductions in estimated creatinine clearance (to approximately 60 mL/min/1.73 m(2)) or modest elevations in serum creatinine (>1.4 mg/dL). Treatment with angiotensin-converting enzyme inhibitors has been shown in clinical trials to delay or stabilize the rate of progression of renal disease. Reduction in cardiovascular events, such as stroke and myocardial infarction, also has been shown in these high-risk individuals. These effects are dependent and independent of blood pressure control, suggesting a nonhemodynamic effect in blockade of the renin-angiotensin system. In conjunction with other therapeutic interventions, such as dietary modification and control of serum lipids, it appears that for at least a subgroup of patients it is possible to delay or prevent progression of kidney failure. There frequently is a clustering of risk factors in these individuals, including insulin resistance, salt sensitivity, hypertension, and dyslipidemia. The mechanism of the relationship between albuminuria and cardiovascular disease is unclear but may be related to endothelial cell dysfunction. Nonetheless, the presence of microalbuminuria/proteinuria as a marker for cardiovascular disease has important implications for the identification and treatment of individuals at risk.
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PMID:Metabolic pathogenesis of cardiorenal disease. 1172 77

Mixed cryoglobulinemia (MC) and glomerulonephritis are the most important extrahepatic manifestations of chronic hepatitis C virus (HCV) infection. In HCV-infected patients with MC, renal involvement worsens the overall prognosis because of a high incidence of infection or cardiovascular disease. The relationship between MC and HCV infection has prompted the use of antiviral therapy. Two patients with chronic HCV infection, type-II MC and membranoproliferative glomerulonephritis (MPGN), presenting as nephrotic syndrome were treated with interferon (IFN)-alpha (3 MU 3 times per week) and ribavirin (15 mg/kg daily) for 6 months. Laboratory tests included measurement of anti-HCV antibodies, HCV RNA, and HCV genotyping, and characterization of circulating cryoglobulins. A pretreatment renal biopsy was performed, and the histopathologic lesions were scored according to the index of disease activity. Viremia and cryoglobulinemia were suppressed in both patients. However, a complete remission of proteinuria was observed in 1 patient only. The evaluation of the renal biopsy specimens revealed a mild MPGN (activity score: 5/24) in the patient with remission of proteinuria and a severe MPGN (activity score: 15/24) in the patient who maintained a nephrotic-range proteinuria. Although a fully satisfactory treatment is not yet available, we feel that a reasonable therapeutic strategy for HCV-infected patients with MC nephritis could be as follows: (1) antiviral treatment alone for patients with a low-grade kidney involvement, and (2) a short-term course of steroids and cytotoxic drugs followed by antiviral therapy for acute exacerbations and/or rapidly progressive GN.
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PMID:Interferon-alpha in combination with ribavirin as initial treatment for hepatitis C virus-associated cryoglobulinemic membranoproliferative glomerulonephritis. 1172 95

Dyslipidemias are common after renal transplantation. Most common are elevations in total and low-density lipoprotein cholesterol. Causes of dyslipidemia are usually multiple, but include immunosuppression (especially prednisone, cyclosporine and sirolimus), graft dysfunction (reduced glomerular filtration rate and proteinuria), and genetic predisposition. There is a growing amount of evidence suggesting that dyslipidemias contribute to the very high incidence of cardiovascular disease after transplantation. Less well established is whether the associations between dyslipidemias and graft dysfunction are due to a causal role of lipid abnormalities on renal injury. In any case, hypercholesterolemia, and especially increases in low density lipoprotein cholesterol, should be treated using guidelines established for patients in the general population.
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PMID:Dyslipidemia and its management after renal transplantation. 1179 52

The incidence of diabetic nephropathy has declined these last decades, but diabetes mellitus still remains the commonest cause of end-stage renal failure, due to an increased prevalence of diabetes mellitus and a longer life expectancy for diabetic patients. The aim of this review is to describe the natural history of diabetic nephropathy and discuss the influence of many factors such as genetic and non-genetic progression promoters, hypertension, hyperglycemia, dyslipidemia, proteinuria and tobacco. Because only a comprehensive treatment strategy of these promoters will reduce the risk of end-stage renal failure, the inclusion of cardiovascular risk factors management and the screening of cardiovascular disease will further contribute to reduce the very high mortality of diabetic patients suffering of diabetic nephropathy.
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PMID:[Diabetic nephropathies: therapeutic aspects]. 1182 Jan 69

Persistent nephrotic syndrome is frequently accompanied by severe hyperlipidemia, and this may pose a substantial risk for cardiovascular disease. Lipid-lowering drugs are prescribed by many nephrologists for adult patients but rarely for nephrotic children. The present investigation was designed to evaluate the safety and efficacy of gemfibrozil in nephrotic children. Eight girls and four boys aged from 5 to 17 years were enrolled in this study. They were all steroid and immunosuppressive resistant patients with nephrotic range proteinuria. Placebo was administered to five patients and gemfibrozil was administered to seven patients for four months. Blood samples were taken for the determination of cholesterol, triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL), BUN, serum creatinine (Scr), ALT, AST, CPK, apolipoprotein A (apo A), apoliporotein B (apo B), and serum albumin levels during the initial and subsequent examinations. At the end of the fourth month, gemfibrozil reduced total cholesterol by 34%, LDL by 30%, apo B by 21% and triglycerides by 53% (p < 0.05). HDL cholesterol and apo A levels were not significantly altered. Renal function and urine protein excretion were not affected by gemfibrozil. In this study gemfibrozil therapy had no side effects and had favorable effects on the lipoprotein profile of nephrotic patients.
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PMID:The effects of gemfibrozil on hyperlipidemia in children with persistent nephrotic syndrome. 1185 78

Microalbuminuria (MA) is associated with adverse health outcomes in diabetic and hypertensive adults. The prevalence and clinical significance of MA in nondiabetic populations is less clear. The purpose of this study was to generate national estimates of the prevalence of MA in the US population. Untimed urinary albumin concentrations (UACs) and creatinine concentrations were evaluated in a nationally representative sample of 22,244 participants aged 6 years and older. Persons with hematuria and menstruating or pregnant women were excluded from analysis. The percent prevalence of clinical proteinuria (UAC > or = 300 mg/L) was similar for males and females. However, the prevalence of MA (urinary albumin-creatinine ratio [ACR], 30 to 299 mg/g) was significantly lower in males (6.1%) compared with females (9.7%). MA prevalence was greater in children than young adults and increased continuously starting at 40 years of age. MA prevalence was greater in non-Hispanic blacks and Mexican Americans aged 40 to 79 years compared with similar-aged non-Hispanic whites. MA prevalence was 28.8% in persons with previously diagnosed diabetes, 16.0% in those with hypertension, and 5.1% in those without diabetes, hypertension, cardiovascular disease, or elevated serum creatinine levels. In adults aged 40+ years, after excluding persons with clinical proteinuria, albuminuria (defined as ACR > or = 30 mg/g) was independently associated with older age, non-Hispanic black and Mexican American ethnicity, diabetes, hypertension, and elevated serum creatinine concentration. MA is common, even among persons without diabetes or hypertension. Age, sex, race/ethnicity, and concomitant disease contribute to the variability of MA prevalence estimates.
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PMID:Microalbuminuria in the US population: third National Health and Nutrition Examination Survey. 1214 24


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