Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/13563
Title: Why is proteinuria such an important risk factor for progression in clinical trials?
Austin Authors: Jerums, George ;Panagiotopoulos, Sianna ;Tsalamandris, Con;Allen, Terri J;Gilbert, Richard E;Comper, Wayne D
Affiliation: Endocrine Unit, University of Melbourne, Austin, Australia
Issue Date: 1-Dec-1997
Publication information: Kidney International. Supplement; 63: S87-92
Abstract: There are strong reasons to justify the concept that proteinuria is a major risk factor for progression in clinical trials. The evidence is strongest where therapeutic intervention has been focused on established renal disease, when changes in albumin excretion rate (AER) and glomerular filtration rate (GFR) occur within a short time span. Proteinuria is also important in emerging renal disease, such as incipient diabetic nephropathy (DN), since natural history studies show that small increases in AER predict clinical nephropathy and, ultimately, a decline in GFR. However, the absence of concurrent changes in GFR in incipient DN complicates the evaluation of clinical trials in this condition. It is also not certain that the degree of coupling of changes in AER and GFR is the same during intervention as during natural history studies. The importance of proteinuria as a risk factor for progression has been strengthened by recent evidence showing that proteinuria itself causes renal damage. Traditional concepts of the damaging effects of proteinuria have focused on the glomeruli, where mesangial expansion induced by transcapillary passage of proteins has been considered to lead to a decrease in glomerular filtration surface and a decline in GFR. New evidence suggests that interaction of albumin with proximal renal tubules may not only lead to renal damage but may also be causally related to increases in AER.
Gov't Doc #: 9407431
URI: http://ahro.austin.org.au/austinjspui/handle/1/13563
ORCID: 0000-0002-0845-0001
URL: https://pubmed.ncbi.nlm.nih.gov/9407431
Type: Journal Article
Subjects: Albuminuria.pathology
Diabetic Nephropathies.pathology
Disease Progression
Humans
Kidney Diseases.pathology
Proteinuria.pathology
Risk Factors
Appears in Collections:Journal articles

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