Proteinuria is a strong predictor of adverse cardiovascular and kidney events, and an accurate assessment of
proteinuria is important for the evaluation and
management of CKD. Total urinary protein can be assessed using a dipstick, precipitation, and
electrophoresis methods. Urinary albumin, the predominant urinary protein in most proteinuric kidney diseases, can be assessed using an albumin-specific dipstick, immunochemical techniques, and size-exclusion high-performance liquid chromatography. Urine albumin may be immune-reactive, immune-unreactive, fragmented, and biochemically modified, and laboratory techniques have variable abilities to detect different types of albumin. A urine specimen for
proteinuria assessment can either be obtained from a timed-collection or a spot urine sample. Recent clinical studies have demonstrated that modification of
proteinuria by the use of angiotensin-converting enzyme (ACE) inhibitors independent of reductions in systemic blood pressure results in a slowing of the rate of loss of renal function and even stabilization of renal function over longer periods of treatment. In patients with renal disease, the totality of evidence suggests that multiple pharmacological and dietary modifications will be necessary to achieve the optimal slowing of the progression of renal disease. In addition, strategies will be required to reduce risks involved in the development of
cardiovascular disease to ensure optimal patient survival. The similarity of risk factors involved in cardio-renal disease progression should allow us to achieve this goal with our current therapeutic armamentarium.
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