Comparison of Different Measures of Urinary Protein Excretion for Prediction of Renal Events
Comparison of Different Measures of Urinary Protein Excretion for Prediction of Renal Events
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DOI：
10.1681/asn.2010010063
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发表时间：
2010-08-01
影响因子：
13.6
通讯作者：
de Zeeuw, Dick
中科院分区：
文献类型：
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作者：
Lambers Heerspink, Hiddo J.;Gansevoort, Ron T.;de Zeeuw, Dick
有许多方法可以筛查蛋白尿的异常量，以确定肾脏疾病进展风险的患者，但哪种方法最能预测肾脏风险尚不清楚。在此，我们分析了参与血管紧张素II拮抗剂氯沙坦降低非胰岛素依赖型糖尿病终点（RENAAL）试验的701例2型糖尿病和肾病患者的亚组，以比较24小时尿液采集的尿蛋白排泄（UPE）和尿白蛋白排泄（UAE）能力以及尿白蛋白浓度（UAC）和白蛋白：肌酐比（ACR）从第一次晨尿预测肾脏事件。主要结局指标为至血清肌酐加倍或终末期肾病的时间。在随访期间，发生了202起事件。在对数转换测量值中，与1-SD增量相关的肾脏结局风险的风险比（95% CI）为：UAE 3.16（2.60 - 3.86），UPE 3.02（2.53 - 3.62），UAC 3.23（2.67 - 3.91），ACR 4.36（3.50 - 5.45）。ACR的ROC曲线下面积显著高于其他指标。总之，测定晨尿白蛋白/肌酐比值是预测2型糖尿病肾病患者肾脏事件的上级方法。
There are many methods to screen for abnormal amounts of proteinuria to identify patients at risk for progression of renal disease, but which method best predicts renal risk is unknown. Here, we analyzed a subset of 701 patients with type 2 diabetes and nephropathy participating in the Reduction of Endpoints in Non Insulin Dependent Diabetes Mellitus with the Angiotensin II Antagonist Losartan (RENAAL) trial to compare the ability of urinary protein excretion (UPE) and urinary albumin excretion (UAE) from a 24-hour urine collection and urinary albumin concentration (UAC) and the albumin: creatinine ratio (ACR) from a first-morning void in predicting renal events. The primary outcome measure was the time to a doubling of serum creatinine or end-stage renal disease. During follow-up, 202 events occurred. The hazard ratios for the risk of a renal outcome (95% CIs) associated with 1-SD increment in the log-transformed measures were 3.16 (2.60 to 3.86) for UAE, 3 02 (2.53 to 3.62) for UPE, 3.23 (2.67 to 3.91) for UAC, and 4.36 (3.50 to 5.45) for ACR. The area under the ROC curve was significantly higher for ACR compared with the other measures In conclusion, measurement of the albumin.creatinine ratio in a first-morning void is the superior method to predict renal events in patients with type 2 diabetes and nephropathy.