Overt proteinuria and microalbuminuria in autosomal dominant polycystic kidney disease.
Overt proteinuria and microalbuminuria in autosomal dominant polycystic kidney disease.
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发表时间：
1994-12
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通讯作者：
Arlene B. Chapman;Ann M. Johnson;P. Gabow;Robert W. Schrier
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作者：
Arlene B. Chapman;Ann M. Johnson;P. Gabow;Robert W. Schrier
蛋白尿量是多种肾小球疾病的预后指标。为了探讨尿蛋白排泄在常染色体显性多囊肾病中的重要性，本研究确定了常染色体显性多囊肾病合并蛋白尿患者的临床特征以及高血压常染色体显性多囊肾病合并无蛋白尿患者微量白蛋白尿的频率。在270例常染色体显性多囊肾病患者中，平均24小时尿蛋白排泄量为259 +/- 22 mg/天。270例常染色体显性多囊肾病患者中有48例蛋白尿过高（蛋白尿300 mg/天）。与非蛋白尿患者相比，蛋白尿患者的平均动脉压更高，肾容量更大，肌酐清除率更低（均P < 0.0001），吸烟史更大（P < 0.05），肾脏疾病病程更严重（P < 0.05）。所有常染色体显性多囊肾病合并蛋白尿的患者均为高血压，而未合并蛋白尿的患者为67% （P < 0.001）。本文对49例高血压合并左心室肥厚、无蛋白尿的患者进行微量白蛋白尿检查；41%表现为微量白蛋白尿。微量白蛋白尿患者有较高的平均动脉压、较大的肾容量和较高的滤过率。因此，常染色体显性多囊肾病患者的蛋白尿和微量白蛋白尿与平均动脉压升高和更严重的肾囊受累相关。
The amount of proteinuria is a prognostic indicator in a variety of glomerular disorders. To examine the importance of urinary protein excretion in autosomal dominant polycystic kidney disease, this study determined the clinical characteristics of autosomal dominant polycystic kidney disease patients with established proteinuria and the frequency of microalbuminuria in hypertensive autosomal dominant polycystic kidney disease patients without proteinuria. In 270 autosomal dominant polycystic kidney disease patients, mean 24-h urinary protein excretion was 259 +/- 22 mg/day. Forty-eight of 270 autosomal dominant poly-cystic kidney disease patients had over proteinuria (> 300 mg/day). The patients with established proteinuria had higher mean arterial pressures, larger renal volumes, and lower creatinine clearances than did their nonproteinuric counterparts (all P < 0.0001), a greater pack year smoking history (P < 0.05), and the projection of a more aggressive course of renal disease (P < 0.05). All autosomal dominant polycystic kidney disease patients with established proteinuria were hypertensive, as compared with 67% without established proteinuria (P < 0.001). Forty-nine patients with hypertension and left ventricular hypertrophy without established proteinuria were examined for microalbuminuria; 41% demonstrated microalbuminuria. Those with microalbuminuria had higher mean arterial pressure, larger renal volumes and increased filtration fraction. Therefore, established proteinuria and microalbuminuria in autosomal dominant polycystic kidney disease patients are associated with increased mean arterial pressure and more severe renal cystic involvement.