Proteinuria, applied physiology and pathophysiology
DOI:
https://doi.org/10.51481/amc.v49i2.302Keywords:
proteinuria, renal physiology, nephropathyAbstract
Proteinuria is defined as the urinary excretion of more than 150 mg of protein in 24 hours. Proteinuria has been used as a marker of renal disease, becoming one of the nephrologists' most used markers. Common conditions such as arterial hypertension and Diabetes Mellitus express their renal damage as proteinuria, which has become a marker of systemic and not only renal disease. Normally, an individual filters 5000mg of proteins each day, of which 4950 mg are reabsorbed in the proximal kidney tubule. In the present article we analyze the different types of proteinuria based on pathophysiological concepts. Currently, there are many laboratory methods for proteinuria quantification, but the proteinuria / creatinuria ratio and the 24 hour urine collection continue to be the more commonly utilized. Proteinuria has been shown to be individually the most important factor used to predict the progression of renal disease. The importance of proteinuria has also been confirmed in cardiac patients, becoming a risk factor for ischemic cardiovascular disease even more important than other classic ones such as smoking, diabetes or left ventricular hypertrophy. Proteinuria is more than just proteins in the urine, it's a sign of alert.
Downloads
References
Abuelo, J. Proteinuria: diagnostic principles and procedures. Ann Intern Med. 1983; 98: 186-91.
Miltenyi, M. Urinary protein excretion in healthy children. Clin Nephrol. 1979; 12: 216-21.
Bergstein, J. A practical approach to proteinuria. Pediatr Nephrol. 1999; 13: 697-700.
Clínica Universitaria de Navarra [home page on the Internet]. España. Análisis de las proteínas plasmáticas. Accedido 30 de abril de 2003. Disponible en: http://www.viatusalud.com/documento.asp?ID=6229&G=133.
Giebisch, G. Windhager, E. Organization of the Urinary System. In: Boron, W. Boulpaep, E. editors. Medical Physiology. Elsevier Science; 2003. p 737 - 755.
Horsey, P. The Cochrane 1998 albumin review - not all it was craked up to be. Euro J Anesth. 2002; 19: 170-704.
Evans, TW. Review article: albumin as a drug-biological effects of albumin unrelated to oncótica pressure. Aliment Phamacol Ther. 2002; 16:6-11.
Valtin, H. Schafer, J. Renal function. 3rd ed. Boston: Little, Brown and Company. 1996.
Ulate, G. Fisiología renal. San José: Editorial de la Universidad de Costa Rica. 2006.
Tryggvason, K. Pettersson, E. Causes and consequences of proteinuria: the kidney filtration barrier and progressive renal failure. J Intern Med. 2003; 254:216-224.
Despopoulos, A. Silbernagl, S. Color Atlas of Physiology. 3rd ed. Revised. New York: Thieme Inc. 1986.
Deen, W. Bridges, C. Brenner, B. Myers, B. Heteroporous model of glomerular size selectivity: application to normal and nephritic humans. Am J Physiol. 1985; 249: F374 - F389.
Ganong, W. Review of Medical Physiology. 22ed. New York: McGrawHill Medical. 2005.
Christensen, E. Birn, H. Megalin and cubulin: multifunctional endocitic receptors. Nature Review. 2002; 3: 258-267.
Devuyst O, Dahan K, Pirson Y. Tamm-Horsfall protein or uromodulin: new ideas about an old molecule. Nephrology dialysis transplantation. 2005 Jul; 20:1290-1294.
Kumar, S. Are Tamm-Horsfall protein and uromodulin identical. Euro J Clin Inv. 1998; 28: 483 - 484
Torffvit, O. Melander, O. Hulten, U. Urinary excretion rate of TammHorsfall protein is related to salt intake in humans. Nephron Physiol. 2004; 97: 31-36.
Zimmerbackl, L. Rostasy, K. Wiegele, G. Rasenack, A. Lohner, M. Brandis, M. Kinne, H. Tamm-Horsfall protein as a marker of tubular maturation. Pediatr Nephrol. 1996; 10: 448-452.
Wangsiripaisan, A. Role of polymeric Tamm-Horsfall protein in cast formation. Kidney Int. 2001; 59: 932 - 940.
Carroll, M. Temte, J. Proteinuria in Adults: A diagnostic approach. American Family Physician. 2000; 62: 1333-1341.
Venkat, K. Proteinuria and microalbuminuria in adults: Significance, evaluation and treatment. Southern Medical J. 2004; 97: 969 -978.
Yamasmit, W. Chaithongwongwatthana, S. Charoenvidhya, D.
Uerpairojkit, B, Tolosa, J. Random urinary protein-to-creatinine ratio for prediction of significant proteinuria in women with Preeclampsia. J Maternal-Fetal and Neonatal Med. 2004; 16: 275-279.
Ginsberg JM, Chang BS, Matarese RA, Garella S. Use of single voided urine samples to estimate quantitative proteinuria. N EngI J Med 1983;309:1543-1546.
Rodby RA, Rohde RD, Sharon Z, Pohl MA, Bain RP, Lewis EJ . The urine protein to creatinine ratio as a predictor of 24-hour urine protein excretion in type 1 diabetic patients with nephropathy. The Collaborative Study Group. Am J Kidney Dis 1995;26:904-909.
Somanathan, N. Farrel, T. Galimerti, A. A comparison between 24hour and 2-hour urine collection for the determination of proteinuria. J Obs and Gyn. 2003; 23: 378-380.
Breckin, C. Garber, S. Primer of Urinalysis: III. Proteinuria - promises and pitfallas. Kidney. 2002 Update I: 95- 97.
D'Amico, G. Bazzi, C. Pathophysiology of proteinuria. Kidney Int. 2003; 63: 809 - 825.
Marks, M. Mclaine, P. Drummond, K. Proteinuria in children with febrile illnesses. Arch Dis Child. 1970; 45:250-253.
Coye, R. Rosandich, R. Proteinuria during the 24-hour period following exercise. J Appl Physiol. 1960; 15:592-594.
Poortmans, J. Postexcersie proteinuria in humans. JAMA. 1985; 253: 236-240.
Lindheimer, M. Katz, A. The kidney and hypertension in pregnancy. In: Brenner, B. Rector, F. editors. The kidney. 4th ed. Philadelphia: WB Saunders C.; 1991. p.1551 - 1595.
Gordon, M. Maternal physiology in pregnancy. In: Gabbe, S. Obstetrics: Normal and Problem Pregnancies. 4th ed. Philadelphia: Churchill Livingstone; 2002: p.63 - 92.
Reuben, D. Watchel, T. Brown, P. Transient proteinuria inemergency medical admissions. N Engl J Med. 1982; 306: 1031-1033.
Randolph, M. Greenfield, M. Proteinuria: a six year study of normal infants, preschool and school age populations previously screened for urinary tract disease. Am J Dis Child. 1967; 114:631-638. Abstract.
Von Bonsdorff M, Koskenvuo K, Salmi HA, Pasternack A. Prevalence and causes of proteinuria in 20-year old Finnish men. Scand J Urol Nephrol 1981;15:285-90.
Levitt JI. The prognostic significance of proteinuria in young college students. Ann Intern Med 1967;66:685-96. Abstract.
Muth RG. Asymptomatic mild intermittent proteinuria. Arch Intern Med 1965;115:569-74.Abstract.
Rytand DA, Speiter S. Prognosis in postural (orthostatic) proteinuria. N Engl J Med 1981;305:618-21.
Springberg PD, Garrett LE , Thompson AL , Collins NF, Lordon RE, Robinson RR . Fixed and reproducible proteinuria: results of a 20year follow-up study. Ann Intern Med 1982;97:516-9.
Vehaskari VM, Rapola J. Isolated proteinuria: Analysis of a schoolage population. J Pediatr 1982;101:661-8.
Houser MT, Jahn MF, Kobayashi A, Walburn J. Assessment of urinary protein excretion in the adolescent: Effect of body position and exercise. J Pediatr 1986;109:556-61.
Vehaskari VM. Mechanism of orthostatic proteinuria. Pediatr Nephrol 1990;4:328-30.
Devarajan, P. Mechanisms of orthostatic proteinuria: lessons from a trasplant donor. J Am Soc Nephrol. 1993; 4:36-39.
Sinniah R, Law CH, Pwee HS. Glomerular lesions in patients with asymptomatic persistent and orthostatic proteinuria discovered on routine medical examinations. Clin Nephrol 1977;7:1-14.
Vehaskari V. Mechanism of orthostatic proteinuria. Pediatr Nephrol 1990; 4: 328-330.
Shintaku N, Takahashi Y, Akaishi K, Sano A, Kuroda Y. Entrapment of left renal vein in children with orthostatic proteinuria. Pediatr Nephrol 1990; 4: 324-327.
Trachtman H, Bergwerk A, Gauthier B. Isolated proteinuria in children. Clin Pediatr 1994;33:468-72.
Urizar RE, Tinglof BO, Smith Jr FG, McIntosh RM. Persistent asymptomatic proteinuria in children. Am J Clin Pathol 1974;62:461- 71.
Yoshikawa N, Kitagawa K, Ohta K, Tanaka R, Nakamura H. Asymptomatic constant isolated proteinuria in children. J Pediatr 1991;119:375-9.
Yoshikawa N, Uehara S, Yamana K, Ikeuchi H, Hiraumi M, Matsuo T, et al. Clinicopathological correlations of persistent asymptomatic proteinuria in children. Nephron 1980;25:127-33.
Kusumoto Y, Takebayashi S. Benign persistent asymptomatic proteinuria with incomplete foot process disease in adolescents: a new clinical entity? Clin Nephrol 1987;28:174-9.
Mogensen CE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med 1984;310:356.
Krasper, D. Braunwald, E. Fauci, A. Hauser, S. Longo, D. Jameson, L. Principles of Internal Medicine. 16th ed. 2004. McGraw-Hill Professional
Universidad Complutense de Madrid. [home page on the Internet]. España. Proteinuria y transplante renal. 2002. Disponible en: http:// www.ucm.es/info/fmed/medicina.edu/Temasinteres/proteina.htm
Brown MJ, Palmer CR, Castaigne A, de Leeuw PW, Mancia G, Rosenthal T, et al. Morbidity and mortality in patients randomised to double-blind treatment with a long-acting calcium-channel blocker or diuretic in the International Nifedipine GITS study: Intervention as a Goal in Hypertension Treatment (INSIGHT). Lancet 356: 366-372, 2000.
Segura J, Campo C, Ruilope LM: Proteinuria: an underappreciated risk factor in cardiovascular disease. Curr Cardiol Rep 4: 458-462, 2002.
Dahlöf B, Devereux RB, Kjeldsen SE, Julius S, Beevers G, de Faire U, et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a
randomized trial against atenolol.. Lancet. 2002 Mar 23;359(9311):995-
Lindholm LH, Ibsen H, Dahlöf B, Devereux RB, Beevers G, de Faire U, et al. Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet. 2002 Mar 23;359(9311):1004-10
Wachtell K, Ibsen H, Olsen MH, Borch-Johnsen K, Lindholm LH, Mogensen CE, et al. Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE study. Ann Intern Med. 2003 Dec 2;139:901-6.
Gerstein HC, Mann JFF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001 Jul 25;286:421-6.
Iseki, K. Proteinuria and the risk of developing end stage renal disease. Kidney Int 2003; 63: 1468-1474.
Hart, P. Maximum reduction of proteinuria in renal disease. Kidney 2004; 13: 99 - 103.
Mulrow, C. Guiding lights for antihypertensive treatment in patients with nondiabetic chronic renal disease. Ann Int Med. 2003; 139: 296 - 298.
Hogg, R. Portman, R. Milliner, D. Lemley, K. Eddy, A. Ingelfinger, J. Evaluation and management of pronteinuria and nephritic syndrome in children: recomendationes from a pediatric nephrology panel established at the national kidney foundation conference on proteinuria, albuminuria, risk, assesmente, detection and elimination (PARADE).
Pediatrics. 2000; 105:1242-1249.
Downloads
Published
Issue
Section
License
Copyright (c) 2008 Acta Médica Costarricense

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Los autores que publican en la revista Acta Médica Costarricense pueden distribuir, copiar, remezclar, retocar, leer, descargar, imprimir, buscar y crear a partir de su obra de modo no comercial, indicando los créditos a la revista y sus autores y compartir su obra en las mismas condiciones. Para ello se aplica la licencia Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0 Internacional(CC BY-NC-SA 4.0)



