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Proteinuria above 300 mg/day raises prognostic red flag. (Monitor in Hypertensive Patients).

PHILADELPHIA -- Proreinuria of 3001,000 mg/day is very bad for a patient's kidneys.

"In the past, physicians have considered proteinuria important only if it exceeded 1 g/day, but results from the African American Study of Kidney Disease and Hypertension (AASK) suggest that proteinuria is a bad prognostic sign down to at least 300 mg/day" Dr. Robert G. Luke said at the annual meeting of the American Society of Nephrology.

As a result, "physicians should monitor urinary protein in all patients with hypertension," said Dr. Luke, director of internal medicine at the University of Cincinnati.

In patients with hypertension and proteinuria levels of more than 300 mg/day--corresponding to a urinary protein to creatinine ratio of more than 0.22--the first-line antihypertensive drug should be an agent that blocks the renin-angiotensin system: either an ACE inhibitor or an angiotensin-receptor blocker. Results from AASK and from many other recent trials have shown that these drugs work best for preserving renal function and blocking progression of proteinuria.

If a patient with hypertension has microalbuminuria (proteinuria of 30-300 mg/day) it probably flags early-stage renal insufficiency and the need for a renal protective antihypertensive drug, Dr. Luke said. But so far there is no evidence to back up this approach from controlled studies.

To monitor proteinuria in hypertensive patients, Dr. Luke recommended assessing the urinary protein to creatinine ratio every 6-12 months. This test can be done using a morning urine specimen. If the result is negative, perform a microalbuminuria test using a 24-hour urine specimen to confirm the negative finding, he suggested.
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Author:Zoler, Mitchel L.
Publication:Internal Medicine News
Geographic Code:1USA
Date:Dec 1, 2002
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