Annals of Clinical Biochemistry > Volume 46, Number 3 > Pp. 205-217

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Review Articles

How should proteinuria be detected and measured?

Edmund J Lamb¹, Finlay MacKenzie³ and Paul E Stevens²

¹ Department of Clinical Biochemistry; ² Department of Renal Medicine, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent CT1 3NG; ³ Wolfson EQA Laboratory, PO Box 3909, Birmingham B15 2UE, UK

Corresponding author: Dr Edmund J Lamb, Department of Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Ethelbert Road, Canterbury, Kent CT1 3NG, UK. Email: Edmund.lamb{at}ekht.nhs.uk

Proteinuria is a classic sign of kidney disease and its presence carries powerful prognostic information. Although proteinuria testing is enshrined in clinical practice guidelines, there is surprising variation among such guidelines as to the definition of clinically significant proteinuria. There is also poor agreement as to whether proteinuria should be defined in terms of albumin or total protein loss, with a different approach being used to stratify diabetic and non-diabetic nephropathy. Further, the role of reagent strip devices in the detection and assessment of proteinuria is unclear. This review explores these issues in relation to recent national and international guidelines on chronic kidney disease (CKD) and epidemiological evidence linking proteinuria and clinical outcome. The authors argue that use of urinary albumin measurement as the front-line test for proteinuria detection offers the best chance of improving the sensitivity, quality and consistency of approach to the early detection and management of CKD.

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