How should proteinuria be detected and measured?

Ann Clin Biochem 2009;46:205-217
doi:10.1258/acb.2009.009007
© 2009 Association for Clinical Biochemistry

 

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What’s this?

Review Articles


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 presencecarries powerful prognostic information. Although proteinuriatesting is enshrined in clinical practice guidelines, thereis surprising variation among such guidelines as to the definitionof clinically significant proteinuria. There is also poor agreementas to whether proteinuria should be defined in terms of albuminor total protein loss, with a different approach being usedto stratify diabetic and non-diabetic nephropathy. Further,the role of reagent strip devices in the detection and assessmentof proteinuria is unclear. This review explores these issuesin relation to recent national and international guidelineson chronic kidney disease (CKD) and epidemiological evidencelinking proteinuria and clinical outcome. The authors arguethat use of urinary albumin measurement as the front-line testfor proteinuria detection offers the best chance of improvingthe sensitivity, quality and consistency of approach to theearly detection and management of CKD.


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