| Nephrotic syndrome in diabetic kidney disease: an evaluation and update of the definition. | |
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MedLine Citation:
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PMID: 19556043 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Nephrotic syndrome is defined as urine total protein excretion greater than 3.5 g/d or total protein-creatinine ratio greater than 3.5 g/g, low serum albumin level, high serum cholesterol level, and peripheral edema. These threshold levels have not been rigorously evaluated in patients with diabetic kidney disease or by using urine albumin excretion, the preferred measure of proteinuria in patients with diabetes. STUDY DESIGN: Diagnostic test study. SETTING & PARTICIPANTS: Adults with type 2 diabetes, hypertension, and urine total protein level greater than 0.9 g/d enrolled in the Irbesartan in Diabetic Nephropathy Trial. INDEX TEST: Baseline measures of proteinuria (total protein and albumin excretion and protein-creatinine and albumin-creatinine ratios). Linear regression to relate measures. REFERENCE TEST: Other signs and symptoms of nephrotic syndrome at baseline (serum albumin < 3.5 g/dL, serum total cholesterol > 260 mg/dL or use of a statin, and edema or use of a loop diuretic); progression of chronic kidney disease during follow-up (doubling of baseline serum creatinine level or requirement for dialysis or kidney transplantation). Logistic regression to relate index and reference tests. RESULTS: In 1,608 participants, total urine protein level of 3.5 g/d was equivalent to urine albumin level of 2.2 g/d (95% confidence interval, 1.4 to 3.5). Of 1,467 participants, 641 (44%) had urine total protein level of 3.5 g/d or greater at baseline, 132 (9%) had other signs and symptoms of nephrotic syndrome at baseline, and 385 (26%) had progression of kidney disease during a mean follow-up of 2.6 years. Areas under the receiver operating curves for measures of proteinuria were 0.80 to 0.83 for other signs and symptoms of nephrotic syndrome and 0.72 to 0.74 for kidney disease progression. Threshold levels for nephrotic-range proteinuria and albuminuria were close to the points of maximal accuracy for both outcomes. LIMITATIONS: Study population limits generalizability; inability to adjust for several variables known to affect serum albumin levels; lack of spot urine samples. CONCLUSIONS: The historical definition of nephrotic-range proteinuria appears reasonable in patients with diabetic kidney disease. Equivalent thresholds for nephrotic-range albuminuria and albumin-creatinine ratio are 2.2 g/d and 2.2 g/g, respectively. |
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Authors:
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Nicholas Stoycheff; Lesley A Stevens; Christopher H Schmid; Hocine Tighiouart; Julia Lewis; Robert C Atkins; Andrew S Levey |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2009-06-25 |
Journal Detail:
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Title: American journal of kidney diseases : the official journal of the National Kidney Foundation Volume: 54 ISSN: 1523-6838 ISO Abbreviation: Am. J. Kidney Dis. Publication Date: 2009 Nov |
Date Detail:
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Created Date: 2009-10-26 Completed Date: 2009-11-16 Revised Date: 2012-03-05 |
Medline Journal Info:
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Nlm Unique ID: 8110075 Medline TA: Am J Kidney Dis Country: United States |
Other Details:
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Languages: eng Pagination: 840-9 Citation Subset: IM |
Affiliation:
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Division of Nephrology, Tufts Medical Center, Boston, MA 02111, USA. nstoycheff@tuftsmedicalcenter.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Albuminuria
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urine Creatinine / urine Diabetic Nephropathies / diagnosis*, urine Disease Progression Female Humans Male Middle Aged Nephrotic Syndrome / diagnosis*, urine |
| Grant Support | |
ID/Acronym/Agency:
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K23 DK081017-05/DK/NIDDK NIH HHS; T32 DK07777/DK/NIDDK NIH HHS; U01 DK053869/DK/NIDDK NIH HHS |
| Chemical | |
Reg. No./Substance:
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60-27-5/Creatinine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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