From the Guidelines
A urine protein-creatinine ratio of 94 mg/mmol is significantly elevated and requires immediate medical attention to prevent further kidney damage and potential progression to chronic kidney disease. This level is well above the normal range, which is typically considered to be less than 15 mg/mmol 1. The presence of significant proteinuria suggests kidney dysfunction and may indicate conditions such as glomerulonephritis, diabetic nephropathy, or other kidney diseases.
Key Considerations
- The patient should consult with a nephrologist or primary care physician promptly for evaluation and management.
- Additional tests, including a complete metabolic panel, full urinalysis, and possibly kidney imaging or biopsy, may be ordered depending on the clinical presentation.
- While waiting for the appointment, it is essential to monitor blood pressure regularly, maintain good hydration, and follow a low-sodium diet.
- Medication management typically involves blood pressure control with ACE inhibitors or ARBs (like lisinopril or losartan), which help reduce proteinuria and protect kidney function 1.
Management and Treatment
- The goal of treatment is to reduce proteinuria to less than 1 g/day, which is associated with a more favorable prognosis 1.
- ACE inhibitors or ARBs should be titrated upward as far as tolerated to achieve this goal, with strict blood pressure targets, such as less than 125/75 mm Hg, especially in patients with proteinuria greater than 1 g/day 1.
- Close monitoring of kidney function and adjustments to diet, including protein intake, may be necessary to prevent further kidney damage.
- Proteinuria at this level occurs because the kidney's filtration barrier is damaged, allowing proteins that should remain in the blood to leak into the urine, which can progressively damage kidney structures if left untreated.
From the Research
Protein Creatinine Ratio in Urine
The protein creatinine ratio in urine is 94 mg/mmol.
Interpretation of Proteinuria
- Proteinuria is a significant risk factor for renal function deterioration and cardiovascular mortality 2.
- The antiproteinuric effect of angiotensin-converting enzyme (ACE) inhibitors seems to be independent of the underlying renal disease 2.
- ACE inhibitors have been shown to reduce proteinuria more effectively than other antihypertensives 2, 3.
Management of Proteinuria
- Current treatment guidelines for albuminuria recommend a single renin–angiotensin–aldosterone inhibitor, which can be an ACE inhibitor or an angiotensin receptor antagonist 4.
- The routine use of combined renin–angiotensin–aldosterone inhibition for albuminuria is not supported by current evidence due to higher rates of adverse events such as hyperkalaemia and progressive renal impairment 4.
- Dual renin-angiotensin system blockade has been shown to reduce proteinuria more effectively than monotherapy in some studies 5.