What does impaired renal function with significant proteinuria mean?

From the Guidelines

Impaired renal function with significant proteinuria is a serious condition that requires prompt medical attention, as it can progress to chronic kidney disease or even kidney failure if left untreated. The lab values provided, including a creatinine level of 2.50 g/24 h, a protein/creatinine ratio of 0.227 mg/mg creat, and a total protein level of 567 mg/24 h, indicate kidney damage and significant protein leakage. According to the most recent and highest quality study 1, proteinuria is a established risk factor for progression of chronic kidney disease (CKD) in adults and children, and monitoring of proteinuria and/or albuminuria should be considered standard care for patients with CKD.

The protein/creatinine ratio is a useful marker for detecting and monitoring proteinuria, and a ratio above 0.1 mg/mg creat is considered abnormal. In this case, the ratio is 0.227 mg/mg creat, which is more than twice the normal limit. The total protein level of 567 mg/24 h is also significantly elevated, exceeding the normal limit of 150 mg/24 h.

Treatment for impaired renal function with significant proteinuria typically involves addressing the underlying cause, controlling blood pressure with ACE inhibitors or ARBs, managing diabetes if present, and implementing dietary protein and salt restrictions. Regular monitoring of kidney function through blood tests and urine protein levels is also essential. As stated in the study by 1, early detection and treatment of CKD can prevent or delay the progression of kidney disease and reduce the risk of cardiovascular disease.

Key points to consider:

• Impaired renal function with significant proteinuria is a serious condition that requires prompt medical attention
• Proteinuria is a established risk factor for progression of CKD
• Monitoring of proteinuria and/or albuminuria should be considered standard care for patients with CKD
• Treatment involves addressing the underlying cause, controlling blood pressure, managing diabetes, and implementing dietary restrictions
• Regular monitoring of kidney function is essential to prevent or delay the progression of kidney disease.

From the FDA Drug Label

The primary endpoint of the study was the time to first occurrence of any one of the following events: doubling of serum creatinine, end-stage renal disease (ESRD) (need for dialysis or transplantation), or death Treatment with losartan potassium resulted in a 16% risk reduction in this endpoint The study population was diverse with regard to race and almost all of the patients (96.6%) had a history of hypertension, and the patients entered the trial with a mean serum creatinine of 1.9 mg/dL and mean proteinuria (urinary albumin/creatinine) of 1808 mg/g at baseline. Compared with placebo, losartan potassium significantly reduced proteinuria by an average of 34%, an effect that was evident within 3 months of starting therapy, and significantly reduced the rate of decline in glomerular filtration rate during the study by 13%, as measured by the reciprocal of the serum creatinine concentration

The lab values provided indicate impaired renal function with:

• Elevated creatinine levels (2.50 g/24 h) above the normal range (0.50-2.15 g/24 h)
• Elevated protein/creatinine ratio (0.227 mg/mg creat) above the normal range (<0.100 mg/mg creat)
• Elevated total protein in 24-hour urine (567 mg/24 h) above the normal range (<150 mg/24 h) These results suggest significant proteinuria, which is a sign of kidney damage or disease. In the context of the RENAAL study 2, these lab values would be consistent with nephropathy in type 2 diabetic patients.

From the Research

Lab Values Explanation

The lab values provided are:

• CREATININE, 24 HOUR URINE: 2.50 g/24 h (high, normal range: 0.50-2.15 g/24 h)
• PROTEIN/CREATININE RATIO: 0.227 mg/mg creat (high, normal range: <0.100 mg/mg creat)
• PROTEIN, TOTAL, 24 HR UR: 567 mg/24 h (high, normal range: <150 mg/24 h)

Impaired Renal Function with Significant Proteinuria

Impaired renal function with significant proteinuria refers to a condition where the kidneys are not functioning properly, leading to an excessive amount of protein in the urine. This can be caused by various factors, including kidney damage or disease.

Possible Causes and Consequences

Possible causes of impaired renal function with significant proteinuria include:

• Kidney damage or disease, such as glomerulonephritis or nephrotic syndrome 3, 4
• Chronic kidney disease (CKD) 5
• Increased intraglomerular hydraulic pressure or damage to the glomerular filtration barrier 3
• Tubular proteinuria, which can lead to inflammation and fibrosis in the kidneys 3

Consequences of impaired renal function with significant proteinuria can include:

• Progression of kidney disease and potential loss of renal function 3, 5
• Increased risk of cardiovascular disease and mortality 5
• Nephrotic syndrome, characterized by heavy proteinuria, hypoalbuminemia, and edema 4, 6

Treatment and Management

Treatment and management of impaired renal function with significant proteinuria may involve:

• Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) to reduce proteinuria and slow disease progression 5, 6
• Steroid therapy, which may be effective in reducing proteinuria in certain cases 4
• Lifestyle modifications, such as dietary changes and exercise, to manage underlying conditions and slow disease progression 3, 5