Proteinuria: Clinical Signficance and Basis for Therapy

摘要: Proteinuria is the hallmark of renal disease and proteinuria exceeding 1 gm a day in patients with augers poorer prognosis. has been shown to be tubulotoxic directly contributes deterioration. Patients non-selective are more likely have progressive disease. Diabetic persistent microhaematuria about 20 times risk developing diabetic nephropathy. In essential hypertension, onset de novo after years adequate BP control marker subsequent decline function. glomerulonephritis, severe associated faster rate progression. Even though initial phase glomerulonephritis usually immunological origin, vast majority established disease, latter proteinuric glomerulopathy result glomerular hyperfiltration which shifts pores larger dimensions resulting excessive leakage protein urine. Endothelial injury from causes increase local generation Angiotensin II kidney as part hemodynamic response. ACE inhibitors angiotensin receptor antagonists (ATRA) can improve pore-selectivity by remodelling basement membrane. addition, these agents also beneficial effects decreasing TGF-beta production therapy mesangial cell proliferation, hence ameliorating progression nephropathy IgA A number recent clinical trials that ACEI ATRA retard deterioration NIDDM those even restore normal function mild impairment. Treatment should regarded important treatment hypertension it prevent failure.