Provenzano Michele, Garofalo Carlo, Chiodini Paolo, Mancuso Cinzia, Barbato Eliana, De Nicola Luca, Andreucci Michele
Dipartimento di Nefrologia, Università Magna Graecia, Catanzaro.
Dipartimento di Nefrologia, Università della Campania Luigi Vanvitelli, Napoli.
Recenti Prog Med. 2020 Feb;111(2):74-81. doi: 10.1701/3309.32797.
The presence of proteinuria, i.e. an abnormal amount of proteins in the urine is a well documented cardiovascular (CV) and renal risk factor either in the general population or in high-risk populations such as patients with type 2 diabetes, previous CV disease and patients under regular nephrology care. Indeed, the increase in proteinuria levels, even if of small entity, is associated to a faster decline in renal function over time, increased risk of End-Stage-Kidney-Disease and CV mortality. The deleterious effect of proteinuria on the kidney is attributable to the primitive glomerular damage as well as to the direct toxicity the proteinuria exerts on the tubule-interstitium. In addition, the more general association with the increased CV risk can be explained by the evidence that proteinuria can be considered a marker of systemic and renal endothelial damage. A reduction in proteinuria over time (a 30% decrease after 6 months of treatment in proteinuria is considered acceptable) as response to antihypertensive or antiproteinuric drugs protects against the development of all mentioned endpoints. Further studies are needed to better clarify: what is the normal value of proteinuria excretion, how many measures should be done during follow-up to truely assess the risk of future outcomes, what is the exact prognostic role of proteinuria.
蛋白尿的存在，即尿液中蛋白质含量异常，在普通人群或高危人群（如2型糖尿病患者、既往有心血管疾病的患者以及接受常规肾病护理的患者）中，是一个有充分文献记载的心血管（CV）和肾脏危险因素。事实上，蛋白尿水平的升高，即使幅度较小，也与肾功能随时间的更快下降、终末期肾病风险增加和心血管死亡率增加相关。蛋白尿对肾脏的有害作用可归因于原发性肾小球损伤以及蛋白尿对肾小管间质的直接毒性。此外，蛋白尿与心血管风险增加的更普遍关联可以通过以下证据来解释：蛋白尿可被视为全身和肾脏内皮损伤的标志物。随着时间的推移，蛋白尿减少（治疗6个月后蛋白尿减少30%被认为是可接受的）作为对抗高血压或抗蛋白尿药物的反应，可预防所有上述终点事件的发生。需要进一步研究以更好地阐明：蛋白尿排泄的正常值是多少，随访期间应进行多少次测量才能真正评估未来结局的风险，蛋白尿的确切预后作用是什么。
