非糖尿病慢性肾病患者晨尿蛋白肌酐比值、24小时尿蛋白排泄率、肾小球滤过率及终末期肾衰竭的横断面纵向研究

Cross sectional longitudinal study of spot morning urine protein:creatinine ratio, 24 hour urine protein excretion rate, glomerular filtration rate, and end stage renal failure in chronic renal disease in patients without diabetes.

作者信息

Ruggenenti P, Gaspari F, Perna A, Remuzzi G

机构信息

Mario Negri Institute for Pharmacological Research, Clinical Research Centre for Rare Diseases, Bergamo, Italy.

出版信息

BMJ. 1998 Feb 14;316(7130):504-9. doi: 10.1136/bmj.316.7130.504.

DOI:10.1136/bmj.316.7130.504

PMID:9501711

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2665663/

Abstract

OBJECTIVE

To evaluate whether the protein:creatinine ratio in spot morning urine samples is a reliable indicator of 24 hour urinary protein excretion and predicts the rate of decline of glomerular filtration rate and progression to end stage renal failure in non-diabetic patients with chronic nephropathy.

DESIGN

Cross sectional correlation between the ratio and urinary protein excretion rate. Univariate and multivariate analysis of baseline predictors, including the ratio and 24 hour urinary protein, of decline in glomerular filtration rate and end stage renal failure in the long term.

SETTING

Research centre in Italy.

SUBJECTS

177 non-diabetic outpatients with chronic renal disease screened for participation in the ramipril efficacy in nephropathy study.

MAIN OUTCOME MEASURES

Rate of decline in filtration rate evaluated by repeated measurements of unlabelled iohexol plasma clearance and rate of progression to renal failure.

RESULTS

Protein:creatinine ratio was significantly correlated with absolute and log transformed 24 hour urinary protein values (P = 0.0001 and P < 0.0001, respectively.) Ratios also had high predictive value for rate of decline of the glomerular filtration rate (univariate P = 0.0003, multivariate P = 0.004) and end stage renal failure (P = 0.002 and P = 0.04). Baseline protein:creatinine ratios and rate of decline of the glomerular filtration rate were also significantly correlated (P < 0.0005). In the lowest third of the protein:creatinine ratio (< 1.7) there was 3% renal failure compared with 21.2% in the highest third (> 2.7) (P < 0.05).

CONCLUSIONS

Protein:creatinine ratio in spot morning urine samples is a precise indicator of proteinuria and a reliable predictor of progression of disease in non-diabetic patients with chronic nephropathies and represents a simple and inexpensive procedure in establishing severity of renal disease and prognosis.

摘要

目的

评估晨尿样本中的蛋白：肌酐比值是否为24小时尿蛋白排泄的可靠指标，并预测非糖尿病慢性肾病患者的肾小球滤过率下降速率及进展至终末期肾衰竭的情况。

设计

该比值与尿蛋白排泄率之间的横断面相关性研究。对包括该比值和24小时尿蛋白在内的基线预测因素进行单变量和多变量分析，以评估其对长期肾小球滤过率下降和终末期肾衰竭的影响。

地点

意大利的研究中心。

研究对象

177名非糖尿病慢性肾病门诊患者，这些患者经筛查参与了雷米普利治疗肾病疗效的研究。

主要观察指标

通过重复测量未标记碘海醇血浆清除率评估滤过率下降速率，以及进展至肾衰竭的速率。

结果

蛋白：肌酐比值与24小时尿蛋白的绝对值及经对数转换后的值显著相关（分别为P = 0.0001和P < 0.零零零零一）。该比值对肾小球滤过率下降速率（单变量P = 0.0003，多变量P = 0.004）和终末期肾衰竭（P = 0.002和P = 0.04）也具有较高的预测价值。基线蛋白：肌酐比值与肾小球滤过率下降速率也显著相关（P < 0.0005）。在蛋白：肌酐比值最低的三分之一组（< 1.7）中，肾衰竭发生率为3%，而在最高的三分之一组（> 2.7）中为21.2%（P < 0.05）。