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Proteinuria and Nephrotic Syndrome
Allan B. Schwartz, MD, is director of the Chronic Kidney Disease Clinic, Division of Nephrology and Hypertension and director of continuing medical education at Drexel University College of Medicine. Here, he says that proteinuria is both a warning sign and a cause of progressive chronic kidney disease. Dr. Schwartz provides a schematic of events with microalbuminuria/proteinuria, showing how decreased nephron mass leads to excessive tubular reabsorption of protein and ultimately to glomeruloscosis and fibrosis. He goes on to discuss angiotensin II and diabetic renal disease, and he shows how antihypertensive therapy slows the progression of diabetic nephropathy. He also touches upon the Ramipril Efficacy in Nephropathy Study (REIN) which addresses the hypothesis that glomerular protein traffic and its modification by an ACE inhibitor influences renal disease progression in nondiabetic chronic nephropathies. Dr Schwartz further posits a unifying hypothesis for the progressive nature of renal disease, and explores the correlation between initial anti-proteinuric response and subsequent rate of renal function loss. He concludes by citing several acronymic studies, and discusses combination antihypertensive therapy in diabetic nephropathy and nondiabetic nephropathy. The lecture is accompanied by more than 60 illustrations. |
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