What is the prognosis of proteinuria?

Updated: Mar 25, 2020
  • Author: Beje Thomas, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

The prognosis for patients with proteinuria depends on the cause, duration, and degree of the proteinuria. Young adults with transient or orthostatic proteinuria have a benign prognosis, while patients with hypertension and microalbuminuria (or higher degrees of albuminuria) have a significantly increased risk of cardiovascular disease.

Proteinuria has been associated with progression of kidney disease, [18] increased atherosclerosis, and left ventricular abnormalities indirectly contributing to cardiovascular morbidity and mortality. In addition to being a predictor of outcome in patients with renal disease, microalbuminuria also is a predictor of morbidity and mortality in patients who do not have evidence of significant renal disease.

In the Assessment, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury (ASSESS-AKI) study, which included 769 patients who experienced AKI during hospitalization, a higher urine albumin-to-creatinine ratio (ACR) quantified 3 months after hospital discharge was associated with increased risk of kidney disease progression. The hazard ratio was 1.53 for each doubling of ACR (95% confidence index, 1.45-1.62), and urine ACR measurement was a strong discriminator for future kidney disease progression. [19]

In patients with hypertension, the presence of microalbuminuria correlates with the presence of left ventricular hypertrophy. In both hypertensive and normotensive patients, the presence of microalbuminuria predicts an increased risk of cardiovascular morbidity and mortality.


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