대한신장학회

논문분류	춘계학술대회 초록집
제목	Urinary Albumin to Protein Ratio Predicts Kidney Disease Progression in Patients with Macroalbuminuria
저자	Seohyun Park* 1, Su-Young Jung1, Jong Hyun Jhee1, Hae-Ryong Yun1, Hyoungnae Kim1, Chang-Yun Yoon1, Youn Kyung Kee1, Young Eun Kwon1, Jung Tak Park1, Seung Hyeok Han1, Tae-Hyun Yoo1, Shin-Wook Kang1
출판정보	2016; 2016(1):
키워드	Albuminuria, Chronic kidney disease, Proteinuria, Renal outcome, Urinary albumin to protein ratio
초록	Background: Both urinary protein to creatinine ratio (uPCR) and albumin to creatinine ratio (uACR) are well-known indicators not only to detect kidney damage but also to predict the clinical outcome in various groups of patients. Previous studies have shown that urinary albumin to protein ratio (uAPR) is also useful in inferring the underlying renal pathology; low uAPR suggests a predominant tubulointerstitial disease, whereas high uAPR implies a main glomerular pathology. However, the clinical value of uAPR as an indicator of renal function loss is not fully explored. Therefore, this study was aimed to evaluate the impact of uAPR on renal function decline in patients with significant proteinuria. Methods: Data from 584 patients with macroalbuminuria (uACR > 250 mg/g for men and > 355 mg/g for women), who were followed-up at Yonsei University Health System from January 2005 to December 2010, were retrospectively retrieved. Patients with stage 5 chronic kidney disease were excluded. Study subjects were divided into two groups according to the median level of uAPR. The primary outcome was defined as the composite of doubling of serum creatinine concentrations, initiation of dialysis, and kidney transplantation. Multiple Cox regression analysis was performed to determine the predictive power of uAPR on the primary outcome. Results: The mean age was 51.3±15.8 years, and 333 patients (57.0%) were male. The median value of uAPR was 0.75 (0.71-0.80). Compared to the lower uAPR group, patients in the high uAPR group were significantly younger (48.8±15.5 vs. 53.8±15.7 years, P < 0.001) and had a significantly higher estimated glomerular filtration rate (eGFR) (60.4±29.4 vs. 50.8±29.0 ml/min/1.73m2, P < 0.001). In addition, the proportion of patients with diabetes was significantly higher in the low uAPR group [159 (54.5%) vs. 115 (39.4%), P < 0.001]. There were significant relationship of uAPR with serum albumin levels (r = 0.26, P < 0.001), eGFR (r = 0.21, P < 0.001), and serum C-reactive protein concentrations (r = -0.10, P = 0.02). During a mean follow-up duration of 65.6 months, the primary outcome was observed in 199 patients (34.1%). In multiple Cox regression analysis, high uAPR was found to be significantly associated with the primary outcome (per 0.1 increase in uAPR; hazard ratio = 1.29, 95% confidence interval = 1.09-1.52, P = 0.003) after adjusting for confounding factors. Conclusion: These findings suggest uAPR can be a useful predictor of renal outcome in patients with significant proteinuria.
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