Proteinuria may help predict loss of kidney function after AKI
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Monitoring proteinuria levels after hospitalization for acute kidney injury may be helpful in predicting subsequent risk for kidney disease progression, according to study results.
“An episode of acute kidney injury (AKI) is strongly associated with more rapid subsequent loss of kidney function,” Chi-yuan Hsu, MD, MSc, of the division of nephrology at the University of California School, San Francisco, and colleagues wrote. “There is a need to improve risk prediction so that those at highest risk for kidney disease progression are identified for appropriate follow-up.”
Hypothesizing that proteinuria level after AKI would be strongly associated with subsequent loss of kidney function, researchers included 1,538 patients from a multicenter prospective cohort study which matched adults hospitalized with AKI to those who did not have an episode of AKI (50% with AKI). At 3 months after hospital discharge, urine albumin-to-creatinine ratio (ACR) was measured (median urine ACR, 15 mg/g).
Patients were followed for a mean of 4.7 years. During this time, 9% had kidney disease progression, with researchers observing that higher post-AKI urine ACR level was associated with increased risk of kidney disease progression (HR = 1.53 for each doubling). Furthermore, urine ACR measurement was determined to be a “strong discriminator” for future kidney disease progression, remaining an independent risk factor after the researchers accounted for other risk factors.
“Our findings suggest that there should be more emphasis on testing of proteinuria after AKI,” they wrote. “Prior studies of assessment of renal health after AKI have focused almost exclusively on [serum creatinine] SCr measurements.”
They added that because most patients who experience an episode of AKI will be seen by primary care clinicians and not nephrologists, these clinicians need to be aware that proteinuria after AKI is an important factor that must be considered. They wrote, “Having a more complete picture of kidney health is necessary for proper clinical decision-making, for example weighing the risk-benefit ratios of any future interventions which may have nephrotoxic potential.” – by Melissa J. Webb
Disclosures: Hsu reports receiving grants from the NIH. Please see the study for all other authors’ relevant financial disclosures.
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