Proteinuria Often Untreated in Hospital

LAS VEGAS -- Although it's easily managed,proteinuria often goes untreated in the hospital, researchers reported here.

In a single-center study, a large proportion of hospitalized patients had protein in their urine, but only 37% of these patients were being treated for the condition, according to Vishesh Kumar, MD, of Albany Medical College in New York, and colleagues.

They reported their findings at the National Kidney Foundation meeting here.

"We were very surprised by the findings," Kumar said in a statement. "We've known for years that ACE inhibitors and ARBs slow the progression of kidney damage, but we were surprised by the fact that over 60% of the patients we looked at with confirmed proteinuria were not taking any of these drugs."

"We can have a major impact on reducing proteinuria in these patients," he added.

Kumar said he had noticed that many patients admitted to general medical floors at his hospital through the emergency department had proteinuria, which is a well-established risk factor for cardiovascular disease.

He decided to investigate how common proteinuria actually was among these hospital patients, and whether they were being treated with standard drugs for the condition such as ACE inhibitors, ARBs, spironolactone, diltiazem, or verapamil.

He and his colleagues assessed 298 patients who were admitted to their facility. About 40% had proteinuria on routine urinalysis.

However, they found that only 37% of these patients were being treated with an antiproteinuric agent for their condition.

They also found that nearly a third (32%) of patients with proteinuria had hypertension – but only 43% were being treated with an antiproteinuric antihypertensive medication.

In other analyses, they observed that the use of NSAIDs – which can worsen kidney function – was also high, with 41% of patients with proteinuria reporting that they were also taking NSAIDs.

They concluded that their results "reveal that even at academic medical centers, there is a significant lack in the identification and optimal management of proteinuria in patients admitted to the hospital service" – adding that the findings provide a "clear opportunity to optimize patient care and reduce cardiovascular risk by overcoming the therapeutic inertia."

"This gives us a huge opportunity to intervene and prevent kidney damage and cardiovascular mortality in patients that have chronic kidney disease," Kumar said in the statement. "It's very common and it's easy to fix, and it's being ignored."

Thomas Manley, MD, director of scientific activities at NKF, said simple inexpensive tests detect proteinuria and kidney disease.

"Consistent with a number of other recent studies, these investigators found that kidney disease is often undetected," Manley said, "which means patients won't begin therapies that have been shown to slow the progression of kidney disease."

He noted that patients who are at higher risk, such as those with diabetes, high blood pressure, and family history of kidney failure, should especially be screened early.

Source: www.medpagetoday.com