TITLE:
Proteinuria in Hypertensive Nephropathy: A Review
AUTHORS:
Rishi Sharma, Surineni Kamalakar, Ellen McCarthy, Timothy A. Fields, Kamal Gupta, Rajat Barua, Virginia Savin
KEYWORDS:
Hypertension, Nephropathy, Proteinuria, ESRD, Genetics
JOURNAL NAME:
Open Journal of Nephrology,
Vol.4 No.2,
June
25,
2014
ABSTRACT: Hypertension defined as a
systolic blood pressure of ≥140 and a diastolic blood pressure ≥90 is anextremely prevalent condition; and it is
responsible for significant mortality and morbidity. NHANESdata from
2005-2006 found that nearly 30% of adult US population has HTN; and nearly 8%
of the population has undiagnosed HTN. HBP mortality in 2008 was 61,005. Any mentioned
mortality in 2008 was 347,689 (NHLBI tabulation of NCHS mortality data). More
than 20% of patients with systemic hypertension have chronic renal
insufficiency (NHANES). Hypertensive nephropathy is a leading cause of end-stage
renal disease (ESRD) requiring dialysis or transplantation or leading to death.
The incidence of hypertension is high but only a subset of hypertensive
patients progress to frank renal failure. A subset of hypertensive patients
develop proteinuria during the course of disease and manifest nephrotic
syndrome. This syndrome includes marked proteinuria, edema, and low serum
albumin. Neither the incidence nor the clinical significance of proteinuria in
hypertension without diabetes is known. Progression to chronic renal failure
in some patients is preceded by proteinuria as indicated on “dip-stick”
analyses of random urine samples. It appears that proteinuria is likely to
increase both prior to and during evident loss of glomerular filtration, but this
clinical observation has never been formally confirmed. There is a need for
large studies to answer these questions. We also need to focus on the roles
that genetic and environmental factors play in development and progression of
renal disease in the setting of hypertension and proteinuria.