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Management of glomerular proteinuria: a commentary
William A Wilmer1, Brad H Rovin, Christopher J Hebert
1Department of Internal Medicine, The Ohio State University Medical Center, Columbus, Ohio 43210-1250, USA. hebert.l@osu.edu
Journal of the American Society of Nephrology : JASN
|November 26, 2003
Summary
Reducing proteinuria is key for chronic kidney disease. This guide details 25 interventions, including ACE inhibitors and ARBs, to help nephrologists choose effective antiproteinuric therapies for kidney protection.
Area of Science:
- Nephrology
- Pharmacology
Background:
- Proteinuria reduction is a recognized therapeutic target in chronic proteinuric kidney disease.
- ACE inhibitors (ACEI) and angiotensin receptor blockers (ARB) are primary antiproteinuric and renoprotective agents based on RCT evidence.
- Numerous other antiproteinuric interventions exist, but testing all in RCTs is impractical.
Purpose of the Study:
- To provide nephrologists with documentation to guide the selection of antiproteinuric therapies.
- To evaluate 25 interventions for antiproteinuric and potential renoprotective efficacy.
- To offer a framework for choosing between evidence-based and plausibly effective interventions.
Main Methods:
- Review and categorization of 25 distinct antiproteinuric interventions.
- Assignment of recommendation levels (1-3) based on evidence strength for antiproteinuric and renoprotective efficacy.
- Discussion of potential pathophysiologic mechanisms for each intervention.
Main Results:
- Seven interventions received Level 1 recommendation (highest).
- Nine interventions received Level 2 recommendation.
- Nine interventions received Level 3 recommendation (lowest).
- The authors' experience suggests achieving most Level 1 and many Level 2/3 recommendations is feasible.
Conclusions:
- A broad-based, multifactorial approach to reduce proteinuria is justifiable for progressive nephropathies.
- This work provides practical details on antiproteinuric interventions for clinical nephrologists.
- Further research may refine recommendations, but current evidence supports a comprehensive strategy.