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Proteinuria and hypertensive nephrosclerosis in African Americans

Robert D Toto1

  • 1University of Texas Southwestern Medical Center Dallas, Dallas, Texas 75390-8856, USA. robert.toto@utsouthwestern.edu

Kidney International. Supplement
|October 16, 2004
PubMed

Insights

Proteinuria, or protein in urine, is a key indicator of kidney disease progression in hypertensive African Americans. Lowering proteinuria levels may help identify individuals at higher risk for worsening kidney function.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Hypertension Research

Background:

  • Proteinuria is a significant risk factor for renal disease progression and cardiovascular complications in hypertensive individuals.
  • African Americans face a disproportionately high burden of end-stage renal disease (ESRD) linked to hypertension.
  • Higher rates of albuminuria in African Americans are partly attributed to increased prevalence of hypertension and diabetes.

Purpose of the Study:

  • To evaluate the impact of aggressive versus usual blood pressure lowering on renal outcomes in African Americans with hypertensive nephrosclerosis.
  • To assess the relationship between baseline proteinuria levels and the rate of kidney function decline and ESRD events.

Main Methods:

  • The African American Study of Kidney Disease and Hypertension (AASK) Trial was a prospective, long-term clinical study.
  • Approximately 1200 African Americans with hypertensive nephrosclerosis were included.
  • Participants were randomized to aggressive or usual blood pressure lowering, with three classes of antihypertensives.

Main Results:

  • A baseline of >300 mg of protein per 24-hour urine specimen was associated with a more rapid decline in renal function.
  • Higher baseline proteinuria levels correlated with increased risk of ESRD events.
  • These findings suggest that even lower levels of proteinuria than previously recognized may indicate elevated risk.

Conclusions:

  • Proteinuria is a critical marker for predicting kidney disease progression in hypertensive African Americans.
  • Identifying and managing proteinuria is essential for mitigating renal and cardiovascular risks in this population.
  • The ongoing AASK cohort study aims to provide further insights into long-term risk factors for kidney disease progression.

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