Albuminuria: more than a renal risk marker?
Albuminuria: more than a renal risk marker? About the prevalence, measurement, and treatment of albuminuria in children
Albuminuria is considered an important therapeutic target in adult renal and cardiovascular disease. The presence of higher levels of urinary albumin in babies and children, appears to make albuminuria an inborn characteristic. The availability of a treatment target which is already present at birth is important, as it could facilitate a shift from intervention to prevention of disease. This thesis investigates the measurement, prevalence and treatment of albuminuria in children, in order to increase the knowledge on this subject, and enable future research in this area.
The best way to collect urine in young children appeared to be the PeeSpot, which was the most reliable and practical instrument in the assessment of albuminuria. Additionally, the optimal strategy for measuring and monitoring albuminuria in toddlers was the collection of three consecutive first morning voids, repeated over time. Use of albumin:creatinine ratio caused more variability and relative high values compared to adults. The natural distribution of albuminuria levels was not different between toddlers and adults, and the prevalence of microalbuminuria was strikingly similar between the toddler and adult cohort. This implied that abnormal values of albumin in the urine occurred already early in life, and that high albuminuria levels was therefore not always the consequence of diseases occurring later in life.
Treatment of albuminuria in children with chronic kidney disease showed that lowering of proteinuria with standardized ACE inhibition was protective for renal disease progression. Moreover, discontinuation of RAAS inhibition appeared to accelerate renal function decline.