Proteinuria Workup: Approach Considerations, Kidney Biopsy (original) (raw)

Approach Considerations

Evaluation of proteinuria normally is conducted on an outpatient basis, unless the patient develops a complication of severe nephrotic syndrome. All patients with evidence of glomerular disease or any reduction in kidney function should be referred to a nephrologist.

Integral to the process of evaluating for proteinuria is quantification of the total amount of protein spilling into the urine. The various methods to detect proteinuria include urine dipstick and sulfosalicyclic acid test (SSA); quantification methods include the ratio of albumin or protein to creatinine and the 24-hour urine protein collection.

The urine dipstick detects albumin primarily. Albuminuria is seen in glomerular proteinuria. False-positive results can occur with recent exposure to iodinated radiocontrast agents, alkaline urine, and gross hematuria. SSA detects all proteins, not just albumin. Proteinuria involving non-albumin proteins as well as albumin is seen more in tubular or overflow proteinuria. Iodinated radiocontrast also will interfere with the accuracy of the SSA test.

The gold standard for quantification of proteinuria is the 24-hour urine collection. The normal amount of protein in the urine is < 150 mg/day.

The 24-hour urine collection is performed by voiding upon waking and then collecting all urine on subsequent voids until the first void of the next day. Obviously, the process can be cumbersome and inaccurate. Results are considered reliable based on comparison with the typical amount of creatinine secreted per kilogram of lean body mass. On average, males secrete 20-25 mg/kg per day and females secrete 15-20 mg/kg. However, after the age of 50 years, lean body muscle mass is lost, so these estimates can be inaccurate in older patients. Another option—possibly more accurate, as it accounts for race and sex—is the following calculation (can be calculated with or without phosphorus):

Estimated creatinine excretion (mg/day) = 1115.89 + (11.97 × weight in kg) - (5.83 × age) - (60.18 × phosphorus in mg/dL) + (52.82 if Black) - (368.75 if female). It is important to note with the use of race-neutral formulas for the estimated glomerular filtration formulas, it would be prudent to remove race when calculating the estimated creatinine excretion.

The spot albumin or protein–to-creatinine ratio was developed to help make the quantification of proteinuria easier and less laborious. However, the ratio can vary depending on the time of day and the amount of creatinine excreted. Consequently, the patient should collect all samples at about the same time of day. The amount of creatinine excretion to adequately reflect a 24-hour urine collection should be about 1 gram. If it is significantly less, that could lead to underestimation of the degree of proteinuria, while overestimation may occur if there is much more than 1 g of creatinine.

A spot protein or albumin–to-creatinine ratio of > 3-3.5 mg protein/mg creatinine, or a 24-hour urine collection showing > 3-3.5 g of protein, is nephrotic-range proteinuria.

Screening for proteinuria can be done using a urine dipstick or early-morning spot protein or albumin–to-creatinine ratio. If significant proteinuria is found or the clinical situation is suspicious for significant proteinuria, a 24-hour urine collection should be done. The spot albumin or protein–to-creatinine ratio can be used for followup. If the ratio shows a significant increase, the 24-hour urine collection should be repeated. [6, 33, 34]

Laboratory studies

To determine whether patients have transient proteinuria, perform the following:

To determine whether patients have orthostatic proteinuria, perform the following:

To determine whether proteinuria may be glomerular in origin, perform the following:

Techniques for calculating proteinuria, to determine prognosis in patients with glomerular proteinuria, include the following [37] :

Results of a study by Kee et al suggest that in patients with glomerular disease, time-varying proteinuria can delineate the association between proteinuria levels and risk of renal progression better than a time-averaged model, as time-varying proteinuria reflects the dynamic change of proteinuria over time. [38]

Imaging studies

Imaging studies in proteinuria can include the following:

eMedicine Logo

Kidney Biopsy

Kidney biopsy should be considered in adult patients with persistent proteinuria (usually, above 1 g per day), because the diagnostic and prognostic information yielded is likely to guide the choice of specific therapy.

In children, most cases of nephrotic syndrome are due to steroid-sensitive minimal-change disease. The clinician may reasonably assume this to be the diagnosis and give a trial of therapy, reserving biopsy for unresponsive cases.

In adult patients who have isolated proteinuria of less than 1 g/day and no other indicators of kidney disease, the renal prognosis is good and the need for specific treatment is unlikely. Most nephrologists would treat these patients with nonspecific measures (see Treatment) and would proceed to biopsy only if the degree of proteinuria increases or if the patient undergoes progressive decline in kidney function.

eMedicine Logo

  1. [Guideline] Rovin BH, Adler SG, Barratt J, et al. Executive summary of the KDIGO 2021 Guideline for the Management of Glomerular Diseases. Kidney Int. 2021 Oct. 100 (4):753-779. [QxMD MEDLINE Link]. [Full Text].
  2. Glassock RJ, Fervenza FC, Hebert L, Cameron JS. Nephrotic syndrome redux. Nephrol Dial Transplant. 2015 Jan. 30 (1):12-7. [QxMD MEDLINE Link].
  3. Levey AS, Becker C, Inker LA. Glomerular filtration rate and albuminuria for detection and staging of acute and chronic kidney disease in adults: a systematic review. JAMA. 2015 Feb 24. 313 (8):837-46. [QxMD MEDLINE Link].
  4. Springberg PD, Garrett LE Jr, Thompson AL Jr. Fixed and reproducible orthostatic proteinuria: results of a 20-year follow-up study. Ann Intern Med. 1982 Oct. 97(4):516-9. [QxMD MEDLINE Link].
  5. Uehara K, Tominaga N, Shibagaki Y. Adult orthostatic proteinuria. Clin Kidney J. 2014 Jun. 7 (3):327-8. [QxMD MEDLINE Link]. [Full Text].
  6. Naderi AS, Reilly RF. Primary care approach to proteinuria. J Am Board Fam Med. 2008 Nov-Dec. 21 (6):569-74. [QxMD MEDLINE Link].
  7. Durvasula RV, Petermann AT, Hiromura K, Blonski M, Pippin J, Mundel P, et al. Activation of a local tissue angiotensin system in podocytes by mechanical strain. Kidney Int. 2004 Jan. 65(1):30-9. [QxMD MEDLINE Link].
  8. Eremina V, Baelde HJ, Quaggin SE. Role of the VEGF--a signaling pathway in the glomerulus: evidence for crosstalk between components of the glomerular filtration barrier. Nephron Physiol. 2007. 106(2):p32-7. [QxMD MEDLINE Link].
  9. Schlöndorff D, Banas B. The mesangial cell revisited: no cell is an island. J Am Soc Nephrol. 2009 Jun. 20(6):1179-87. [QxMD MEDLINE Link].
  10. Burton C, Harris KP. The role of proteinuria in the progression of chronic renal failure. Am J Kidney Dis. 1996 Jun. 27(6):765-75. [QxMD MEDLINE Link].
  11. Hladunewich MA, Troyanov S, Calafati J, et al. The natural history of the non-nephrotic membranous nephropathy patient. Clin J Am Soc Nephrol. 2009 Aug 6. [QxMD MEDLINE Link]. [Full Text].
  12. Hebert LA, Birmingham DJ, Shidham G, et al. Random spot urine protein/creatinine ratio is unreliable for estimating 24-Hour proteinuria in individual systemic lupus erythematosus nephritis patients. Nephron Clin Pract. 2009 Aug 12. 113(3):c177-c182. [QxMD MEDLINE Link]. [Full Text].
  13. Masani N, Jhaveri KD, Fishbane S. Update on membranoproliferative GN. Clin J Am Soc Nephrol. 2014 Mar. 9 (3):600-8. [QxMD MEDLINE Link]. [Full Text].
  14. Zhang W, Feng LJ, Teng F, Li YH, Zhang X, Ran YG. Incidence and risk of proteinuria associated with newly approved vascular endothelial growth factor receptor tyrosine kinase inhibitors in cancer patients: an up-to-date meta-analysis of randomized controlled trials. Expert Rev Clin Pharmacol. 2020 Mar 5. 1-10. [QxMD MEDLINE Link].
  15. Jones CA, Francis ME, Eberhardt MS, Chavers B, Coresh J, Engelgau M, et al. Microalbuminuria in the US population: third National Health and Nutrition Examination Survey. Am J Kidney Dis. 2002 Mar. 39(3):445-59. [QxMD MEDLINE Link].
  16. Bryson CL, Ross HJ, Boyko EJ, Young BA. Racial and ethnic variations in albuminuria in the US Third National Health and Nutrition Examination Survey (NHANES III) population: associations with diabetes and level of CKD. Am J Kidney Dis. 2006 Nov. 48(5):720-6. [QxMD MEDLINE Link].
  17. Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007 Nov 7. 298(17):2038-47. [QxMD MEDLINE Link].
  18. Friedman DJ, Kozlitina J, Genovese G, Jog P, Pollak MR. Population-Based Risk Assessment of APOL1 on Renal Disease. J Am Soc Nephrol. 2011 Nov. 22(11):2098-105. [QxMD MEDLINE Link].
  19. Ruggenenti P, Perna A, Mosconi L. Proteinuria predicts end-stage renal failure in non-diabetic chronic nephropathies. The "Gruppo Italiano di Studi Epidemiologici in Nefrologia" (GISEN). Kidney Int Suppl. 1997 Dec. 63:S54-7. [QxMD MEDLINE Link].
  20. Hsu CY, Chinchilli VM, Coca S, Devarajan P, Ghahramani N, Go AS, et al. Post-Acute Kidney Injury Proteinuria and Subsequent Kidney Disease Progression: The Assessment, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury (ASSESS-AKI) Study. JAMA Intern Med. 2020 Jan 27. [QxMD MEDLINE Link].
  21. Jackson CE, Solomon SD, Gerstein HC, et al. Albuminuria in chronic heart failure: prevalence and prognostic importance. Lancet. 2009 Aug 15. 374(9689):543-50. [QxMD MEDLINE Link].
  22. Yuyun MF, Khaw KT, Luben R, Welch A, Bingham S, Day NE, et al. Microalbuminuria, cardiovascular risk factors and cardiovascular morbidity in a British population: the EPIC-Norfolk population-based study. Eur J Cardiovasc Prev Rehabil. 2004 Jun. 11(3):207-13. [QxMD MEDLINE Link].
  23. Rein P, Saely CH, Zanolin D, Vonbank A, Drexel H. Albuminuria significantly predicts cardiovascular events in patients with type 2 diabetes independently from the baseline coronary artery state. European Heart Journal. Available at https://eurheartj.oxfordjournals.org/content/34/suppl_1/P5175. August 2013; Accessed: March 24, 2020.
  24. Ruggenenti P, Porrini E, Motterlini N, Perna A, Ilieva AP, Iliev IP, et al. Measurable urinary albumin predicts cardiovascular risk among normoalbuminuric patients with type 2 diabetes. J Am Soc Nephrol. 2012 Oct. 23(10):1717-24. [QxMD MEDLINE Link]. [Full Text].
  25. Chiu YW, Adler SG, Budoff MJ, et al. Coronary artery calcification and mortality in diabetic patients with proteinuria. Kidney Int. 2010 Mar 17. [QxMD MEDLINE Link].
  26. Sandsmark DK, Messé SR, Zhang X, Roy J, Nessel L, Lee Hamm L, et al. Proteinuria, but Not eGFR, Predicts Stroke Risk in Chronic Kidney Disease: Chronic Renal Insufficiency Cohort Study. Stroke. 2015 Aug. 46 (8):2075-80. [QxMD MEDLINE Link].
  27. Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH, Barnett RL, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020 Jul. 98 (1):209-218. [QxMD MEDLINE Link]. [Full Text].
  28. Huart J, Bouquegneau A, Lutteri L, Erpicum P, Grosch S, Résimont G, et al. Proteinuria in COVID-19: prevalence, characterization and prognostic role. J Nephrol. 2021 Apr. 34 (2):355-364. [QxMD MEDLINE Link]. [Full Text].
  29. Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020 May. 97 (5):829-838. [QxMD MEDLINE Link]. [Full Text].
  30. Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C, et al. Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia. J Am Soc Nephrol. 2020 Jun. 31 (6):1157-1165. [QxMD MEDLINE Link]. [Full Text].
  31. Li Z, Chen S, Tan Y, Lv J, Zhao M, Chen Q, et al. Twenty-four-hour proteinuria levels are associated with adverse pregnancy outcomes among women with CKD. Clin Kidney J. 2023 Oct. 16 (10):1634-1643. [QxMD MEDLINE Link]. [Full Text].
  32. [Guideline] ElSayed NA, Aleppo G, Aroda VR, et al, on behalf of the American Diabetes Association. 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes-2023. Diabetes Care. 2023 Jan 1. 46 (Suppl 1):S191-S202. [QxMD MEDLINE Link]. [Full Text].
  33. Ix JH, Wassel CL, Stevens LA, Beck GJ, Froissart M, Navis G, et al. Equations to estimate creatinine excretion rate: the CKD epidemiology collaboration. Clin J Am Soc Nephrol. 2011 Jan. 6 (1):184-91. [QxMD MEDLINE Link].
  34. Viswanathan G, Upadhyay A. Assessment of proteinuria. Adv Chronic Kidney Dis. 2011 Jul. 18 (4):243-8. [QxMD MEDLINE Link].
  35. Methven S, Macgregor MS, Traynor JP, et al. Assessing proteinuria in chronic kidney disease: protein-creatinine ratio versus albumin-creatinine ratio. Nephrol Dial Transplant. 2010 Mar 17. [QxMD MEDLINE Link].
  36. Cirillo M. Evaluation of glomerular filtration rate and of albuminuria/proteinuria. J Nephrol. 2010 Mar-Apr. 23(2):125-32. [QxMD MEDLINE Link].
  37. Avasare RS, Radhakrishnan J. Proteinuria as a surrogate marker for renal outcome: are we there yet?. Kidney Int. 2015 Dec. 88 (6):1228-1230. [QxMD MEDLINE Link]. [Full Text].
  38. Kee YK, Yoon CY, Kim SJ, Moon SJ, Kim CH, Park JT, et al. Determination of the optimal target level of proteinuria in the management of patients with glomerular diseases by using different definitions of proteinuria. Medicine (Baltimore). 2017 Nov. 96 (44):e8154. [QxMD MEDLINE Link]. [Full Text].
  39. Krensky AM, Ingelfinger JR, Grupe WE. Peritonitis in childhood nephrotic syndrome: 1970-1980. Am J Dis Child. 1982 Aug. 136(8):732-6. [QxMD MEDLINE Link].
  40. Chapman S, Taube D, Brown Z, Williams DG. Impaired lymphocyte transformation in minimal change nephropathy in remission. Clin Nephrol. 1982 Jul. 18(1):34-8. [QxMD MEDLINE Link].
  41. Pneumococcal ACIP Vaccine Recommendations. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/pneumo.html. October 2, 2023; Accessed: October 7,2023.
  42. [Guideline] Kobayashi M, Farrar JL, Gierke R, Britton A, Childs L, Leidner AJ, et al. Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep. 2022 Jan 28. 71 (4):109-117. [QxMD MEDLINE Link]. [Full Text].
  43. [Guideline] Kobayashi M, Pilishvili T, Farrar JL, Leidner AJ, Gierke R, Prasad N, et al. Pneumococcal Vaccine for Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023. MMWR Recomm Rep. 2023 Sep 8. 72 (3):1-39. [QxMD MEDLINE Link]. [Full Text].
  44. Roozbeh J, Banihashemi MA, Ghezlou M, et al. Captopril and combination therapy of captopril and pentoxifylline in reducing proteinuria in diabetic nephropathy. Ren Fail. 2010 Jan. 32(2):172-8. [QxMD MEDLINE Link].
  45. Robles NR, Romero B, de Vinuesa EG, et al. Treatment of proteinuria with lercanidipine associated with renin-angiotensin axis-blocking drugs. Ren Fail. 2010 Jan. 32(2):192-7. [QxMD MEDLINE Link].
  46. Lewis EJ, Hunsicker LG, Bain RP. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group [published erratum appears in N Engl J Med 1993 Jan 13;330(2):152]. N Engl J Med. 1993 Nov 11. 329(20):1456-62. [QxMD MEDLINE Link].
  47. Giatras I, Lau J, Levey AS. Effect of angiotensin-converting enzyme inhibitors on the progression of nondiabetic renal disease: a meta-analysis of randomized trials. Angiotensin-Converting-Enzyme Inhibition and Progressive Renal Disease Study Group. ALYSIS. 1997 Sep 1. 127(5):337-45. [QxMD MEDLINE Link].
  48. Bakris GL, et al; Mineralocorticoid Receptor Antagonist Tolerability Study–Diabetic Nephropathy (ARTS-DN) Study Group. Effect of Finerenone on Albuminuria in Patients With Diabetic Nephropathy: A Randomized Clinical Trial. JAMA. 2015 Sep 1. 314 (9):884-94. [QxMD MEDLINE Link].
  49. Pozzi C. Treatment of IgA nephropathy. J Nephrol. 2016 Feb. 29 (1):21-5. [QxMD MEDLINE Link].
  50. Carmines PK, Navar LG. Disparate effects of Ca channel blockade on afferent and efferent arteriolar responses to ANG II. Am J Physiol. 1989 Jun. 256 (6 Pt 2):F1015-20. [QxMD MEDLINE Link].
  51. Smith AC, Toto R, Bakris GL. Differential effects of calcium channel blockers on size selectivity of proteinuria in diabetic glomerulopathy. Kidney Int. 1998 Sep. 54 (3):889-96. [QxMD MEDLINE Link].
  52. Kohan DE, Pollock DM. Endothelin antagonists for diabetic and non-diabetic chronic kidney disease. Br J Clin Pharmacol. 2013 Oct. 76 (4):573-9. [QxMD MEDLINE Link].
  53. Wenzel RR, Littke T, Kuranoff S, Jürgens C, Bruck H, Ritz E, et al. Avosentan reduces albumin excretion in diabetics with macroalbuminuria. J Am Soc Nephrol. 2009 Mar. 20 (3):655-64. [QxMD MEDLINE Link].
  54. de Zeeuw D, Agarwal R, Amdahl M, Audhya P, Coyne D, Garimella T, et al. Selective vitamin D receptor activation with paricalcitol for reduction of albuminuria in patients with type 2 diabetes (VITAL study): a randomised controlled trial. Lancet. 2010 Nov 6. 376(9752):1543-51. [QxMD MEDLINE Link].
  55. de Borst MH, Hajhosseiny R, Tamez H, Wenger J, Thadhani R, Goldsmith DJ. Active vitamin D treatment for reduction of residual proteinuria: a systematic review. J Am Soc Nephrol. 2013 Nov. 24(11):1863-71. [QxMD MEDLINE Link]. [Full Text].
  56. Nakamura T, Sato E, Fujiwara N, et al. Co-administration of ezetimibe enhances proteinuria-lowering effects of pitavastatin in chronic kidney disease patients partly via a cholesterol-independent manner. Pharmacol Res. 2009 Aug 7. [QxMD MEDLINE Link].
  57. Bianchi S, Bigazzi R, Caiazza A, Campese VM. A controlled, prospective study of the effects of atorvastatin on proteinuria and progression of kidney disease. Am J Kidney Dis. 2003 Mar. 41(3):565-70. [QxMD MEDLINE Link].
  58. Vegter S, Perna A, Postma MJ, et al. Sodium Intake, ACE Inhibition, and Progression to ESRD. J Am Soc Nephrol. 2012 Jan. 23(1):165-73. [QxMD MEDLINE Link].
  59. Klahr S, Levey AS, Beck GJ. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group. N Engl J Med. 1994 Mar 31. 330(13):877-84. [QxMD MEDLINE Link].
  60. Robertson L, Waugh N, Robertson A. Protein restriction for diabetic renal disease. Cochrane Database Syst Rev. 2007 Oct 17. CD002181. [QxMD MEDLINE Link].
  61. Wish JB, Pergola P. Evolution of Mineralocorticoid Receptor Antagonists in the Treatment of Chronic Kidney Disease Associated with Type 2 Diabetes Mellitus. Mayo Clin Proc Innov Qual Outcomes. 2022 Dec. 6 (6):536-551. [QxMD MEDLINE Link].
  62. Mosenzon O, Schechter M, Leibowitz G. Kidney Outcomes With Glucagon-Like Peptide-1 Receptor Agonists in Patients With Type 2 Diabetes. Adv Chronic Kidney Dis. 2021 Jul. 28 (4):347-360. [QxMD MEDLINE Link].
  63. Schechter M, Melzer Cohen C, Fishkin A, Rozenberg A, Yanuv I, Sehtman-Shachar DR, et al. Kidney function loss and albuminuria progression with GLP-1 receptor agonists versus basal insulin in patients with type 2 diabetes: real-world evidence. Cardiovasc Diabetol. 2023 May 27. 22 (1):126. [QxMD MEDLINE Link]. [Full Text].
  64. Davidson JA. SGLT2 inhibitors in patients with type 2 diabetes and renal disease: overview of current evidence. Postgrad Med. 2019 May. 131 (4):251-260. [QxMD MEDLINE Link].
  65. Feng C, Wu M, Chen Z, Yu X, Nie Z, Zhao Y, et al. Effect of SGLT2 inhibitor on renal function in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Int Urol Nephrol. 2019 Apr. 51 (4):655-669. [QxMD MEDLINE Link].
  66. Waller KV, Ward KM, Mahan JD, Wismatt DK. Current concepts in proteinuria. Clin Chem. 1989 May. 35 (5):755-65. [QxMD MEDLINE Link].
  67. Burton C, Harris KP. The role of proteinuria in the progression of chronic renal failure. Am J Kidney Dis. 1996 Jun. 27(6):765-75. [QxMD MEDLINE Link].
  68. Friedman DJ, Kozlitina J, Genovese G, Jog P, Pollak MR. Population-based risk assessment of APOL1 on renal disease. J Am Soc Nephrol. 2011 Nov. 22(11):2098-105. [QxMD MEDLINE Link]. [Full Text].
  69. Gorriz JL, Martinez-Castelao A. Proteinuria: detection and role in native renal disease progression. Transplant Rev (Orlando). 2012 Jan. 26 (1):3-13. [QxMD MEDLINE Link].
  70. Shamseddin MK, Knoll GA. Posttransplantation proteinuria: an approach to diagnosis and management. Clin J Am Soc Nephrol. 2011 Jul. 6 (7):1786-93. [QxMD MEDLINE Link].
  71. Miner JH. Glomerular basement membrane composition and the filtration barrier. Pediatr Nephrol. 2011 Sep. 26 (9):1413-7. [QxMD MEDLINE Link].
  72. Comper WD, Hilliard LM, Nikolic-Paterson DJ, Russo LM. Disease-dependent mechanisms of albuminuria. Am J Physiol Renal Physiol. 2008 Dec. 295 (6):F1589-600. [QxMD MEDLINE Link].
  73. Kodner C. Diagnosis and Management of Nephrotic Syndrome in Adults. Am Fam Physician. 2016 Mar 15. 93 (6):479-85. [QxMD MEDLINE Link].
  74. Abe M, Okada K, Maruyama N, Matsumoto S, Maruyama T, Fujita T, et al. Comparison between the antiproteinuric effects of the calcium channel blockers benidipine and cilnidipine in combination with angiotensin receptor blockers in hypertensive patients with chronic kidney disease. Expert Opin Investig Drugs. 2010 Sep. 19 (9):1027-37. [QxMD MEDLINE Link].
  75. Delgado C, Baweja M, Crews DC, Eneanya ND, Gadegbeku CA, Inker LA, et al. A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease. Am J Kidney Dis. 2022 Feb. 79 (2):268-288.e1. [QxMD MEDLINE Link].
  76. Yau K, Dharia A, Alrowiyti I, Cherney DZI. Prescribing SGLT2 Inhibitors in Patients With CKD: Expanding Indications and Practical Considerations. Kidney Int Rep. 2022 Jul. 7 (7):1463-1476. [QxMD MEDLINE Link].

Author

Coauthor(s)

Chief Editor

Vecihi Batuman, MD, FASN Professor of Medicine, Section of Nephrology-Hypertension, Deming Department of Medicine, Tulane University School of Medicine

Vecihi Batuman, MD, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Edgar V Lerma, MD, FACP, FASN, FAHA, FASH, FNLA, FNKF Clinical Professor of Medicine, Section of Nephrology, Department of Medicine, University of Illinois at Chicago College of Medicine; Research Director, Internal Medicine Training Program, Advocate Christ Medical Center; Consulting Staff, Associates in Nephrology, SC

Edgar V Lerma, MD, FACP, FASN, FAHA, FASH, FNLA, FNKF is a member of the following medical societies: American Heart Association, American Medical Association, American Society of Hypertension, American Society of Nephrology, Chicago Medical Society, Illinois State Medical Society, National Kidney Foundation, Society of General Internal Medicine

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Astra Zeneca
Author for: UpToDate, ACP Smart Medicine, Elsevier, McGraw-Hill, Wolters Kluwer.

Acknowledgements

George R Aronoff, MD Director, Professor, Departments of Internal Medicine and Pharmacology, Section of Nephrology, Kidney Disease Program, University of Louisville School of Medicine

George R Aronoff, MD is a member of the following medical societies: American Federation for Medical Research, American Society of Nephrology, Kentucky Medical Association, and National Kidney Foundation

Disclosure: Nothing to disclose.

Kevin McLaughlin, MBChB, PhD, MSc Associate Professor, Assistant Dean, Department of Medicine, University of Calgary Faculty of Medicine, Calgary Health Region

Kevin McLaughlin, MBChB, PhD, MSc is a member of the following medical societies: American Society of Nephrology, American Society of Transplantation, and College of Physicians and Surgeons of Alberta

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment