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Damages to Kidney Disease

Kidney damage is defined as structural or functional abnormalities of the kidney, initially without decreased GFR, which over time can lead to decreased GFR. As described earlier, markers of kidney damage include abnormalities in the composition of the blood or urine or abnormalities in imaging tests. This section will emphasize proteinuria as a marker of kidney damage because it has been studied most thoroughly, including in NHANES III.
Proteinuria is an early and sensitive marker of kidney damage in many types of chronic kidney disease. Albumin is the most abundant urine protein in most types of chronic kidney disease. Low molecular weight (LMW) globulins are the most abundant urine proteins in some types of chronic kidney disease. In this and later guidelines, the term proteinuria(Proteinuria and Kidney Disease) includes albuminuria, increased urinary excretion of other specific proteins, and increased excretion of total urine protein. On the other hand, the term albuminuria has been used only when referring to increased urinary albumin excretion. Older laboratory methods, such as the urine dipstick or acid precipitation, detect most urine proteins. Microalbuminuria refers to excretion of small but abnormal amounts of albumin, which requires recently developed, more sensitive laboratory methods that are now widely available.
Normal mean value for urine albumin excretion in adults is approximately 10 mg/d. Albumin excretion is increased by physiological variables, such as upright posture, exercise, pregnancy, and fever. Normal mean value for urine total protein is approximately 50 mg/d. Major constituents of normal urine protein are albumin, LMW proteins filtered from the blood, and proteins derived from the urinary tract.

In practice, it is difficult to collect a timed urine specimen. the urinary excretion rate for albumin and total protein can be estimated from the ratio of albumin or total protein to creatinine concentration in an untimed (“spot”) urine specimen. Because protein excretion varies throughout the day, the normal ratio varies throughout the day. The ratio in a first morning specimen correlates most closely with overnight protein excretion rate, whereas the ratio in mid-morning specimens correlates most closely with 24-hour protein excretion rate. Creatinine excretion is higher in normal men than women,(How to Reduce High Creatinine Level in Blood ); therefore, the values in the general population and cut-off values for abnormalities in urine albumin-to-creatinine ratio are lower for men than women

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