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Proteinuria should be used as a surrogate in CKD

Nature Reviews Nephrology volume 8, pages 301–306 (2012)Cite this article

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Abstract

Surrogate end points of renal failure are instrumental to the testing of new treatments in patients with chronic kidney disease, the natural history of which is characterized by a slow, asymptomatic decline in renal function. The magnitude of proteinuria is widely recognized as a marker of the severity of glomerulopathy. Population-based studies have identified proteinuria as a predictor of future decline in glomerular filtration rate and of the development of end-stage renal disease. More importantly, a reduction in proteinuria invariably translates into a protection from renal function decline in patients with diabetic and nondiabetic renal disease with overt proteinuria. Thus, proteinuria should be considered a valuable surrogate end point for clinical trials in patients with proteinuric renal diseases.

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Figure 1: Association between proteinuria level, ESRD and rate of GFR decline in patients with nondiabetic chronic nephropathies enrolled in the Ramipril Efficacy In Nephropathy (REIN) study.
Figure 2: Association between reductions in proteinuria and increased proteinuria selectivity.

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Authors and Affiliations

  1. Mario Negri Institute of Pharmacological Research, Azienda Ospedaliera Ospedali Riuniti di Bergamo, Via Stezzano 87, 24126, Bergamo, Italy

    Paolo Cravedi, Piero Ruggenenti & Giuseppe Remuzzi

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  1. Paolo Cravedi
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  2. Piero Ruggenenti
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  3. Giuseppe Remuzzi
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The authors contributed equally to all aspects of the manuscript.

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Correspondence to Giuseppe Remuzzi.

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Cravedi, P., Ruggenenti, P. & Remuzzi, G. Proteinuria should be used as a surrogate in CKD. Nat Rev Nephrol 8, 301–306 (2012). https://doi.org/10.1038/nrneph.2012.42

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