OVERT PROTEINURIA AND MICROALBUMINURIA IN AUTOSOMAL-DOMINANT POLYCYSTIC KIDNEY-DISEASE

The amount of proteinuria is a prognostic indicator in a variety of gl omerular disorders. To examine the importance of urinary protein excre tion in autosomal dominant polycystic kidney disease, this study de te rmined the clinical characteristics of autosomal dominant polycystic k idney disease patients with estab, Iished proteinuria and the frequenc y of microalbumin uria in hypertensive autosomal dominant polycystic k idney disease patients without proteinuria. In 270 auto somal dominant polycystic kidney disease patients, mean 24-h urinary protein excreti on was 259 +/- 22 mg/day. Forty/eight of 270 autosomal dominant polycy stic kidney disease patients had overt proteinuria (> 300 mg/day). The patients with established proteinuria had higher mean arterial pressu res, larger renal volumes, and lower creatinine clearances than did th eir nonproteinuric counterparts (all P < 0.0001), a greater pack year smoking history (P < 0.05), and the projection of a more aggressive co urse of renal disease (P < 0.05). All autosomal dominant polycystic ki dney disease patients with established proteinuria were hypertensive, as compared with 67% without established proteinuria (P < 0.001). Fort y-nine patients with hypertension and left ventricular hypertrophy wit hout established pro teinuria were examined for microalbuminuria; 41% demonstrated microalbuminuria. Those with microalbuminuria had higher mean arterial pressure, larger renal volumes and increased filtration fraction. Therefore, established proteinuria and microalbuminuria in a utosomat dominant polycystic kidney disease patients are associated wi th increased mean arterial pressure and more severe renal cystic invol vement.