PROTEINURIA PREDICTS END-STAGE RENAL-FAILURE IN NONDIABETIC CHRONIC NEPHROPATHIES

We correlated baseline parameters with glomerular filtration rate (GFR ) decline and kidney survival in 274 patients with proteinuric non-dia betic chronic nephropathies (creatinine clearance 20 to 70 ml/min/1.73 m(2) and proteinuria > 1 g/24 hr over the last three months) enrolled in the Ramipril Efficacy In Nephropathy (REIN) trial. The GFR, evalua ted at baseline, one, three and six months after randomization then ev ery six months, declined linearly by 0.52 +/- 0.83 ml/min/1.73 m(2)/mo nth (mean +/- SD) over a follow-up (median: range) of 21: 3 to 52 mont hs, and kidney survival was 64%. In multivariate analysis, higher base line proteinuria (P = 0.006), and lower GFR (P = 0.0001) and creatinin e clearance (P = 0.0001) correlated with a faster GFR decline. Higher proteinuria was the only baseline predictor of a shorter kidney surviv al (P = 0.0007) and its predictive value was independent of the underl ying renal disease, treatment randomization, and blood pressure contro l during the followup. Patients in the lowest tertile of baseline prot einuria (< 2.5 g/24 hr) had the slowest rate of GFR decline (-0.25 +/- 0.72 ml/min/1.73 m(2)/month) and the highest kidney survival (94%), c ompared with patients in the middle tertile (proteinuria 2.5 to 4.3 g/ 24 hr; Delta GFR, -0.59 +/- 0.82 ml/min/1.73 m(2)/month, P = 0.008; ki dney survival 57%, P = 0.0011) and in the highest tertile (proteinuria > 4.3 g/24 hr; Delta GFR, -0.79 +/- 0.87 ml/min/1.73 m(2)/month, P = 0.0001, kidney survival 44%, P = 0.0001). Kidney survival significantl y differed even between the middle and highest tertiles (P < 0.05). Th us, in non-diabetic chronic nephropathies proteinuria is an independen t and accurate predictor of disease progression and ESRF.