title: Glomerular and tubular damage markers in individuals with progressive albuminuria.
abstract: OBJECTIVE
  Albuminuria is associated with risk for renal and cardiovascular disease. It is difficult to predict which persons will progress in albuminuria. This study investigated whether assessment of urinary markers associated with damage to different parts of the nephron may help identify individuals that will progress in albuminuria.
  
  
  METHODS
  Individuals were selected from a prospective community-based cohort study with serial follow-up and defined as "progressors" if they belonged to the quintile of participants with the most rapid annual increase in albuminuria, and reached an albuminuria ≥150 mg/d during follow-up. Patients with known renal disease or macroalbuminuria at baseline were excluded. Each progressor was matched to two control participants, based on baseline albuminuria, age, and sex. Furthermore, damage markers were measured in a separate set of healthy individuals.
  
  
  RESULTS
  After a median follow-up of 8.6 years, 183 of 8394 participants met the criteria for progressive albuminuria. Baseline clinical characteristics were comparable between progressors and matched controls (n=366). Both had higher baseline albuminuria than the overall population. Urinary excretion of the glomerular damage marker IgG was significantly higher in progressors, whereas urinary excretion of proximal tubular damage markers and inflammatory markers was lower in these individuals compared with controls. Healthy individuals (n=109) had the lowest values for all urinary damage markers measured.
  
  
  CONCLUSIONS
  These data suggest that albuminuria associated with markers of glomerular damage is more likely to progress, whereas albuminuria associated with markers of tubulointerstitial damage is more likely to remain stable.
authors.affiliation: Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Ferdau L
authors.initials: FL
authors.lastname: Nauta
authors.forename: Lieneke
authors.initials: L
authors.lastname: Scheven
authors.forename: Esther
authors.initials: E
authors.lastname: Meijer
authors.forename: Wim
authors.initials: W
authors.lastname: van Oeveren
authors.forename: Paul E
authors.initials: PE
authors.lastname: de Jong
authors.forename: Stephan J L
authors.initials: SJ
authors.lastname: Bakker
authors.forename: Ron T
authors.initials: RT
authors.lastname: Gansevoort
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000473:pathology* / Q000652:urine*; D015415:Biomarkers / Q000652:urine; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000652:urine; D018836:Inflammation Mediators / Q000652:urine; D007678:Kidney Glomerulus / Q000378:metabolism* / Q000473:pathology*; D007684:Kidney Tubules / Q000378:metabolism* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D015415:Biomarkers; D007074:Immunoglobulin G; D018836:Inflammation Mediators
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