Cited by 217Renal Diseases and GlomerulopathiesChronic Kidney Disease and DiabetesAcute Kidney Injury Research

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Management of Glomerular Proteinuria: A Commentary

Wilmer, William A., Rovin, Brad H., Hebert, Christopher J., Rao, Sunil V., Kumor, Karen, Hebert, Lee A.·2003·Journal of the American Society of Nephrology

DOI 10.1097/01.asn.0000100145.27188.33

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Abstract

It is widely accepted that proteinuria reduction is an appropriate therapeutic goal in chronic proteinuric kidney disease. Based on large randomized controlled clinical trials (RCT), ACE inhibitor (ACEI) and angiotensin receptor blocker (ARB) therapy have emerged as the most important antiproteinuric and renal protective interventions. However, there are numerous other interventions that have been shown to be antiproteinuric and, therefore, likely to be renoprotective. Unfortunately testing each of these antiproteinuric therapies in RCT is not feasible. The nephrologist has two choices: restrict antiproteinuric therapies to those shown to be effective in RCT or expand the use of antiproteinuric therapies to include those that, although unproven, are plausibly effective and prudent to use. The goal of this work is to provide the documentation needed for the nephrologist to choose between these strategies. This work describes 25 separate interventions that are either antiproteinuric or may block injurious mechanisms of proteinuria. Each intervention is assigned a level of recommendation (Level 1 is the highest; Level 3 is the lowest) according to the strength of the evidence supporting its antiproteinuric and renoprotective efficacy. Pathophysiologic mechanisms possibly involved are also discussed. The number of interventions at each level of recommendation are: Level 1, n = 7; Level 2, n = 9; Level 3, n = 9. Our experience indicates that we can achieve in most patients the maj…

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Authors: Wilmer, W. A., Rovin, B. H., Hebert, C. J., Rao, S. V., Kumor, K., & Hebert, L. A.
Affiliations: The Ohio State University Wexner Medical Center (US)
Louis Stokes Cleveland VA Medical Center (US)
Duke University (US)
Alexion Pharmaceuticals (United States) (US)
Corresponding author: Wilmer, William A.
Rovin, Brad H.
Hebert, Lee A.
ORCID: Rovin, Brad H.
Rao, Sunil V.
Venue: Journal of the American Society of Nephrology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2003-12
Volume: 14
Issue: 12
Pages: 3217-3232
ISSN: 1046-6673 (ISSN-L)
DOI: 10.1097/01.asn.0000100145.27188.33
OpenAlex: W2110754607
Cited by: 217
References: 168
Citations by year: 2026: 1 · 2025: 5 · 2024: 3 · 2023: 4 · 2022: 6 · 2021: 7 · 2020: 3 · 2019: 8 · 2018: 3 · 2017: 4 · 2016: 7 · 2015: 8 · 2014: 6 · 2013: 19 · 2012: 14
FWCI: 10.93
Type: journal article
Language: en
Open access: closed
Locations: Journal of the American Society of Nephrology (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5u01dk039485-05)
National Institute of Diabetes and Digestive and Kidney Diseases (P01-DK55546, P01DK055546, U10 DK 48621, U01 DK 39485)
National Center for Research Resources (M01-RR-00034, M01RR000034)
Topics: Health Sciences › Medicine › Nephrology › Renal Diseases and Glomerulopathies
Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
Keywords: glomerular proteinuria, proteinuria reduction, chronic kidney disease, renal protection, antiproteinuric therapy, ACE inhibitors, angiotensin receptor blockers, evidence-based recommendations, pathophysiological mechanisms
MeSH terms: Humans, Kidney Diseases, Kidney Glomerulus, Monitoring, Physiologic, Proteinuria, Disease Progression

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Management of Glomerular Proteinuria: A Commentary

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