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[Work up and follow-up of a proteinuria: who does what and how?]
Reagent strip urinalysis is a very simple and affordable way to detect proteinuria. This mean, however efficient, generally requires further laboratory analysis of an early morning urine sample, as readily available. Lately, urinary albumin-to-creatinine ratio (ACR) has largely taken over other detection methods by its precision and ability to foreshow earlier stages of diabetic nephropathy. The confirmation of this biological abnormality enables chronic kidney disease staging, helps appreciate the risk it is associated with, and must lead to different interventions in order to reduce its burden : cause determination (which might eventually lead to a kidney biopsy) ; renin-angiotensin-system blockade in every ACR ⟩ 300 mg/g patients (or in ACR 30 - 300 mg/g diabetic patients) ; hypertension control ; or specific treatment (e.g. immunosuppressive drugs in glomerulonephritis).
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