nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2009-13-3-33-38nefr-1175Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESМНОГОГРАННАЯ АЛЬБУМИНУРИЯ: АСПЕКТЫ КЛИНИЧЕСКОГО ЗНАЧЕНИЯMANYSIDED ALBUMINURIA: ASPECTS OF CLINICAL VALUEДобронравовВ. А.DobronravovV. A.

Научно-исследовательский институт нефрологии,

кафедра пропедевтики внутренних болезней

СмирновА. В.SmirnovA. V.

Научно-исследовательский институт нефрологии,

кафедра пропедевтики внутренних болезней

КаюковИ. Г.KayukovI. G.

Научно-исследовательский институт нефрологии,

кафедра нефрологии и диализа

197022, Санкт-Петербург, ул. Л. Толстого, 17, СПбГМУ им. акад. И.П. Павлова, Нефрокорпус; тел.: (812)-346-39-26; факс: (812)-234-91-91.

kaukov@nephrolog.ruСанкт-Петербургский государственный медицинский университет им. акад. И.П. ПавловаРоссия2009100320091333338Copyright © Добронравов В.А., Смирнов А.В., Каюков И.Г., 20092009Добронравов В.А., Смирнов А.В., Каюков И.Г.Dobronravov V.A., Smirnov A.V., Kayukov I.G.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1175

Диагностика хронической болезни почек (ХБП) может базироваться на выявлении любых морфологических и клинических маркёров почечного повреждения в зависимости от клинической ситуации. К рутинным лабораторным маркёрам почечного повреждения можно отнести протеинурию, изменения в осадке мочи, данные анализов крови и мочи, изменения при функциональных и визуализирующих методах исследования. В клинической практике при отсутствии любых других признаков хронического повреждения почек уровень альбуминурии является единственным и относительно ранним показателем, позволяющим исключить или подтвердить наличие субклинического течения ХБП, особенно в условиях сохранной скорости клубочковой фильтрации. Повышение отдаленных почечных и кардиоваскулярных рисков также ассоциируется с наличием микроальбуминурии (30–299 мг/сут). Тем не менее, имеющиеся данные позволяют признать целесообразным снижение верхнего порога нормальных значений мочевого альбумина до 15 мг/сут, а не до 30 мг/сут, как это сейчас общепринято в обычной клинической практике. Обсуждается необходимость использования в клинической практике индексации стадий ХБП в зависимости от уровня альбуминурии/протеинурии, которая в компактной форме позволяет иметь важную информацию для оценки прогноза течения дисфункции почек и планирования соответствующих профилактических мероприятий.

Diagnostics of chronic kidney disease (CKD) can be based on the revealing of any morphological and clinical markers of kidney injury depending on a clinical situation. Proneinuria, changes in the urinary sediment, results of blood and urine analyses, changes observed with the use of functional and visualizing methods of examination could be considered as routine laboratory markers of kidney injury. In clinical practice in the absence of any other signs of chronic kidney injury the severity of albuminuria is the only and comparatively early indicator, allowing to exclude or to confirm the presence of subclinical CKD course, especially in conditions of remaining glomerular filtration rate. The rise of remote renal and cardiovascular risks also associates with microalbuminuria (30-299 mg/days). Nevertheless, the available data allow to consider it expedient to decrease the upper level of normal urinary albumin to 15 mg/day, instead of 30 mg/days as it is now in usual clinical practice. The necessity of use of CKD stages indexation in clinical practice depending on the level of albuminuria/proteinuria is discussed; it allows getting important information ina compact form to estimate the longterm prognosis for the kidney dysfunction and to plan preventive measures.

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The authors declare that there are no conflicts of interest present.