Does reduction in proteinuria decrease cardiovascular risk?
The greater the proteinuria, the higher the cardiovascular risk. A reduction in urine protein excretion is associated with long-term slowing in the loss of kidney function.
However, whether or not reduction in proteinuria will reduce cardiovascular risk is unclear at this time. Nevertheless, given the benefit of the slowing rate of decline of the GFR, attempts should be made to reduce urine protein excretion to at least <1.0 g/day.
There are two broad strategies for reducing urine protein excretion:
• Therapies specific to the underlying disease (like that for glomerular diseases)
• Nonspecific therapies. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are the most effective nonspecific anti-proteinuric therapies and should be the first-line antihypertensive therapies as long as there are no contraindications for their use. The combined use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers is no longer recommended, as it is associated with a higher risk for clinically meaningful acute worsening of kidney function.