Proteinuria as a therapeutic target in patients with chronic kidney disease.

Patients excreting large amounts of urinary protein, who are otherwise deemed to be optimally treated, should still be considered at high risk for renal disease progression. The observation that reductions in urinary protein excretion, in a graded fashion over a relatively short period of time, correlate with long-term preservation of renal function supports the idea of using urinary protein excretion as a guide to implementation of renoprotective therapies. The association between residual proteinuria and renal outcomes suggests that minimization of proteinuria is an important therapeutic goal in the management of proteinuric chronic kidney disease patients. This article reviews the evidence for using proteinuria as a target for the implementation of therapies shown to have renal protective effects.