Proteinuria Screening in the Primary Care Office: A Review and a Quality Improvement Project

Abstract

BACKGROUND: Proteinuria is associated with substantial cardiovascular and renal morbidity, mortality, and increased rates of hospitalization. It serves as an early indicator of chronic kidney disease (CKD). OBJECTIVES: This review examined the relationship between proteinuria, CKD, and major adverse cardiovascular events, summarized evidence-based therapies, identified gaps in screening, and presented a quality improvement (QI) project from Kaiser Permanente East Bay. METHODS: The authors conducted a literature review and a QI project using the Kaiser Permanente national CKD staging algorithm. Patients aged 18–75 years old with CKD stages 3 or 4 were identified and categorized by comorbidities. Screening rates were analyzed. RESULTS: All patients with diabetes and CKD 3 and 4 received proteinuria screening. Screening rates were lower among patients with hypertension and without diabetes. CONCLUSIONS: Early detection and intervention can reduce major adverse cardiovascular events and CKD progression. The QI project highlights effective workflows and the need to expand screening protocols to broader populations.