CASE Medicine
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NEWS: 25th Aug 2010
The Snow Capped Peaks of Proteinuria

Protein excretion in the urine is a persistent finding in the high altitude environment. Moreover, there seems to be a correlation between the quantity of proteinuria, the altitudes reached, and the duration of stay. The origin of proteinuria at altitude is hypothesised to result from a systemic inflammatory response in hypoxic states, which leads to increased vascular permeability.

Proteinuria is equally omnipresent in clinical conditions of hypoxia such as chronic obstructive airways disease and has been implicated in the pathophysiology of the multisystem diseases encountered in patients requiring intensive care. Importantly, quantifying proteinuria has been shown to have predictive value for mortality and supportive drug requirements on admission to intensive care. These findings further imply that proteinuria may provide a means of monitoring the micovascular effects of systemic inflammation.

On the Xtreme Alps expedition we follow on from work on the Xtreme Everest treks to base camp in 2009 which quantified proteinuria using the Siemens DCA Vantage Analyzer to measure microalbumin : creatinine ratios with slow ascent to altitude over several weeks. The fast ascent profile on the Xtreme Alps expedition should allow us some insight as to the time scale and predictive value of this method along with its correlates to other physiological markers.

With the added nitrate intervention in our Xtreme Alps study, we hope to further elucidate the role of the kidney in adaptations to hypoxia via nitric oxide induced changes in both vascular and molecular mechanisms.

Maryam Khosravi