!"
A Portable Color Sensor Based Urine Analysis
System to Detect Chronic Kidney Disease
Gahan B G1, Sumir R M2, Nikhil Thomas3, Pratiksha Umesh4, Lakshmi Priyanka5, Rahul U6
Dr. Jagdish Chaturvedi7, Dr. Rohan D’Souza8, Abu Tauheed9
1,6
. BMS College of Engineering, 2,3,4,5 .MVJ College of Engineering
7.
HiiiH Innovations,8,9InnAccel
gahan97@gmail.com, sumirramesh3@gmail.com, rohaniandsouza@gmail.com, abu@innaccel.com
Abstract— Chronic kidney disease (CKD) is a condition
characterized by a loss of kidney function gradually over a
period of time with five stages. Usually, in the initial stages, the
disease appears to be asymptomatic as a result diagnosis of the
disease in the early stages is unlikely. When diagnosed in the
early stages (stages 1-2) the disease is completely reversible. For
early diagnosis of the disease, we use a system consisting of
sensor TCS3200 and a urine strip. The sensor detects the change
in color on the strip when the sample is introduced. Change in
color of the strip is due to the presence of albumin in urine,
which is the primary biomarker considered to detect the early
stage of kidney dysfunction.
Keywords—Chronic Kidney Disease, Albumin, Color sensor
I. INTRODUCTION
Chronic Kidney Disease (CKD) is a serious clinical
condition characterized by loss of kidney function over the
course of time. Persistence of impaired kidney function over a
period of 3 months can have major health implications [1].
Stages 1-3 of CKD are usually asymptomatic (GFR > 30
mL/min/1.73 m²). By stage 4 or 5, some of the clinical
implications manifest as anemia, peripheral neuropathy,
malnutrition, dry skin, nausea, and diarrhea and platelet
dysfunction. Hypertension, Cystic kidney disease, Diabetic
Kidney Disease, Renal Vein Thrombosis can all be viewed as
causative factors of Chronic Kidney Disease. Owing to the
high prevalence, mortality and morbidity rates, CKD is often
observed as a major public health issue. About 17% of the
people living in India are affected by CKD, which
approximately amounts to 224 million Indians. This
essentially indicates that 1 in 6 people are affected by CKD.
Despite this alarming statistic, CKD is utterly disregarded as
an area of concern when compared to other communicable
diseases such as infant and maternal mortality [2]. End-stage
renal disease, Cardiovascular risk and high mortality rate are
attributed as serious clinical implications of Chronic Kidney
Disease. Laboratory tests, imaging studies, physical
examinations are used for screening of CKD and other
diseases. A screening procedure is generally followed by
detailed testing, specific treatment, and a follow-up procedure
fixated on turning around, slowing down or averting the
progression of the disease [3]. Operational difficulty, social
stigma, resource constraints and cost of treatment are some of
the issues related to screening. Difficulty in locating the
physician’s office, scarcity of computer-based diagnostic
systems, economic considerations, lack of understanding with
regard to the clinical condition and inadequate information
about clinical guidelines are some of the barriers for screening
of CKD [3]. In the case of CKD, Microalbuminuria is not
filtered out by the process of ultrafiltration. Due to lack of a
reliable diagnostic procedure, this goes undetected in the
asymptomatic stages. This is indicative of the impairment in
kidney function. The objective of this paper is to implement
#$%%&'$(%#%))*'+, 876
an easy, cost-effective method to screen a population with
asymptomatic chronic kidney disease and initiate therapy to
reduce the risk of cardiovascular events and end-stage renal
disease in an outreach camp setting. To achieve this we will
be using Urine test strips, the color sensor (TCS3200)
interfaced with a microcontroller and an Arduino board. The
proposed system is able to detect the change in color in the
urine strips, which is indicative of albuminuria content in
urine
The rest of the paper is structured as follows, Methodology
is explained in section 2, and section 3 is used to discuss
results, discussion about the disease state, present
technologies is done in section 4, section 5 gives conclusion
and future scope.
II. METHODOLOGY
The current issues faced in mass screening have
operational difficulty outside the laboratory setting, cultural
stigma, resource constraints and are cost ineffective.
These issues can be compensated using a portable urine
analyzer specifically designed for mass screening application
that incorporates TCS3200(color sensor), Urine test strips,
Arduino board and an Arduino software to interface the board
with the sensor. The detailed description of urine strips, the
color sensor is further explained.
A. Urine Strips
A Urine strip is a basic diagnostic tool used to determine
pathological variations in the patient’s urine sample. The test
results are usually obtained within a timeframe ranging from
a few seconds to minutes. There can also be instances where
it could exceed the mentioned limit. The various proteins
present are Aldohexose, Hemoprotein, Ketones, Hematoidin,
Stercobilinogen. Parameters like pH and relative density are
also considered during urinalysis.
Since our focus is on the early detection of kidney failure, one
of the best biomarkers that can be utilized is the protein
albumin (Albuminuria) in urine. Proteinuria is related to the
presence of abnormal quantities of protein in the urine, which
leads to the formation of urinary macromolecules. Urinary
organ impairment can be viewed as a direct consequence of
this phenomenon. In general, the color of the test strip changes
to green when it comes in contact with the sample. This is
indicative of albumin content in urine. Based on this
observation, a color sensor is used to detect the color change
on the strip, which in turn indicates the presence of protein in
the urine sample..
B. TCS 3200 Colour Sensor
The sensor TCS3200 senses light using an 8x8 array of
photodiodes, which converts light energy to current. The
current is then converted into square wave frequencies using
a current to frequency converter whose frequency is directly
proportional to light intensity. Finally, by exploiting the
Arduino Board, a square wave is observed as a result. This
exemplifies color detection by means of a sensor.

Fig.1: Current to Frequency Conversion

The photodiodes have 3 different color filters - Red, green
and blue, each of which are sixteen in number. The other
sixteen photodiodes are clear with no filters. Each of the
sixteen photodiodes is arranged in a parallel manner. The
required photodiode type can be derived by using the two
control pins S2 and S3. Consider an example to detect green
color, both pins are set to high based on the logic table given Fig.3. Operational flow of proposed method
below.
TABLE 1. LOGIC TABLE
SENSOR LOGIC III. RESULTS
S2 S3 Photodiode Type
The TCS 3200 is a color sensor used to detect 3 colors red,
blue and green. Urine test strips are used to detect the presence
L L RED of albumin in urine. In the proposed system the sensor is used
L H BLUE
to detect a change in color which indicates the presence of
albumin in the urine. A multi parameter urine test strip is used.
H L CLEAR Egg white is used to detect the presence of protein for the
H H GREEN experimentation purpose. The TCS 3200 color sensor was
able to detect the change in color from yellow to green. The
results are shown in the table below.
The sensing element has 2 additional management pins, S0 TABLE II. COLOR DETECTION USING SENSOR
and S1 that are used for scaling of the output frequency. The COLOUR RESULT
PARAMETRS
frequency can be scaled to three different preset values of 2%, DETECTED
20%, 100%. This frequency-scaling factor allows the output
EGG WHITE GREEN ALBUMIN PRESENT
of the sensor to be optimized for numerous embedded
systems. Circuit connection made between color sensor WATER YELOW ALBUMIN
TCS3200 and Arduino board is shown below.
ABSENT

Fig.3: Color Sensor interfaced with Arduino

The flowchart below portrays the operational flow of the
whole system which includes sample collection, color
detection of the strip which results in the early detection of
renal disease.
Fig.3. Urine Test Strips

877

IV. DISCUSSION
This section of the paper is intended to discuss the
pathophysiology, risk factors, stages of CKD, negative
outcomes and importance of screening. The exploration of
present technologies and future developments is a part of this
discourse. The analysis is extended so as to explain why the
proposed system is better by comparing it with existing
screening methods.
A. Pathophysiology :
There are 1 million nephrons in the kidney. Even in the case
renal injuries, the kidney can take care of GFR. In spite of
increasing destruction of nephrons, the healthy nephrons show
hyper filtration and hypertrophy. This Characteristic ability of
nephron allows for the normal flow of plasma solutes, only
after the decrease in GFR by 50 % there is a measurable
increase in the urea and creatinine levels in the Plasma [4].
With this reduction in GFR by 50 % the plasma creatinine
value is doubled approximately. Kidney dysfunction is
indicated by an increase in plasma creatinine value in a patient
(0.6 mg/dL to 1.2 mg/dL), even though this value is still within
the normal adult range. The capillaries may be damaged due
to the increased glomerular capillary pressure.
B. Risk Factors and Population Affected:
As indicated by the American Diabetes Association
(ADA), diabetes mellitus is "a gathering of metabolic disease
marked by hyperglycemia, resulting as a defect in insulin
secretion, insulin activity, or both"[5]. As indicated by
Hjelmesaeth, et al. (2010), obesity and resistance caused by
insulation are the two most regular causes for the advancement
of diabetes mellitus of type 2[6]. Muscle assumes a vital job
in controlling the body's insulin levels as skeletal muscle is the
most essential site of insulin resistance. Skeletal muscle
likewise represents glucose transfer after infusion. Because of
this, it has been discovered that muscle mass is contrarily
corresponding to insulin resistance. Then again, creatinine is
the main metabolite of creatine, or, found primarily in striated
muscle. Low serum creatinine degrees has been linked to an
extended danger of developing T2DM (Harita et al, 2009).
Hypertension has a serious impact on many organs,
basically the kidneys. Most kidney problems, which includes
CKD, are related to increase blood pressure. It has been found
that high blood pressure directly reduces kidney functionality
and indirectly decreases perfusion. This increase in creatinine
levels is an indication of kidney disease. Hypertension impacts
the blood vessels, resulting in decreased blood, depriving vital
organs of oxygen. Hypertension damages the kidneys by
damaging the functionality of nephrons in the kidney causing
kidney damage. As extra fluids and waste products cannot be
filtered out. (Shulman et al, 1989). A study conducted by Jha
et al (2013) the worldwide incidence of high blood pressure in
2000 was 972 million cases, with maximum instances being
located in developing nations. It’s been estimated that this
discern will increase to 1.56 billion by 2025. Age-specific and
sex-specific adjustments are considered for the analysis.
It has been observed that Cardiovascular Disease is
closely related to the progression of Chronic Kidney Disease
to end-stage Kidney failure (Van holder et al, 2005). The
chances of cardiac episodes in patients suffering from renal
dysfunction can be decreased by taking an immediate and
adequate preventive care [7]. A study conducted by Weiner et
878
al (2004) states that patients receiving dialysis treatment are
10 to 30 times more likely to die from CVD events this study
reviewed previously conducted research and pooled together
the statistics as a way to decide what danger CKD poses for
those susceptible to CVD. It was speculated that CKD
improved the threat of CVD consequences through several
manners; the degree of decreased kidney function can act as
an indicator for both duration and severity of different CVD
contributing elements (as an instance: high blood pressure),
and also decreased kidney function may want to exacerbate
any underlying CVD danger factors including hypertension
and cardiomyopathy. Weiner et al (2004) concluded that CKD
turned into an independent threat component with a chance
ratio of 1.19, and there was a vast relationship among kidney
function and race. These results recommend that CKD is a
threat aspect all-reason mortality and CVD in the standard
population
C. Stages of CKD:
The progression of Kidney Dysfunction can be broadly
classified into five stages, from an asymptomatic mild damage
to end-stage kidney failure. The stages of kidney disease can
be categorized based on their ability to filter out waste which
in CKD decreases as the disease progresses. In the early stages
of kidney disease, your kidneys are still able to filter out waste
from the blood. In the final stages, the kidneys have to work
harder to filter out the waste.
Stage 1: There is moderate Kidney harm in stage 1
Chronic Kidney Disease and there are no signs and symptoms.
Physician consultation is vital in preventing the further loss of
kidney malfunction. The kidneys are healthy if the GFR is
more than 90. Even though the GFR is normal there might be
signs of CKD
Stage 2: There is a slight kidney damage in stage 2 kidney
disease. If the GFR is between 60 and 89 then the kidney is in
good condition. At this stage is advised to take care of the
disease and prevent it from getting worst.
Stage 3: The initial loss of kidney functionality is indicated
by stage 3 CKD. There is a variation in the GFR based on the
subcategories in stage 3. If it is between 45 to 59 then it is
stage 3a and if between 30 and 44 it is stage 3b. Bone disease,
anemia are the further clinical complications.
Stage 4: The kidneys are seriously damaged in stage 4.
This is a critical stage and should be considered more
seriously [9]. At this stage, the kidney has lost its ability to
function properly. Waste building up in the body is the other
complication at stage 4.
Stage 5 of CKD indicates Kidney failure and there are severe
symptoms. The normal kidney function is disturbed by the
accumulation of waste and toxins in the blood. The patient has
to undergo a kidney transplantation or dialysis once the
kidneys have completely failed
Fig 4: Stages of Kidney Disease
 Glomerular filtration rate is considered in
classification of CKD stages:
TABLE III. GFR RATES AT DIFFERENT STAGES OF CKD
Stages/levels GFR rate Kidney Functionality
G1 >90 ml/min/1.73 m2 Normal
G2 60–89ml/min/1.73 m2 Mildly decreased
G3a 45–59ml/min/1.73 m2 Mildly to moderately
decreased
G3b 30–44ml/min/1.73 m2 Moderately to severely
decreased
G4 15–29ml/min/1.73 m2 Severely decreased
G5 <15 ml/min/1.73 m2 Kidney failure
D. Complications:
CKD has severe complications which are often seen as
the negative outcomes of the disease. Some of which are
discussed below
Morbidity is referred to as the state of illness and
this has serious implications for patients suffering from
Chronic Kidney Disease.
End-Stage Kidney Disease (ESKD): The incidence of
ESKD was reported by Modi and Jha as 229 per million
population. 0.785 % of the population was reported to have
Stage 3 kidney disease. Serum creatinine was considered as
the defining criteria with a cutoff over 1.8 mg/dl. The semi-
urban statistics of CKD was reported by Singh et al and found
out that 7.3 % were diabetic and 31.2 % were hypertensive.
Proteinuria and glomerular filtration rate were calculated and
urine test strips were used for screening and found 4.2 % of
the population was affected by stage 3. Even though the
number of patients with CKD who reach ESKD is less (0.15–
0.20%/year) this population is at risk with cardiovascular
disease and are almost 10-100 times vulnerable. Due to the
lack of facilities, the real burden of end-stage kidney disease
in India is not recognized
Cardiovascular Risk: The heart and the kidneys work
intently together. When there is a problem with one, things can
go wrong with the other. Heart disease can cause CKD, and
CKD can also lead to coronary heart disorder. If a heart
disease persists the heart does not work in the intended way.
The heart could be completely filled with blood [11]. This
leads to stress buildup in the major vein associated with the
kidneys, this might lead to kidney blockage and decreased
oxygen enriched blood supply to the renal system. This will
result in kidney disease. When the kidneys are not functioning
well the hormone system, which controls blood pressure
works harder to compensate the blood supply to the renal
system the kidneys. When this happens, heart is forced to
pump harder, this could lead to heart malfunction. People with
CKD are at greater risk of cardiac death about 2-4 folds
compared to people without CKD. And it is observed that
people with CKD dying from cardiovascular diseases is about
20 times higher than the risk of transplantation or dialysis
Cost burden to the patient and family: The overall median
cost of CKD patients on hemodialysis turned into substantially
higher than other CKD patients INR 61,170 vs. 12,664.
the E. Importance of Screening:
Screening, whether or not for CKD or any other
clinical condition, typically refers to use of laboratory
assessments, physical examination findings, or imaging
research to detect subclinical disease in asymptomatic people.
An uncommon finding as a results of screening is discovered
by a lot of elaborated and specific diagnostic testing,
treatment, and semi-permanent follow-up focused on
secondary prevention aimed toward reversing, preventing and
development of detected illness and rising patient effects [12].
CKD is curable: Over the past few years, the efficacy of
disease management alternatives to reduce the risk
progression of CKD to ESRD and to reduce the risk of
cardiovascular disease have been proved by meta-analysis and
medical trials. According to various studies conducted by the
researchers have shown that the progression of CKD is slower
with those who have lower blood pressure. The progression of
non-diabetic CKD and diabetic CKD can be effectively
slowed down by controlling Proteinuria levels. Diabetes
control, weight reduction, smoking cessation are linked with
lower rates of CKD development.
F. Current Methods of Diagnosis:
Complete blood count (CBC): Normochromic normocytic
anemia is typically seen in CKD. Other underlying causes of
anemia have to be ruled out.
Metabolic panel: The blood urea nitrogen (BUN) and serum
creatinine levels will be increased in patients with CKD.
Hyperkalemia or low bicarbonate levels may be present.
Serum albumin levels will also be measured, as patients can
also have hypoalbuminemia as a result of urinary protein loss
or malnutrition. A lipid profile must be carried out in all
patients with CKD because of their risk of cardiovascular
disease.
Total Protein: Total Protein screening can be carried out with
urine dipstick for patients who are not at increased risk of
CKD, according to guidelines from the National Kidney
foundation’s Kidney disease effects quality Initiative
(KDOQI). The patients have to go through the test for
affirmation of Proteinuria if the dipstick test is positive (1+
more). Total protein and creatinine clearance (CrCl) are
collected over a duration of 24-hour from the Urine. The
reliable extrapolation of total urinary protein excretion is
analyzed using Total Protein to Creatinine Ratio (%). The
patients should go through a complete diagnostic evaluation if
the ratio is above 200 mg. The nephrotic range is indicated by
the level more than 300-350 mg.
Albuminuria: KDOQI recommends the use of albumin-
specific dipstick for screening patients at high risk of CKD.
Compared to Total protein Albuminuria is a more sensitive
Biomarker.
879
 Ultrasonography: Useful to screen for hydronephrosis, H. Present Technologies:
which cannot be determined in early obstruction, or The below given table depicts the present
involvement of the retroperitoneum with fibrosis, tumor, or technologies in screening CKD:
diffuse adenopathy. Small, echogenic kidneys are ascertained
in advanced nephrosis. In distinction, kidneys sometimes are TABLE IV. PRESENT TECHNOLOGIES
traditional in size in advanced diabetic kidney disease, within TECHNOLOGY BIOMARKERS METHODOLOGY
which affected kidneys are ab initio enlarged from In humans, Cystatin C
hyperfiltration. Structural abnormalities, like those indicative present in material body
of polycystic kidneys, additionally may be ascertained on fluids is freely filtered by
ultrasonography. the capillary, which will
be reabsorbed and broken
G. Biomarkers Selected: down into small units by
Proteinuria and Albuminuria: Ultrasensitive Cystatin C nephritic tubule.
The earliest Biomarkers of kidney Dysfunction sensor
in patients suffering from diabetes, glomerular disease and The multiwalled carbon
hypertension are Albuminuria and Proteinuria. Increased Nanotubes are
excretion of serum proteins and Albumin is Proteinuria. functionalized using
Urinary tract infection, hemodynamic stress, hyperglycemia carboxyl group which
can cause a transient increase in excretion of albumin and acts as an electrode
Total Protein. The persistent levels of Proteinuria over a sensor can detect the
period of three months indicate kidney damage. The important small trace of cystatin
determinant of progression of End Stage Renal Disease present in the urine,
(ESRD) is Proteinuria [13]. The screening program is initiated which indicates some
for the individuals who have proteinuria secretion in kidney .a abnormality.
study was initiated by Japanese to understand the relationship
between increased ESRD levels and urinalysis results.
Microalbuminuria (MA) is recognized as a crucial risk issue
for cardiovascular and renal complications in diabetes. -The main aim of the
Microalbuminuria was ab initio found to predict consequent device is to detect the
overt proteinuria (dipstick positive, or >300 mg/24 h), that presence of a blood
successively predicted loss of GFR (1–3) [14]. From the protein called albumin in
strength of those relationships, it's often been assumed that the urine. The phone
micro albuminuria and overt proteinuria are requisite first and attachment is an associate
second steps on one pathway that results in loss of GFR and A Portable device Albumin degree Opto-mechanical
ESRD. A meta-analysis of eight cohorts of 845,125 general used to perform a device that beams of light
and risky individuals confirms increased risk for ESRD in kidney test through two little
those with stage 3 chronic kidney disease that is GFR about fluorescent tubes
60ml/min and in individuals with symptom the least bit levels connected to it. One
independent of traditional cardiovascular risk issue .Because channel contains an effect
medical treatment reducing the chance of complications is liquid and the other
accessible, urine albumin (UA) is very suggested as a contains excretion
screening test for diabetes patients, though it's progressively samples mixed with
recommended also for the early diagnosis of nephritic fluorescent dyes. The
unwellness and cardiovascular risk stratification[15]. The fluorescent light passes
tests for screening albumin are less expensive and have high through an extra lens
sensitivity and specificity for chronic kidney disease caused before being captured by
by Diabetes. The occurrence of cardiovascular disease is a smartphone. The
indicative of higher levels of Microalbuminuria. The study processing of the data is
conducted by the Japanese researchers showed that dipstick done using an Android
Proteinuria test may be used to detect the Microalbuminuria application.
and gave positive results [16].
The main aim of this
A device is to present
smartphone- Human a smartphone-based
based point- serum urinalysis for chronic
of-care urine albumin kidney disease (CKD)
analysis
device In this method patients,
themselves conduct rapid
and reliable quantitative
urinalysis of human
serum albumin (HSA)
using an aggregation-
induced emission (AIE)
nanomaterial probe with
their own smartphones

880

V. CONCLUSION AND FUTURE SCOPE
Chronic kidney disease is a gradual loss of kidney function
over 5 stages. The disease is completely reversible when
detected in the initial two stages. We use a portable and
reliable system consisting of light sensor TCS3200 and a urine
strip to detect CKD in the initial stages. The biomarker
considered is albumin detected through the change in color in
the urine strip. With the detection of CKD in the initial stages,
further deterioration of the kidney is prevented also risks of
diabetes, hypertension and cardiovascular disease is reduced
In the future, we aim to modify the system for measuring
other parameters such as pH, specific gravity, glucose etc.
This system can be implemented to be a home-based system.
A dedicated Android application developer can keep a track
of various parameters of kidney obtained from patient data.
An IOT system can be enforced to trace the varied different
vitals of the kidney that facilitate in early detection of CKD.
VI. LIMITATIONS
Every System tends to have its own advantages and
limitations. Chances of False Positive results, Problem in
focusing light on strips, Use of Color Specific sensors are
some of the limitations of the proposed system
881
REFERENCES
[1] KDIGO 2012 Clinical Practice Guideline for the Evaluation and
Management of Chronic Kidney Disease. January 2013
[2] Abraham G, Varghese S, Thandavan T, Iyengar A, Fernando Naqvi
SA, Sheriff R, Ur-Rashid H, Gopalakrishnan N, Kafle RK,” Chronic
kidney disease hotspots in developing countries inSouth Asia”. Clin
Kidney J 9: 135–141, 2016
[3] Berns, Jeffrey S. "Routine screening for CKD should be done in
asymptomatic adults… selectively." Clinical Journal of the American
Society of Nephrology 9.11 (2014): 1988-1992.
[4] NIDDK Causes of CKD https://www.niddk.nih.gov/health-
information/kidney-disease/chronic-kidney-disease-ckd/causes
Accessed 2/7/2018
[5] American Diabetes Association (ADA). 2010. Standards pf medical
care in diabetes-2010. Diabetes Care. 33(1): 11-61.
[6] Hjelmesæth J, Trond J, Egeland T, Hagen M, Hartmann A: Response
to Montori (Letter). Diabetes Care 25:1667
[7] Vanholder R1, Massy Z, Argiles A, Spasovski G, Verbeke F, Lameire
N” Chronic kidney disease as cause of cardiovascular morbidity and
mortality” DOI: 10.1093/ndt/gfh813I.
[8] http://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-
ckd/stages-of-chronic-kidney-disease
[9] https://www.freseniuskidneycare.com/about-chronic-kidney-
disease/stages/chronic-kidney-disease-ckd
[10] Modi, Gopesh et al.” Incidence of ESRD in India Kidney International,
Volume 79 , Issue 5 , 573 DOI: https://doi.org/10.1038/ki.2010.477Y.
[11] http://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-
ckd/complications/heart-disease.
[12] Couser, William G., et al. "The contribution of chronic kidney disease
to the global burden of major noncommunicable diseases." Kidney
international 80.12 (2011): 1258-1270.
[13] Iseki K, Ikemiya Y, Iseki C et al. Proteinuria and the risk of developing
end-stage renal disease. Kidney International. 2003; 63: 1468-74
[14] de Boer, Ian H., and Michael W. Steffes. "Glomerular filtration rate
and albuminuria: twin manifestations of nephropathy in diabetes."
Journal of the American Society of Nephrology 18.4 (2007): 1036-
1037.
[15] Brantsma, Auke H., et al. "Cardiovascular and renal outcome in
subjects with K/DOQI stage 1–3 chronic kidney disease: the
importance of urinary albumin excretion." Nephrology Dialysis
Transplantation 23.12 (2008): 3851-3858.
[16] Kannel WB, Stampfer MJ, Castelli WP et al. The prognostic
significance of proteinuria: the Framingham study. American Heart
Journal. 1984; 108: 1347-52