Microalbuminuria as a Risk Predictor in Diabetes: The Continuing Saga

Author:

Bakris George L.1,Molitch Mark2

Affiliation:

1. ASH Comprehensive Hypertension Center, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, The University of Chicago Medicine, Chicago, IL

2. Department of Medicine, Division of Endocrinology, Northwestern University School of Medicine, Chicago, IL

Abstract

OBJECTIVE The rationale for this study was to review the data on microalbuminuria (MA), an amount of albumin in the urine of 30–299 mg/day, in patients with diabetes in the context of cardiovascular risk and development of kidney disease. The objective was to review the pathophysiology of MA in patients with diabetes and review the data from trials regarding MA in the context of risk for cardiovascular events or kidney disease progression. RESEARCH DESIGN AND METHODS Data sources were all PubMed-referenced articles in English-language peer-reviewed journals since 1964. Studies selected had to have a minimum 1-year follow-up and be either a randomized trial linking MA to cardiovascular or kidney disease outcome, a meta-analysis/systematic review, or a large observational cohort study. RESULTS The data suggest that MA is a risk marker for cardiovascular events and possibly for kidney disease development. Its presence alone, however, does not indicate established kidney disease, especially if the estimated glomerular filtration rate is >60 mL/min/1.73 m2. An increase in MA, when blood pressure and other risk factors are controlled, portends a poor prognosis for kidney outcomes over time. Early in the course of diabetes, aggressive risk factor management focused on glycemic and blood pressure goals is important to delay kidney disease development and reduce cardiovascular risk. CONCLUSIONS MA is a marker of cardiovascular disease risk and should be monitored per guidelines once or twice a year for progression to macroalbuminuria and kidney disease development, especially if plasma glucose, lipids, and blood pressure are at guideline goals.

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

Reference73 articles.

1. Urinary albumin excretion and diabetes mellitus;Keen;Lancet,1964

2. The consomitants of raised blood sugar: studies in newly-detected hyperglycaemics. II. Urinary albumin excretion, blood pressure and their relation to blood sugar levels;Keen;Guys Hosp Rep,1969

3. Urinary albumin excretion during exercise in juvenile diabetes. A provocation test for early abnormalities;Mogensen;Scand J Clin Lab Invest,1975

4. Increased glomerular permeability to albumin induced by exercise in diabetic subjects;Viberti;Diabetologia,1978

5. Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus;Viberti;Lancet,1982

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