Detection while there is time to act
Microalbuminuria, a condition in which low but abnormal amounts of albumin are present in the urine, is increasingly recognized as an early risk marker for chronic kidney disease (CKD). Numerous studies have linked an elevated urine albumin level in people with diabetes to a dramatically increased risk of diabetic nephropathy.1
Yet microalbuminuria can indicate more than renal dysfunction – and can do so within a much larger target group. The condition can signal more generalized vascular damage, not only among people with diabetes, but also among people with hypertension and the population as whole.2 This makes it a powerful risk marker for cardiovascular disease (CVD) and stroke, as well as for renal impairment.3 With this in mind, screening for microalbuminuria is a matter of urgency.
Screening and preventive treatment
By creating opportunities for early detection, microalbuminuria screening enables treatment that can slow or prevent the onset of CKD and CVD. Antihypertensive therapies that intervene in the renin-angiotensin-aldosteronsystem, for example, may lower the excretion of albumin in urine4 while reducing the risk to the kidneys, heart and vascular system.5 How much the albuminuria is reduced, along with the resulting level of urinary albumin, predicts the degree of protection of the vital organs.6
In light of these connections, microalbuminuria testing has a rightful place alongside more common tests of blood pressure and cholesterol. Yet even among people at risk, this inexpensive procedure is seldom performed in clinical practice.7 For this reason, the International Society of Nephrology (ISN) has urged an immediate focus on three risk groups:
- People with diabetes
- People with hypertension
- People over the age of 50 with a family history of diabetes and/or CVD
1 Responding to the challenge of diabetic nephropathy: the historic evolution of detection,prevention and management. Vora JP, Ibrahim HA, Bakris GL J Hum Hypertens. 2000 Oct-Nov;14(10-11):667-85.
2 Microalbuminuria is common, also in a nondiabetic, nonhypertensive population, and an independent indicator of cardiovascular risk factors and cardiovascular morbidity. HillegeHL, Janssen WM, Bak AA, Diercks GF, Grobbee DE, Crijns HJ, Van Gilst WH, De Zeeuw D, De Jong PE; Prevend Study Group. J Intern Med. 2001 Jun;249(6):519-26.
3 Proteinuria: an underappreciated risk factor in cardiovascular disease. Segura J, Campo C,Ruilope LM. Curr Cardiol Rep. 2002 Nov;4(6):458-62.
4 Diabetic Nephropathy: Diagnosis, Prevention, and Treatment. Gross JL,. de Azevedo MJ,Silveiro SP, Canani LH, Caramori ML, Zelmanovitz T. Diabetes Care 28:164-176, 2005.
5 Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE study. Ibsen H, Wachtell K, Olsen MH, Borch-Johnsen K, Lindholm LH, Mogensen CM, Dahllöf B. Kidney International. Vol 66, Supplement 92 (2004):S56-S58.
6 Albuminuria not only a cardiovascular/renal risk marker, but also a target for treatment? De Zeeuw D. Kidney International. Vol 66, Supplement 92(2004):52-56.
7 Microalbuminuria: Marker of Kidney and Cardiovascular Disease. George L Bakris.ISBN 978-1-85873-420-0.
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