Vnitr Lek 2011, 57(3):293-298

Microalbuminuria. From diabetes to cardiovascular risk

V. Monhart1,2
1 Interní klinika 1. lékařské fakulty UK a ÚVN Praha, přednosta prof. MUDr. Miroslav Zavoral, Ph.D.
2 Nefrologická ambulance Synlab Czech s.r.o. Praha

An increased albuminuria level, known as microalbuminuria is associated with a range of diseases, most frequently with diabetes mellitus and hypertension. Microalbuminuria in type 1 diabetes is an early sign of diabetic nephropathy onset, while it tends to be an indicator of the level of cardiovascular risk in type 2 diabetes and essential hypertension. At present, an increased albumin excretion is considered to be a renal symptom of generalized endothelial dysfunction. A simple investigation, not bothersome to a patient, should be performed early and repeatedly in all patients with diabetes and hypertension, as low microalbuminaemia levels can be managed with appropriate treatment.

Keywords: microalbuminuria; diabetes mellitus; hypertension; endothelial dysfunction; cardiovascular risk

Received: January 10, 2011; Published: March 1, 2011  Show citation

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Monhart V. Microalbuminuria. From diabetes to cardiovascular risk. Vnitr Lek. 2011;57(3):293-298.
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References

  1. Ruggenenti P, Remuzzi G. Time to abandon microalbuminuria? Kidney Int 2006; 70: 1214-1222. Go to original source... Go to PubMed...
  2. Lambers Heerspink HJ, Brantsma AH, de Zeeuw D et al. PREVEND Study Group. Albuminuria assessed from first-morning-void urine samples versus 24-hour urine collections as a predictor of cardiovascular morbidity and mortality. Am J Epidemiol 2008; 168: 897-905. Go to original source... Go to PubMed...
  3. Busby DE, Bakris GL. Comparison of commonly used assays for the detection of microalbuminuria. J Clin Hypertens 2004; 6 (Suppl 3): 8-12. Go to original source... Go to PubMed...
  4. Levey AS, Eckardt KU, Tsukamoto et al. Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improve Global Outcomes (KDIGO). Kidney Int 2005; 67: 2089-2100. Go to original source... Go to PubMed...
  5. de Zeeuw D, Parving HH, Hening RH et al. Microalbuminuria as an early marker for cardiovascular disease. J Am Soc Nephrol 2006; 17: 2100-2105. Go to original source... Go to PubMed...
  6. Comper WD, Osicka TM, Clark M et al. Earlier detection of microalbuminuria in diabetic patients using a new urinary albumin assay. Kidney Int 2004; 65: 1850-1855. Go to original source... Go to PubMed...
  7. Ewald B, Attia J. Which test to detect microalbuminuria in diabetic patients? A systematic review. Aust Fam Physician 2004; 33: 565-568. Go to PubMed...
  8. de Jong PE, Curhan GC. Screening, monitoring, and treatment of albuminuria: Public health perspectives. J Am Soc Nephrol 2006; 17: 2120-2126. Go to original source... Go to PubMed...
  9. The American Diabetes Association. Standards of medical care in diabetes - 2009. Diabetes Care 2009; 32 (Suppl 1): S13-S61. Go to PubMed...
  10. Hillege HL, Janssen WM, Bak AA et al. Prevend Study Group. Microalbuminuria is common, also in a nondiabetic, nonhypertensive population, and an independent indicator of cardiovascular risk factors and cardiovascular morbidity. J Intern Med 2001; 249: 519-526. Go to original source... Go to PubMed...
  11. Romundstad S, Holmen J, Kvenild K et al. Microalbuminuria and all-cause mortality in 2,089 apparently healthy individuals: A 4.4-year follow-up study The Nord-Trøndelag Health Study (HUNT), Norway. Am J Kidney Dis 2003; 42: 466-473. Go to original source... Go to PubMed...
  12. Jones CA, Francis ME, Eberhardt MS et al. Microalbuminuria in the US population: third National Health and Nutrition Examination Survey. Am J Kidney Dis 2002; 39: 445-459. Go to original source... Go to PubMed...
  13. Tapp RJ, Shaw JE, Zimmet PZ et al. Albuminuria is evident in the early stages of diabetes onset: results from the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Am J Kidney Dis 2004; 44: 792-798. Go to original source... Go to PubMed...
  14. Coresh J, Selvin E, Stevens LA et al. Prevalence of chronic kidney disease in the United States. JAMA 2007; 298: 2038-2047. Go to original source... Go to PubMed...
  15. Parving HH, Lewis JB, Ravid M et al. DEMAND investigators. Prevalence and risk factors for microalbuminuria in a referred cohort of type II diabetic patients: a global perspective. Kidney Int 2006; 69: 2057-2063. Go to original source... Go to PubMed...
  16. Wachtell K, Palmieri V, Olsen MH et al. Urine albumin/creatinine ratio and echocardiographic left ventricular structure and function in hypertensive patients with electrocardiographic left ventricular hypertrophy: The LIFE study. Losartan Intervention for Endpoint Reduction. Am Heart J 2002; 143: 319-326. Go to original source... Go to PubMed...
  17. Böhm M, Thoenes M, Danchin N et al. Association of cardiovascular risk factors with microalbuminuria in hypertensive individuals: the i-SEARCH global study. J Hypertens 2007; 25: 2317-2324. Go to original source... Go to PubMed...
  18. Agrawal B, Berger A, Wolf K et al. Microalbuminuria screening by reagent strip predicts cardiovascular risk in hypertension. J Hypertens 1996; 14: 223-228. Go to original source... Go to PubMed...
  19. Cerasola G, Mulé G, Nardi E et al. Hypertension, microalbuminuria and renal dysfunction. The Renal Dysfunction in Hypertension (REDHY) study. J Nephrol 2008; 21: 368-373. Go to PubMed...
  20. Leoncini G, Viazzi F, Rosei EA et al. Chronic kidney disease in hypertension under specialist care: the I-DEMAND study. J Hypertens 2010; 28: 2317-2324. Go to original source... Go to PubMed...
  21. de Zeeuw D, Remuzzi G, Parving HH et al. Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation 2004; 110: 921-927. Go to original source... Go to PubMed...
  22. Cerasola G, Cottone S, Mulè G. The progressive pathway of microalbuminuria: from early marker of renal damage to strong cardiovascular risk predictor. J Hypertens 2010; 28: 2357-2369. Go to original source... Go to PubMed...
  23. Basi S, Lewis JB. Microalbuminuria as a target to improve cardiovascular and renal outcomes. Am J Kidney Dis 2006; 47: 927-946. Go to original source... Go to PubMed...
  24. Wolf G, Chen S, Ziyadeh FN. From the periphery of the glomerular capillary wall toward the center of disease: podocyte injury comes of age in diabetic nephropathy. Diabetes 2005; 54: 1626-1634. Go to original source... Go to PubMed...
  25. Ochodnicky P, Henning RH, van Dokkum RP et al. Microalbuminuria and endothelial dysfunction: emerging targets for primary prevention of end-organ damage. J Cardiovasc Pharmacol 2006; 47 (Suppl 2): S151-S162. Go to original source... Go to PubMed...
  26. Rüster C, Wolf G. Renin-angiotensin-aldosterone system and progression of renal disease. J Am Soc Nephrol 2006; 17: 2985-2991. Go to original source... Go to PubMed...
  27. Klausen K, Borch-Johnsen K, Feldt-Rasmussen B et al. Very low levels of microalbuminuria are associated with increased risk of coronary heart disease and death independently of renal function, hypertension, and diabetes. Circulation 2004; 110: 2-35. Go to original source... Go to PubMed...
  28. Menne J, Chatzikyrkou Ch, Haller H. Microalbuminuria as a risk factor: the influence of renin-angiotensin system blockade. J Hypertens 2010; 28: 1983-1994. Go to original source... Go to PubMed...
  29. Ärnlöv J, Evans JC, Meigs JB et al. Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals: the Framingham Heart Study. Circulation 2005; 112: 969-975. Go to original source... Go to PubMed...
  30. Jager A, Kostense PJ, Ruhé HG et al. Microalbuminuria and peripheral arterial disease are independent predictors of cardiovascular and all-cause mortality, especially among hypertensive subjects. Five-year follow-up of the Hoorn Study. Arterioscler Thromb Vasc Biol 1999; 19: 617-624. Go to original source... Go to PubMed...
  31. Hillege HL, Fidler V, Diercks GF et al. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation 2002; 106: 1777-1782. Go to original source... Go to PubMed...
  32. Gerstein HC, Mann JFE, Yi Q et al. HOPE Study Investigators. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001; 286: 421-426. Go to original source... Go to PubMed...
  33. Valmadrid CT, Klein R, Moss SE et al. The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus. Arch Intern Med 2000; 160: 1093-1100. Go to original source... Go to PubMed...
  34. Wachtell K, Ibsen H, Olsen MH et al. Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE study. Ann Intern Med 2003; 139: 901-906. Go to original source... Go to PubMed...
  35. Yuyun MF, Dinneen SF, Edwards OM et al. Absolute level and rate of change of albuminuria over 1 year independently predict mortality and cardiovascular events in patients with diabetic nephropathy. Diabet Med 2003; 20: 277-282. Go to original source... Go to PubMed...
  36. O'Hare AM, Hailpern SM, Pavkov ME et al. Prognostic implications of the urinary albumin to creatinine ratio in veterans of different ages with diabetes. Arch Intern Med 2010; 170: 930-936. Go to original source... Go to PubMed...
  37. Berton G, Cordiano R, Palmieri R et al. Albumin excretion in diabetic patients in the setting of acute myocardial infarction: association with 3-year mortality. Diabetologia 2004; 47: 1511-1518. Go to original source... Go to PubMed...
  38. Berton G, Cordiano R, Mazzuco S et al. Albumin excretion in acute myocardial infarction: A guide for long-term prognosis. Am Heart J 2008; 156: 760-768. Go to original source... Go to PubMed...
  39. Yuyun MF, Khaw KT, Luben R et al. Microalbuminuria and stroke in a British population: the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) population study. J Intern Med 2004; 255: 247-256. Go to original source... Go to PubMed...
  40. Özyilmaz A, Bakker SJ, de Zeeuw D et al. PREVEND Study Group. Selection on albuminuria enhances the efficacy of screening for cardiovascular risk factors. Nephrol Dial Transplant 2010; 25: 3560-3568. Go to original source... Go to PubMed...
  41. Hallan S, Astor B, Romundstad S et al. Association of kidney function and albuminuria with cardiovascular mortality in older vs younger individuals: The HUNT II Study. Arch Intern Med 2007; 167: 2490-2496. Go to original source... Go to PubMed...
  42. Chronic Kidney Disease Prognosis Consortium. Matsushita K, van der Velde M, Astor BC et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010; 375: 2073-2081. Go to original source... Go to PubMed...
  43. Mancia G, De Backer G, Dominiczak A et al. Management of Arterial Hypertension of the European Society of Hypertension; European Society of Cardiology. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25: 1105-1087. Go to original source... Go to PubMed...
  44. Chobanian AV, Bakris GL, Black HR et al. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 2003; 289: 2560-2572. Go to original source... Go to PubMed...
  45. Ogihara T, Kikuchi K, Matsuoka H et al. Japanese Society of Hypertension Committee. The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2009). Hypertens Res 2009; 32: 3-107. Go to original source...
  46. Ruggenenti P, Fassi A, Ilieva AP et al. Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) Investigators. Preventing microalbuminuria in type 2 diabetes. N Engl J Med 2004; 351: 1941-1951. Go to original source... Go to PubMed...
  47. Mann JFE, Schmieder RE, Dyal L et al. TRANSCEND (Telmisartan Randomised Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease) Investigators. Effect of Telmisartan on Renal Outcomes: A Randomized Trial. Ann Intern Med 2009; 151: 1-10. Go to original source... Go to PubMed...
  48. Bilous R, Chaturvedi N, Sjølie AK et al. Effect of Candesartan on Microalbuminuria and Albumin Excretion Rate in Diabetes: Three Randomized Trials. Ann Intern Med 2009; 151: 11-20. Go to original source... Go to PubMed...
  49. Mauer M, Zinman B, Gardiner R et al. Renal and retinal effects of enalapril and losartan in type 1 diabetes. N Engl J Med 2009; 361: 40-51. Go to original source... Go to PubMed...
  50. Haller H, Ito S, Izzo JL Jr et al. Prevention of microalbuminuria: in type 2 diabetes (Roadmap Trial). J Hypertension 2010; 28: 233. Go to original source...
  51. Haller J, Ito S, Izzo JL et al. Prevention of microalbuminuria: Predictors for a good response to olmesartan treatment (Roadmap Trial). J Hypertension 2010; 28: 275. Go to original source...
  52. Ritz E, Viberti GC, Ruilope LM et al. Determinants of urinary albumin excretion within the normal range in patients with type 2 diabetes: the Randomised Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study. Diabetologia 2010; 53: 49-57. Go to original source... Go to PubMed...
  53. Mann JF, Schmieder RE, McQueen M et al. ONTARGET investigators. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet 2008; 372: 547-553. Go to original source... Go to PubMed...
  54. Douglas K, O'Malley PG, Jackson JL. Meta-analysis: the effect of statins on albuminuria. Ann Intern Med 2006; 145: 117-124. Go to original source... Go to PubMed...
  55. Keech A, Simes RJ, Barter P et al. FIELD study investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9 795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 2005; 366: 1849-1861. Go to original source... Go to PubMed...
  56. Schrader J, Lüders S, Kulschewski A et al. MARPLE Study Group. Microalbuminuria and tubular proteinuria as risk predictors of cardiovascular morbidity and mortality in essential hypertension: final results of a prospective long-term study (MARPLE Study). J Hypertens 2006; 24: 541-548. Go to original source... Go to PubMed...
  57. Bakris GL, Ruilope L, Locatelli F et al. Treatment of microalbuminuria in hypertensive subjects with elevated cardiovascular risk: Results of the IMPROVE trial. Kidney Int 2007; 72: 879-885. Go to original source... Go to PubMed...
  58. Ibsen H, Olsen MH, Wachtell K et al. Reduction in albuminuria translates to reduction in cardiovascular events in hypertensive patients: losartan intervention for endpoint reduction in hypertensive study. Hypertension 2005; 45: 198-202. Go to original source... Go to PubMed...




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