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microalbuminuria

Etiology: - diabetic nephropathy - yearly assessment in patients with diabetes mellitus type 2 - after 5 years in patients with diabetes mellitus type 1 [1] Clinical significance: - excretion of albumin in the urine in the range of 30-100 mg/day (15-200 ug/min) - it is a marker of glomerular hyperfiltration & endothelial dysfunction. - earliest manifestation of diabetic nephropathy - predicts development of hypertension [3] - doubles risk of venous thromboembolism, likely a result of endothelial dysfunction [4] - any degree of albuminuria is associated with increased risk of cardiovascular events, heart failure hospitalizations, & all-cause mortality [1] Factors favoring resolution of microalbuminuria in diabetics [2]* 1) Hgb A1c < 8% 2) systolic blood pressure < 115 mm Hg 3) cholesterol < 200 mg/dL or triglycerides < 150 mg/dL * ACE inhibitors but not ARBs, associated with resolution of microalbuminuria in type-2 diabetes [5] * ACE inhibitors are NOT associated with resolution of microalbuminuria in type-1 diabetes [2] * olmesartan (an ARB) may delay or prevent microalbuminuria in patients with type-2 diabetes at the cost of increased cardiovascular risk [6] * ACE inhibitors or ARBs do not prevent of slow progression of diabetic nephropathy in normotensive diabetics with microalbuminuria Laboratory: - 24 hour urine albumin 30-300 mg/24 hours [1] - albumin/creatinine in urine > 0.030* (0.030-0.300)* - conventional urine dipstick negative for protein * urine albumin & urine creatinine in same units - a ratio of 0.030 is equivalent to 30 mg Albumin/g Creatinine

Related

albumin (ALB) albumin/creatinine in urine

General

proteinuria

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018, 2021.
  2. Journal Watch 23(13):107, 2003 Perkins BA et al Regression of microalbuminuria in type 1 diabetes. NEJM 348(23):2285, 2003 PMID: 12788992
  3. Journal Watch 25(11):90, 2005 Wang TJ, Evans JC, Meigs JB, Rifai N, Fox CS, D'Agostino RB, Levy D, Vasan RS. Low-grade albuminuria and the risks of hypertension and blood pressure progression. Circulation. 2005 Mar 22;111(11):1370-6. Epub 2005 Feb 28. PMID: 15738353
  4. Mahmoodi BK et al Microalbuminuria and the risk of venous thromboembolism. JAMA 2009 May 6; 301:1790. PMID: 19417196
  5. Mann JFE et al Effect of telmisartan on renal outcomes: A randomized trial. Ann Intern Med 2009 Jul 7; 151:1 PMID: 19451556 - Bilous R et al. Effect of candesartan on microalbuminuria and albumin excretion rate in diabetes: Three randomized trials. Ann Intern Med 2009 Jul 7; 151:11. PMID: 19451554 - Parfrey PS Angiotensin-receptor blockers in the prevention or treatment of microalbuminuria. Ann Intern Med 2009 Jul 7; 151:63. PMID: 19581647
  6. Haller H et al Olmesartan for the Delay or Prevention of Microalbuminuria in Type 2 Diabetes N Engl J Med 2011; 364:907-917March 10, 2011 PMID: 21388309 http://www.nejm.org/doi/full/10.1056/NEJMoa1007994
  7. Prescriber's Letter 19(4): 2012 COMMENTARY: Treating Microalbuminuria CHART: Antihypertensive Combinations Detail-Document#: 280425 (subscription needed) http://www.prescribersletter.com
  8. Hallan SI et al Age and Association of Kidney Measures With Mortality and End-stage Renal Disease JAMA. Oct 30, 2012 PMID: 23111824 http://jama.jamanetwork.com/article.aspx?articleid=1387683 - de Boer IH Chronic Kidney Disease--A Challenge for All Ages JAMA. Oct 30, 2012 PMID: 23111858 http://jama.jamanetwork.com/article.aspx?articleid=1387684