microalbuminuria
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Etiology
- diabetic nephropathy
- yearly assessment in patients with diabetes mellitus type 2
- after 5 years in patients with diabetes mellitus type 1[1]
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
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]*
- Hgb A1c < 8%
- systolic blood pressure < 115 mm Hg
- 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
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018, 2021.
- ↑ 2.0 2.1 2.2 Journal Watch 23(13):107, 2003 Perkins BA et al Regression of microalbuminuria in type 1 diabetes. NEJM 348(23):2285, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12788992
- ↑ 3.0 3.1 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: https://www.ncbi.nlm.nih.gov/pubmed/15738353
- ↑ 4.0 4.1 Mahmoodi BK et al Microalbuminuria and the risk of venous thromboembolism. JAMA 2009 May 6; 301:1790. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19417196
- ↑ 5.0 5.1 Mann JFE et al Effect of telmisartan on renal outcomes: A randomized trial. Ann Intern Med 2009 Jul 7; 151:1 PMID: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/19451554
Parfrey PS Angiotensin-receptor blockers in the prevention or treatment of microalbuminuria. Ann Intern Med 2009 Jul 7; 151:63. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19581647 - ↑ 6.0 6.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21388309 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1007994
- ↑ Prescriber's Letter 19(4): 2012 COMMENTARY: Treating Microalbuminuria CHART: Antihypertensive Combinations Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=280425&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Hallan SI et al Age and Association of Kidney Measures With Mortality and End-stage Renal Disease JAMA. Oct 30, 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23111824 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1387683
de Boer IH Chronic Kidney Disease--A Challenge for All Ages JAMA. Oct 30, 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23111858 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1387684