Microalbuminuria

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Contents 1 Etiology 2 Laboratory 3 Clinical-significance 4 More General Terms 5 Additional Terms 6 References

Etiology

• diabetic nephropathy

Laboratory

• albumin/creatinine in urine > 0.030*
  

• * urine Albumin & Creatinine in same units 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]
  

• 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

• proteinuria

Additional Terms

• albumin
• albumin/creatinine in urine

References

1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
2. Journal Watch 23(13):107, 2003 Perkins BA et al Regression of microalbuminuria in type 1 diabetes. NEJM 348(23):2285, 2003 PMID: [1]
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: [2]
4. Mahmoodi BK et al Microalbuminuria and the risk of venous thromboembolism. JAMA 2009 May 6; 301:1790. PMID: [3]
5. Mann JFE et al Effect of telmisartan on renal outcomes: A randomized trial. Ann Intern Med 2009 Jul 7; 151:1 PMID: [4]
   - 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: [5]
   - Parfrey PS Angiotensin-receptor blockers in the prevention or treatment of microalbuminuria. Ann Intern Med 2009 Jul 7; 151:63. PMID: [6]
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 <PubMed> PMID: [7] <Internet> [8]
7. Prescriber's Letter 19(4): 2012 COMMENTARY: Treating Microalbuminuria CHART: Antihypertensive Combinations Detail-Document#: [9] (subscription needed) [10]

microalbuminuria