Microalbuminuria. Epidemiology, pathogenesis, clinical role

Abstract

Microalbuminuria is defined as increased urinary albumin secretion which is not detectable by standard diagnostic methods. The incidence of microalbuminuria is estimated to be 20-30% in diabetes patients, 15% in hypertensive patients, and about 4-5% in patients without diabetes or hypertension. Microalbuminuria may not only reflect renal malfunction but can also be a marker of generalised angiopathy. In diabetes and hypertension microalbuminuria is a useful marker of changes in the cardiovascular system that are already present and can indicate the risk of future cardiovascular events. Rigorous control of blood pressure in diabetes patients diminishes microalbuminuria and slows down the progression of nephropathy and the development of end-stage renal insufficiency. It is uncertain whether decreased urinary albumin secretion in hypertensive patients is associated with similar benefits. The data available suggest that the most effective reduction in microalbuminuria is obtained from ACE inhibitors. Evidence from the NESTOR trial shows that Indapamid SR may be as effective as ACE-I in diabetes type 2 patients and hypertensive patients.