Moderately increased albuminuria (microalbuminuria) and cardiovascular disease
- George L Bakris, MD
George L Bakris, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Professor of Medicine
- The University of Chicago
INTRODUCTION, TERMINOLOGY, AND DEFINITIONS
The urine dipstick is a relatively insensitive marker for albuminuria, not becoming positive until albumin excretion exceeds 300 to 500 mg/day. Using a specific assay for albumin is a more sensitive technique. The normal rate of albumin excretion is less than 30 mg/day (20 mcg/min); persistent albumin excretion between 30 and 300 mg/day (20 to 200 mcg/min) is called moderately increased albuminuria (formerly called "microalbuminuria") [1,2]. Albumin excretion above 300 mg/day (200 mcg/min) is considered to represent overt or dipstick positive proteinuria (also called severely increased albuminuria [formerly called "macroalbuminuria"]). (See "Definition and staging of chronic kidney disease in adults".)
The distinction between the terms "albuminuria" and "proteinuria" is discussed elsewhere in detail. (See "Assessment of urinary protein excretion and evaluation of isolated non-nephrotic proteinuria in adults", section on 'Definitions'.)
Initial studies demonstrated that moderately increased albuminuria may be the earliest clinical manifestation of diabetic nephropathy in patients with type 1 diabetes, and first begins to appear five years after diagnosis. This is no longer thought to be the case, as albuminuria levels are quite variable early in the course of disease [3-5]. By comparison, moderately increased albuminuria is often present at diagnosis in patients with type 2 diabetes and may reflect underlying cardiovascular disease rather than diabetic nephropathy. Yearly screening for moderately increased albuminuria is recommended in patients with both type 1 diabetes (starting five years after disease onset) and type 2 diabetes (starting at disease onset). (See "Moderately increased albuminuria (microalbuminuria) in type 1 diabetes mellitus" and "Moderately increased albuminuria (microalbuminuria) in type 2 diabetes mellitus".)
In addition to being associated with diabetic nephropathy, moderately increased albuminuria has also been associated with cardiovascular disease in both nondiabetic and diabetic patients. These studies will be reviewed here.
Establishing the diagnosis of moderately increased albuminuria (formerly called "microalbuminuria") requires the demonstration of a persistent elevation in albumin excretion. Transient elevations in the excretion of albumin can be seen in the following settings  (see "Assessment of urinary protein excretion and evaluation of isolated non-nephrotic proteinuria in adults"):
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- INTRODUCTION, TERMINOLOGY, AND DEFINITIONS
- Urine albumin concentration
- Albumin-to-creatinine ratio
- - Limitations
- CORRELATION OF MODERATELY INCREASED ALBUMINURIA (MICROALBUMINURIA) WITH CARDIOVASCULAR DISEASE
- Clinical trials
- Population-based studies
- High-normal albuminuria
- ST and T wave changes
- Possible mechanisms
- CORRELATION OF CARDIOVASCULAR DISEASE WITH MODERATELY INCREASED ALBUMINURIA (MICROALBUMINURIA)
- Antihypertensive drugs
- Statin therapy
- SUMMARY AND RECOMMENDATIONS