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Current Opinion in Nephrology and... Sep 1994Microalbuminuria indicates slightly elevated urinary albumin excretion. In most cases, microalbuminuria is of glomerular origin and indicates initial glomerulosclerosis.... (Review)
Review
Microalbuminuria indicates slightly elevated urinary albumin excretion. In most cases, microalbuminuria is of glomerular origin and indicates initial glomerulosclerosis. Microalbuminuria has a high predictive value for nephropathy in insulin-dependent diabetes subjects and for premature mortality due to cardiovascular disease in non-insulin-dependent diabetes subjects and in the general population. All cardiovascular risk factors can be determinants for microalbuminuria constitution, especially the genetic determinants of these risk factors. Thus, microalbuminuria can be an indicator to summarize renal or cardiovascular risk, or both, in various populations. Treatment interventions were performed using microalbuminuria as the endpoint. So far, the most convincing results were obtained with angiotensin I-converting enzyme inhibitors to prevent nephropathy in insulin-dependent diabetes subjects.
Topics: Albuminuria; Animals; Endothelium, Vascular; Genetic Predisposition to Disease; Humans; Kidney Diseases; Nephrology; Prognosis; Risk Factors; Vascular Diseases
PubMed: 7804756
DOI: 10.1097/00041552-199409000-00015 -
Current Hypertension Reports Jun 2003A body of evidence indicates that microalbuminuria is a well-recognized marker of cardiovascular complications and increased cardiovascular risk in hypertension.... (Review)
Review
A body of evidence indicates that microalbuminuria is a well-recognized marker of cardiovascular complications and increased cardiovascular risk in hypertension. However, the prognostic significance of microalbuminuria remains controversial because only the results of a few prospective studies performed in small groups of hypertensive subjects without diabetes mellitus are available. Several factors can affect the prevalence of microalbuminuria in hypertension including age, sex, race, severity of the disease, and concomitant risk factors. This accounts for the large differences in the prevalence of microalbuminuria that can be found in the literature, with prevalence rates going from a low of 4.7% to a high of 46%. The main determinant of albumin excretion rate in subjects with mild hypertension and no cardiovascular complications seems to be the hemodynamic load, whereas in subjects with more severe hypertension and associated target organ damage, the augmented urinary albumin leak is probably the consequence of glomerular damage. Inhibition of the renin-angiotensin system with angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists is particularly effective at reducing the albumin excretion rate, but whether these classes of drugs are more beneficial in patients with microalbuminuria remains to be determined. There is general consensus that evaluation of microalbuminuria is useful for the assessment of overall cardiovascular risk in hypertension, since albumin excretion rate appears to be a cost-effective way to identify patients at higher risk for whom additional preventive and therapeutic measures are advisable.
Topics: Albuminuria; Cardiovascular Diseases; Hemodynamics; Humans; Hypertension; Risk Assessment; Risk Factors; Vascular Diseases
PubMed: 12724052
DOI: 10.1007/s11906-003-0022-0 -
Indian Heart Journal 2023Microalbuminuria has been elevated as an outcome predictor in cardiovascular medicine. However, due to the small number of studies investigating the association of... (Meta-Analysis)
Meta-Analysis Review
AIM
Microalbuminuria has been elevated as an outcome predictor in cardiovascular medicine. However, due to the small number of studies investigating the association of microalbuminuria and mortality in the coronary heart disease (CHD) population, the prognosis value of microalbuminuria in CHD remains under debate. The objective of this meta-analysis was to investigate the relationship between microalbuminuria and mortality in individuals with CHD.
METHOD
A comprehensive literature search was performed using Pubmed, EuroPMC, Science Direct, and Google Scholar from 2000 to September 2022. Only prospective studies investigating microalbuminuria and mortality in CHD patients were selected. The pooled effect estimate was reported as risk ratio (RR).
RESULTS
5176 patients from eight prospective observational studies were included in this meta-analysis. Individuals with CHD have a greater overall risk of all-cause mortality (ACM) [rR = 2.07 (95% CI = 1.70-2.44); p = 0.0003; I = 0.0%] as well as cardiovascular mortality (CVM) [rR = 3.23 (95% CI = 2.06-4.39), p < 0.0001; I = 0.0%]. Subgroup analysis based on follow-up duration and a subset of CHD patients were similarly associated with an increased risk of ACM.
CONCLUSION
This meta-analysis indicates that microalbuminuria is associated with a higher risk of mortality in individuals with CHD. Microalbuminuria can serve as a predictor of poor outcomes in CHD patients.
Topics: Humans; Prospective Studies; Coronary Disease; Prognosis; Heart; Risk Factors; Observational Studies as Topic
PubMed: 37207828
DOI: 10.1016/j.ihj.2023.05.006 -
Clinics in Laboratory Medicine Sep 2006Microalbuminuria, originally described more than 3 decades ago as a predictor of nephropathy in patients who had type 1 diabetes mellitus and associated with higher... (Review)
Review
Microalbuminuria, originally described more than 3 decades ago as a predictor of nephropathy in patients who had type 1 diabetes mellitus and associated with higher cardiovascular risk, is now linked with increased risk for cardiovascular events rather than progression to end-stage kidney disease. This article reviews the role of microalbuminuria in the context of atherosclerotic vascular disease. It presents the methods for microalbuminuria assessment in clinical practice, its relations with other cardiovascular risk factors, and the pathophysiologic associations between microalbuminuria and vascular damage. In addition, this article discusses the prognostic significance of microalbuminuria for cardiovascular disease as well as existing therapeutic interventions for reducing urine albumin excretion in patients who are at high cardiovascular risk.
Topics: Albuminuria; Endothelium; Humans
PubMed: 16938588
DOI: 10.1016/j.cll.2006.06.005 -
Current Opinion in Nephrology and... May 1996Microalbuminuria is the presence of albumin above the normal but below the detectable range with the conventional urine dipstick methodology. Microalbuminuria is present... (Review)
Review
Microalbuminuria is the presence of albumin above the normal but below the detectable range with the conventional urine dipstick methodology. Microalbuminuria is present in a variety of renal and non-renal diseases but only recently has its importance as a prognostic indicator been appreciated. It is an independent risk factor for renal mortality in patients with insulin-dependent diabetes mellitus and most probably for those with non-insulin-dependent diabetes mellitus. Moreover, it is associated with a four- to sixfold increase in cardiovascular mortality in diabetic subjects. Its role as a prognostic indicator in non-diabetic subjects is controversial. The available data suggest that it is not an independent risk factor in patients without diabetes, including hypertensive subjects. Moreover, in this latter group it appears to be simply a reflection of events that result in tissue injury from elevated arterial pressures rather than an initiator of injury. The converse may be true in the diabetic patient. A large body of data also exists to support the notion of early aggressive intervention to attenuate the rise of microalbuminuria with blood glucose control. In addition, agents such as angiotensin-converting enzyme inhibitors attenuate both the rise in microalbuminuria and progression of insulin-dependent diabetes mellitus nephropathy. Fewer but similar findings have been reported for subjects with non-insulin-dependent diabetes mellitus nephropathy. Thus, microalbuminuria should be assessed annually in all diabetic subjects. Routine screening for microalbuminuria in hypertensive non-diabetic subjects is not recommended at this time.
Topics: Albuminuria; Biomarkers; Biomechanical Phenomena; Cardiovascular Diseases; Diabetes Complications; Humans; Hypertension; Kidney Diseases; Kidney Failure, Chronic; Prognosis
PubMed: 8737856
DOI: 10.1097/00041552-199605000-00006 -
Clinical and Experimental Hypertension... 2004The capacity of microalbuminuria to predict an increased cardiovascular and renal risk is well established in diabetic patients, as well as in essential hypertensive... (Review)
Review
The capacity of microalbuminuria to predict an increased cardiovascular and renal risk is well established in diabetic patients, as well as in essential hypertensive patients and in general population. Detection of microalbuminuria could then be relevant to select specific therapeutic strategies for reducing or preventing cardiovascular events in patients with essential hypertension. Microalbuminuria is detectable in almost 40% of the population with established hypertension, particularly in those patients not controlled satisfactorily with medical therapy. Albuminuria may represent a marker of renal damage and cardiovascular risk in essential hypertension. Microalbuminuria seems to represent a simple and reproducible method to better define cardiovascular risk profile in the hypertensive patient and to stratify the prognosis in relation to renal and cardiovascular risk. ACE-inhibitors and more recently angiotensin II receptor antagonists seem to exhibit a more market capacity to reduce microalbuminuria in patients with essential hypertension or diabetes mellitus. Determination of this parameter in daily clinical practice could facilitate the stratification of risk as well as the choice of therapy in essential hypertensive patients.
Topics: Albuminuria; Antihypertensive Agents; Diabetic Nephropathies; Humans; Hypertension, Renal; Risk Factors
PubMed: 15702624
DOI: 10.1081/ceh-200031985 -
Diabetes Research and Clinical Practice Jan 2015Diabetic nephropathy is characterised by persistent albuminuria, elevated blood pressure, relentless decline in GFR and enhanced fatal and nonfatal cardiovascular... (Review)
Review
Diabetic nephropathy is characterised by persistent albuminuria, elevated blood pressure, relentless decline in GFR and enhanced fatal and nonfatal cardiovascular diseases. Microalbuminuria has been central to the development of clinical practise in prevention and treatment of diabetic nephropathy and cardiovascular disease. Treatment-induced and spontaneous remission of microalbuminuria has been reported both in type 1 and type 2 diabetic patients, underlining the importance of sustained elevation of urinary albumin excretion. Recently many new biomarkers have been evaluated in diabetic patients, and apart from urinary proteomics, none has yet outperformed Harry Keen's discovery of microalbuminuria as the best screening tool for diabetic nephropathy. Remission of microalbuminuria preserves renal function. Microalbuminuria has also stood the test of time as a valid powerful independent predictor for fatal and nonfatal cardiovascular outcome in diabetes. Improved glycaemic control, blood pressure reduction, RAS blockade and multifactorial treatment of cardiovascular risk factors reduce the risk of development of micro-and macroalbuminuria, declining renal function and cardiovascular events.
Topics: Albuminuria; Biomarkers; Blood Glucose; Cardiovascular Diseases; Diabetic Nephropathies; Humans; Risk Factors
PubMed: 25467616
DOI: 10.1016/j.diabres.2014.10.014 -
American Journal of Hypertension Oct 2004Microalbuminuria is a marker for generalized vascular dysfunction. Its prevalence in United States and European general population surveys ranges from 6% to 10%.... (Review)
Review
Microalbuminuria is a marker for generalized vascular dysfunction. Its prevalence in United States and European general population surveys ranges from 6% to 10%. Increased risk for cardiovascular morbidity and mortality begins with albumin excretion rates that are well within normal limits. Although microalbuminuria interacts with the traditional cardiovascular risk factors, it has an independent relationship to renal and cardiovascular outcomes. For example, microalbuminuria doubles the risk for a cardiovascular event in patients with type 2 diabetes mellitus even after adjusting for the usual risk factors. Elevated rates of urinary albumin excretion predict target organ damage, notably renal disease, but are also related to left ventricular dysfunction, stroke, and myocardial infarction. Screening for microalbuminuria, which is recommended by several expert committees and associations, has become a readily accessible procedure. Screening can give clinicians prognostic information concerning cardiovascular risk and assist in guiding therapy. The goal of treatment is to prevent progression of, and even to reverse, microalbuminuria. Abundant evidence demonstrates that antihypertensive therapy is an important key to the control of urinary albumin excretion, and blockade of the renin-angiotensin system (with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers) is the treatment of choice. These drugs have successfully halted or delayed the progression to nephropathy and have reversed elevated rates of albumin excretion to normal values, even when blood pressure reduction has been minimal.
Topics: Albuminuria; Cardiovascular Diseases; Humans; Risk Factors
PubMed: 15485765
DOI: 10.1016/j.amjhyper.2004.08.010 -
International Journal of Stroke :... Feb 2010Stroke is potentially preventable through risk factor modification. Over the past decade, there has been considerable interest on microalbuminuria as a risk factor for... (Review)
Review
Stroke is potentially preventable through risk factor modification. Over the past decade, there has been considerable interest on microalbuminuria as a risk factor for chronic diseases. The concept of microalbuminuria was originally introduced, about 25 years ago, to clinical practice as a useful marker of nephropathy. Since then various studies reported an association of microalbuminuria with the increased risk of cardiovascular events and all cause of mortality in subjects with or without diabetes. The presence of microalbuminuria was related to left ventricular dysfunction, stroke, and myocardial infarction. Microalbuminuria may be a predictor of stroke but further studies are required. However data on prognostic significance and therapeutic consequence, particularly in haemorrhagic stroke are lacking. This review focuses on the importance of microalbuminuria for cerebrovascular disease, stressing the clinical and therapeutic implications using antihypertensive therapy to control the urinary albumin excretion.
Topics: Albuminuria; Cerebrovascular Disorders; Diabetes Complications; Endothelium, Vascular; Humans; Hypertension; Neuroprotective Agents; Prognosis; Research Design; Risk Factors; Sepsis
PubMed: 20088991
DOI: 10.1111/j.1747-4949.2009.00398.x -
Nephron. Experimental Nephrology 2011Advancing age is associated with albuminuria and vascular changes. This review will explore the putative links between the two. Vascular ageing involves endothelial... (Review)
Review
Advancing age is associated with albuminuria and vascular changes. This review will explore the putative links between the two. Vascular ageing involves endothelial dysfunction as well as increased arterial diameter, wall thickness and stiffness, ultimately leading to arterial sclerosis. This process is accelerated by a defective vascular repair process. Endothelial dysfunction is likely to be involved in the initiation and development of microalbuminuria. It is often followed by the development and progression of atherosclerosis. Initially, microalbuminuria is reversible but becomes fixed with the progression of vascular structural changes including glomerulosclerosis. The prevalence of microalbuminuria increases with age and has been shown to be a marker of widespread microvasculopathy at various levels including cerebral, cardiac and renal microcirculations. This has been linked to endpoint clinical events, with microalbuminuria increasing the risk of cognitive impairment and strokes, cardiovascular disease outcomes, and progression to end-stage renal failure. Evidence of microvascular damage such as microalbuminuria associated with increased cardiovascular risk may suggest that microvascular damage and dysfunction predate overt macrovascular disease. Microalbuminuria and reduced glomerular filtration rate (GFR) may be markers of different pathologic processes. It is likely that microalbuminuria and reduced GFR simply represent, respectively, the spectrum of renal vascular manifestations from systemic endothelial dysfunction (microvascular disease) to systemic atherosclerosis (macrovascular disease).
Topics: Aging; Albuminuria; Cardiovascular Diseases; Endothelium, Vascular; Glomerular Filtration Rate; Humans; Risk Assessment; Risk Factors
PubMed: 21832857
DOI: 10.1159/000328015