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Renal Failure 2013Microalbuminuria screening is widely used in high-risk populations but seldom used in the general population for detecting chronic kidney disease (CKD). Systematic... (Review)
Review
BACKGROUND
Microalbuminuria screening is widely used in high-risk populations but seldom used in the general population for detecting chronic kidney disease (CKD). Systematic reviews focused on screening for CKD are rare, and the issues about microalbuminuria screening in the general population have never been reviewed. We systematically reviewed studies regarding microalbuminuria screening and evaluated the benefits and harms of this screening method in the general population.
METHODS
We systematically searched MEDLINE, PubMed, and the Cochrane Library for English articles published from January 1970 to 13 December 2011. Quality assessments were performed using the QUADAS tool or the Drummond's 10-point checklist. Due to the high heterogeneity of the study designs, meta-analysis for the study results was not possible. Therefore, we performed a narrative synthesis.
RESULTS
Six articles from four studies made up our final study population, with four articles evaluating different screening methodologies and two reporting cost-effectiveness analyses. The qualities of the included articles ranged from fair to high. Spot urine albumin concentration and spot urine albumin:creatinine ratio had a similar diagnostic performance for microalbuminuria screening in the general population. Screening for microalbuminuria in high-risk populations, such as patients with diabetes, hypertension, or old age, was cost-effective. However, there was no consensus regarding the cost-effectiveness for microalbuminuria screening in the general population.
CONCLUSIONS
Microalbuminuria screening in high-risk populations is cost-effective. However, the cost-effectiveness of screening for microalbuminuria in the general population deserves further study. To keep costs low, spot urine albumin concentration may be preferable than the albumin:creatinine ratio.
Topics: Albuminuria; Humans; Mass Screening; Renal Insufficiency, Chronic
PubMed: 23534678
DOI: 10.3109/0886022X.2013.779907 -
Vascular Medicine (London, England) Feb 2002Based on the data from large single and multi-center clinical trials, including the Heart Outcomes Prevention Evaluation (HOPE) study, it is clear that the presence of... (Review)
Review
Based on the data from large single and multi-center clinical trials, including the Heart Outcomes Prevention Evaluation (HOPE) study, it is clear that the presence of microalbuminuria is a signal from the kidney that cardiovascular risk is increased and that vascular responses are altered. This is exemplified by studies that have demonstrated that the compensatory vasodilation seen following relief from prolonged ischemia or infusion of vasodilators such as nitroglycerin is blunted in people with microalbuminuria. Thus, the presence of between 30 and 299 mg/day of albumin in the urine is associated with abnormal vascular responsiveness, which may be the result of more advanced atherosclerosis and not necessarily related to the presence of hypertension or renal disease. Agents known to reduce the rise in microalbuminuria or actually reduce the level of microalbuminuria, such as ACE inhibitors, angiotensin receptor blockers, HMG-CoA reductase inhibitors, beta blockers, non-dihydropyridine calcium channel blockers and diuretics, have all been shown to reduce cardiovascular mortality and in some cases preserve renal function. This article will present an overview of the data that support the assertion that a reduction in the rise of microalbuminuria is a significant consideration in the selection of agents to treat a given risk factor (cholesterol or blood pressure) to a recommended target goal. Achieving such a goal with agents that also impact microalbuminuria will provide for a more complete cardiovascular risk reduction.
Topics: Albuminuria; Animals; Biomarkers; Cardiovascular Diseases; Clinical Trials as Topic; Endothelium, Vascular; Humans; Multicenter Studies as Topic; Prevalence; Risk Factors
PubMed: 12083733
DOI: 10.1191/1358863x02vm412ra -
Diabetic Medicine : a Journal of the... Aug 1995Microalbuminuria is defined as urinary excretion of albumin that is persistently above normal, although below the sensitivity of conventional semiquantative test strips.... (Review)
Review
Microalbuminuria is defined as urinary excretion of albumin that is persistently above normal, although below the sensitivity of conventional semiquantative test strips. Several studies have reported that Type 1 diabetic patients with microalbuminuria are apparently more likely to develop diabetic nephropathy eventually progressing to renal failure. Microalbuminuria is also a strong predictor of mortality in Type 2 diabetes, and is correlated with increased blood pressure in patients with benign essential hypertension. Radioimmunoassay revealed a significantly higher urinary albumin excretion rate in normal pregnant women in the third trimester of pregnancy, compared to the second and first, and compared to non-pregnant women. Microalbuminuria was found in 30% of women who had a record of gestational diabetes mellitus. Published results are controversial regarding the assumption that microalbuminuria is an early predictor of pregnancy-induced hypertensive complications.
Topics: Albuminuria; Biomarkers; Diabetes, Gestational; Female; Humans; Hypertension; Predictive Value of Tests; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy in Diabetics; Prognosis; Sensitivity and Specificity
PubMed: 7587001
DOI: 10.1111/j.1464-5491.1995.tb00564.x -
QJM : Monthly Journal of the... Jun 1998The term 'microalbuminuria' has been introduced to describe a measurable increase in urine albumin excretion, which is still within normal total urine protein excretion... (Review)
Review
The term 'microalbuminuria' has been introduced to describe a measurable increase in urine albumin excretion, which is still within normal total urine protein excretion levels. Many data suggest that microalbuminuria is of value as an index of vascular damage, especially in hypertension and diabetes, and there is increasing information on its associations with traditional cardiovascular risk factors and its prognostic value. The association between microalbuminuria and peripheral markers of endothelial damage or dysfunction, such as von Willebrand factor, suggests the possibility that microalbuminuria may be a simple, cheap and easy index of endothelial abnormalities in cardiovascular disease. Nevertheless, further information on the value of microalbuminuria in other atherosclerotic vascular complications, such as ischaemic heart disease, stroke and peripheral artery disease is still needed.
Topics: Albuminuria; Biomarkers; Cardiovascular Diseases; Diabetes Complications; Humans; Hypertension; Insulin Resistance; Risk Factors; Smoking
PubMed: 9709456
DOI: 10.1093/qjmed/91.6.381 -
Diabetic Medicine : a Journal of the... Oct 1991It now seems worth while to identify Type 1 diabetic patients with microalbuminuria, as improved blood glucose control and reduction of arterial blood pressure will slow... (Review)
Review
It now seems worth while to identify Type 1 diabetic patients with microalbuminuria, as improved blood glucose control and reduction of arterial blood pressure will slow if not prevent the progression to persistent proteinuria. Measurement of albumin excretion rate (AER) in a timed urine sample remains the gold standard for the definition of microalbuminuria, but is not a practical screening procedure. Thus attempts have been made to relate the albumin concentration of albumin:creatinine ratio in random or first morning urine samples to AER. There is a weak correlation of albumin concentration (r = 0.32 to 0.68) and albumin:creatinine ratio (r = 0.43 to 0.54) in a random urine sample with AER, and low sensitivity and specificity of a variety of different albumin concentrations and albumin:creatinine ratios to predict microalbuminuria. The correlation of albumin concentration (r = 0.86 to 0.90) and albumin:creatinine ratio (r = 0.74 to 0.91) in an early morning urine sample with AER is stronger. Measurement of albumin:creatinine ratio in an early morning urine sample appears to be the most reliable method of screening for microalbuminuria, with sensitivity of 88 to 100% and specificity 81 to 100% depending on the cut-off ratio chosen and the definition of microalbuminuria used. If the albumin:creatinine ratio in an early morning urine sample is less than or equal to 3.5 mg mmol-1, the patient can be classed as normoalbuminuric and re-screened annually. If the ratio is greater than or equal to 10.0 mg mmol-1, confirmation of microalbuminuria should be sought in a timed urine collection and appropriate therapy begun.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Albuminuria; Diabetes Mellitus, Type 1; Humans; Mass Screening
PubMed: 1838060
DOI: 10.1111/j.1464-5491.1991.tb01688.x -
The Journal of the Association of... Mar 2016Microalbuminuria represents a condition wherein the urinary albumin excretion is in the range of 30 mg/24 hrs -300 mg/24 hrs. Recently microalbuminuria is gaining... (Review)
Review
Microalbuminuria represents a condition wherein the urinary albumin excretion is in the range of 30 mg/24 hrs -300 mg/24 hrs. Recently microalbuminuria is gaining attention as more than just a surrogate marker of kidney damage. Although apparently representing passage of a rather trace amount of protein excretion, this has great implication in terms of clinico-pathological association with diabetic nephropathy and other cardiovascular complications in subjects with or without diabetes. Early detection of microalbuminuria is considered to be the aim of clinicians in context to patient's health perspective so as to change the treatment strategy accordingly. Therefore quite reasonably, understanding of exact patho-physiological significance of microalbuminuria and its prognostic impact in kidney diseases should be of immense help in providing better clinical outcome. To this end, an approach from the clinical biochemistry perspective might provide a better overview. The present commentary is an endeavor to address several relevant issues in this context for development of a better insight.
Topics: Albuminuria; Biomarkers; Cardiovascular Diseases; Diabetes Mellitus; Diabetic Nephropathies; Heart Diseases; Humans
PubMed: 27731559
DOI: No ID Found -
American Journal of Hypertension Dec 1990Clinically apparent proteinuria in essential hypertension is associated with increased cardiovascular and total mortality and is an independent risk factor for... (Review)
Review
Clinically apparent proteinuria in essential hypertension is associated with increased cardiovascular and total mortality and is an independent risk factor for cardiovascular and cerebrovascular disease. Subclinical elevation of urinary albumin excretion is seen more frequently than clinical proteinuria in essential hypertension and the levels of microalbuminuria (excretions of 30 to 300 mg/24 h) correlate with blood pressure. The increased urinary albumin excretion in hypertension may be explained by several factors such as renal hemodynamic changes, permselectivity changes of the glomerular filter, and structural arteriolar and glomerular changes due to nephrosclerosis. It has been clearly demonstrated that microalbuminuria is a risk factor for the development of clinical proteinuria, renal failure and increased cardiovascular mortality in insulin-dependent diabetes mellitus. It is still not known whether microalbuminuria also predicts development of proteinuria and decline in renal function in hypertension but there is some evidence indicating that microalbuminuria may be a marker of increased cardiovascular risk in hypertensives.
Topics: Albuminuria; Cardiovascular Diseases; Humans; Hypertension; Prognosis; Proteinuria; Risk Factors
PubMed: 2081017
DOI: 10.1093/ajh/3.12.956 -
Diabetes & Metabolism Jul 2000Microalbuminuria was originally considered to be an important new risk factor for diabetic nephropathy. More recently, it has been convincingly shown that... (Review)
Review
Microalbuminuria was originally considered to be an important new risk factor for diabetic nephropathy. More recently, it has been convincingly shown that microalbuminuria is also an independent risk factor for cardiovascular morbidity and mortality in Type 1 and Type 2 diabetic patients. Even in the non-diabetic background population, microalbuminuria is a risk factor for cardiovascular mortality. What is the link between increased loss of albumin in urine and cardiovascular disease and mortality? As microalbuminuria is apparently associated with increased universal vascular sieving of albumin in terms of the transcapillary escape rate of albumin (TER-alb), microalbuminuria may reflect this universal sieving. The pathophysiology of increased TER-alb is unknown, but could be caused by haemodynamics or damage to the functional properties of the vascular wall. A number of studies have provided evidence of endothelial dysfunction in patients with microalbuminuria, which may be the common link accounting for the associations mentioned above. In this context, a number of markers of endothelial cell dysfunction have been found to be increased in patients with microalbuminuria. In addition, a number of functional in vivo tests of endothelial dysfunction have been performed in Type 1 and Type 2 diabetic patients as well as in normal controls. Overall, these studies indicate the existence of a functional vascular dysfunction in Type 1 diabetic patients and normal controls with microalbuminuria, which may be related to dysfunction of endothelial cells.
Topics: Albuminuria; Cardiovascular Diseases; Diabetic Angiopathies; Diabetic Nephropathies; Endothelium, Vascular; Risk Factors
PubMed: 10922975
DOI: No ID Found -
Journal of Diabetes and Its... 1994The concept of microalbuminuria is reviewed. Measuring the urinary albumin excretion rate and testing for microalbuminuria is well established in the control and... (Review)
Review
The concept of microalbuminuria is reviewed. Measuring the urinary albumin excretion rate and testing for microalbuminuria is well established in the control and treatment of patients with insulin-dependent diabetes mellitus. Microalbuminuria predicts nephropathy and early cardiovascular death. In the presence of microalbuminuria frequent examinations are warranted for early detection of retinopathy, blood-pressure rise, and for optimizing the glycemic control. In patients with non-insulin-dependent diabetes, the independent value of microalbuminuria as a cardiovascular risk factor is not yet clarified. The urinary albumin excretion rate should be measured at diagnosis, because the indications are that presence of microalbuminuria reinforces the urge to intervene against other well-documented cardiovascular risk factors (hypertension, dyslipidemia, tobacco, and obesity). In the nondiabetic population, there is accumulating evidence that an elevated urinary albumin excretion rate is associated with early cardiovascular morbidity and mortality. Large scale cross-sectional and prospective studies are needed in order to clarify further the role of microalbuminuria as an independent risk factor in the background population.
Topics: Albuminuria; Diabetic Nephropathies; Humans; Predictive Value of Tests; Risk Factors
PubMed: 8086648
DOI: 10.1016/1056-8727(94)90030-2 -
Kidney International Jul 2014The concept of microalbuminuria has been central to the development of clinical practice and research in the area of diabetic kidney disease (DKD). However, in recent... (Review)
Review
The concept of microalbuminuria has been central to the development of clinical practice and research in the area of diabetic kidney disease (DKD). However, in recent times, the value of a paradigm of DKD based solely on microalbuminuria has been questioned. Although both the absolute level and rate of change of microalbuminuria are linked to the development and progression of DKD, microalbuminuria on its own lacks the necessary sensitivity or specificity to accurately predict kidney outcomes for people with diabetes. The development of microalbumiuria can no longer be viewed as a committed and irreversible stage of DKD, as spontaneous remission is now reported as a common occurrence. In addition, the absence of microalbuminuria or its progression to proteinuria does not signify that an individual patient is safe from a progressive decline in glomerular filtration rate (GFR). Furthermore, although reductions in albuminuria within the microalbuminuric range can be linked to a slower GFR decline in observational studies, this relationship has not been robustly demonstrated in intervention studies. Conclusions regarding the kidney health of individuals with diabetes will continue to be flawed if an inappropriate emphasis is placed on the presence or absence of albuminuria or changes in albuminuria within the microalbuminuric range. This has important implications in terms of undermining the value of microalbuminuria as a surrogate renal end point for intervention trials. There is a need to develop broader models of progressive DKD that include novel pathways and risk markers apart from those related to the traditional 'albuminuric pathway' to renal impairment.
Topics: Albuminuria; Biomarkers; Diabetic Nephropathies; Disease Progression; Glomerular Filtration Rate; Humans; Kidney; Prognosis; Risk Factors
PubMed: 24717301
DOI: 10.1038/ki.2014.98