Microalbuminuria

The separation of proteins and peptides mixtures is the objective of protein biochemisdy. Albumin (Mr 66 000) concentration in a biological fluid (seaim, urine or cerebrbrospinal fluid) is assayed as markers for a series disease, such as nephritic syndrome or chronic glomuleronephritis. In diabetic patients the progression of microalbuminuria is accompanied by an increase in urinary concentrations of human semm albumen. In normal the excretion of albumin is 20 (tg/ml, in pathology - 20-200 p.g/ml. 

Microalbuminuria Not included S20 pg/min or albumin creatinine ratio >30mg/g... 

Microalbuminuria (protein in urine which is excreted at a rate of 30-300 mg per 24 hours or 20-200 mcg/minute)... 

Dyslipidemia Microalbuminuria Family history Central obesity Physical inactivity Tobacco use... 

Elevated blood urea nitrogen Elevated serum creatinine Microalbuminuria/proteinuria... 

International Verapamil-Trandolapril Study Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria study intrinsic sympathomimetic activity intravenous... 

The presence of protein in the urine is a marker of glomerular and tubular dysfunction and is recognized as an independent risk factor for the progression of CKD.8 Furthermore, the degree of proteinuria correlates with the risk for progression of CKD. An increase of 1 g of protein excretion per day is associated with a five-fold increase in the risk of progression of CKD, regardless of the cause of CKD.9 The mechanisms by which proteinuria potentiates CKD are discussed later. Microalbuminuria is also linked with vascular injury and increased cardiovascular mortality.10... 

Microalbuminuria Presence of small quantities of urine albumin (a urine albumin test measures the amount of protein in urine) the presence of a small amount of albumin (30 to 300 mg/day) in the urine, which is an early sign of chronic kidney disease. 

Patients with type 2 DM should have a routine urinalysis at diagnosis as the initial screening test for albuminuria. If positive, a 24-hour urine for quantitative assessment will assist in developing a treatment plan. If the urinalysis is negative for protein, a test to evaluate the presence of microalbuminuria is recommended. 

K3. Kapelrud, H., Bangstad, H. J., Dahl-Jorgensen, K., Berg, K., and Hanssen, K. F., Serum Lp(a) lipoprotein concentrations in insulin dependent diabetic patients with microalbuminuria. BMJ 303, 675-677 (1991). 

Reduction in risk of Ml, stroke, and death from cardiovascular causes - In patients 55 years of age or older at high risk of developing a major cardiovascular event because of a history of coronary artery disease, stroke, peripheral vascular disease, or diabetes that is accompanied by at least 1 other cardiovascular risk factor (eg, hypertension, elevated total cholesterol levels, low FIDL levels, cigarette smoking, documented microalbuminuria). 

Also contraindicated for the treatment of hypertension in patients with the following conditions Type 2 diabetes with microalbuminuria serum creatinine greater than 2 mg/dL in males or greater than 1.8 mg/dL in females Ccr less than 50 mL/min concomitant use of potassium supplements or potassium-sparing diuretics (amiloride, spironolactone, or triamterene). 

ARBs Type 2 diabetic nephropathy Type 2 diabetic microalbuminuria Proteinuria Left ventricular hypertrophy ACE-I cough or intolerance Pregnancy Hyperkalaemia Bilateral renal artery stenosis ... 

Stroke secondary prevention Diabetes type 1 or 2 with or without evidence of microalbuminuria or proteinuria... 

McFarlane PA. Review ACE inhibitors delay microalbuminuria in diabetes without nephropathy and reduce mortality in diabetic nephropathy. Evid Based Med 2006 11(5) 144. 

Diabetes mellitus causes about 50% of all patients being treated for End Stage Renal Disease (ESRD) in the USA and this is because the disease (type 2 disease) is pervasive. Recent studies have shown that the onset and progression of the disease can be ameliorated if treatment is instituted early on in the course of the disease. ESRD is the commonest complication of type 1 diabetes. A higher proportion of individuals with type 2 diabetes was found to have microalbuminuria and overt nephropathy shortly after the diagnosis of diabetes, because the diabetes had actually been present for many years before the diagnosis was made. There is a correlation between the degree of albuminuria and cardiovascular disease. 

Contraindications Concurrent use of potassium supplements or potassium-sparing diuretics (such as amiloride, spironolactone, and triamterene), or strong inhibitors of the cytochrome P450 3A4 enzyme system (including ketoconazole and itraconazole), creatinine clearance less than 50 ml/min, serum creatinine level greater than 2 mg/dl in males or 1.8 mg/dl in females, serum potassium level greater than 5.5 mEq/L, type 2 diabetes mellitus with microalbuminuria... 

Hyperkalemia may occur, particularly in patients with type 2 diabetes mellitus and microalbuminuria. 

ACE Inhibitors in Diabetic Nephropathy Trialist Group Should all patients with type 1 diabetes mellitus and microalbuminuria receive angiotensin-converting enzyme inhibitors A meta-analysis of individual patient data. Ann Intern Med 2001 134 370. 

Monster TB, Janssen WM, de Jong PE, de Jong-van den Berg LTPrevention of Renal Vascular End Stage Disease Study Group. Oral contraceptive use and hormone replacement therapy are associated with microalbuminuria. Arch Intern Med 2001 161(16) 2000-5. 

Imano E, Kanda T, Nakatani Y, Nishida T, Arai K, Motomura M, Kajimoto Y, Yamasaki Y, Hori M. Effect of troglitazone on microalbuminuria in patients with incipient diabetic nephropathy. Diabetes Care 1998 21(12) 2135-9. 

Depression and Diabetes Mellitus. Patients with chronic medical illness have a high prevalence of major depressive disorder [59], Depression may be three times more prevalent in the diabetic population when compared with its occurrence in nondiabetic individuals [60], In addition, microalbuminuria, hypertension, and hyperinsulinemia are another three independent risk factors for cardiac disease in non-insulin-dependent diabetes mellitus (NIDDM) [61], Nosadini et al. showed that peripheral insulin resistance, hypertension, microalbuminuria, and lipid abnormalities are associated with NIDDM [61], Further, Helkala et al. determined that cognitive and memory dysfunction are associated with NIDDM and explored the disease s relationship with depression, metabolic control, and serum lipids. The results showed that the NIDDM patients had impaired control of their learning processes [62], Obviously, future research examining the causal relationship of depression to the onset on diabetes and the effect of depression on the natural course of diabetes is needed [60]. 

The CARDS randomized 2838 people with Type 2 diabetes plus retinopathy, microalbuminuria, hypertension, or smoking and no history of macrovascular disease to receive either ator-vastatin or placebo. Atorvastatin reduced the combined... 

HbA1c Blood glucose Accelerated Atherosclerosis Vascular Damage CrCI, Cystatin C Microalbuminuria... 

Many investigators have shown heightened sympathetic nerve activity observed in plasma norepinephrine or microneurography in patients with ESRD in cross-sectional studies [20, 21], These observations show renal injury or ESRD is a consequence of hypertension and obesity, however, most of previous studies regarding the relationships between sympathetic nerve activity and renal function have investigated proteinuria or microalbuminuria as a maker for renal injury. Few investigations have simultaneously taken into account... 

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