Microalbuminuria/proteinuria

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

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

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... 

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

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... 

Mogensen C (1984) Microalbuminuria predicts clinical proteinuria and early mortality in maturity onset diabetes. New England journal of Medicine 310 356-360. 

No proteinuria Monitor blood pressure Monitor blood glucose Screen for microalbuminuria if type 1 diabetes for >5 years or type 2 diabetes Aim for <130/80 mmHg Aim for <120/70 mmHg if type 1 diabetes Aim for HbAlc <7% Dietary advice for sugar and fat STOP SMOKING... 

Proteinuria Declining kidney function Close monitoring of blood pressure, blood glucose and blood lipid levels Monitor urinary protein As for microalbuminuria Prepare for dialysis and/or transplantation... 

At any level, the proteinuria may be nonselective in that it contains the spectrum of molecular sizes. For example, when microalbuminuria is observed in the absence of low molecular weight proteinuria, it may... 

Marchewka Z, Kuzniar J, DIugosz A. Enzymuria and alpha-2-microalbuminuria in the assessment of the influence of proteinuria on the progression of glomerulopathies. Int Urol Nephrol 2001 33 673-676. 

Chapman AB, Johnson AM, Gabow PA, Schrier RW Overt proteinuria and microalbuminuria in autosomal dominant polycystic kidney disease.dAm SocNephrol 5 1349-1354,1994. 

Laboratory tests Microalbuminuria Mildly-elevated Scr and BUN Persistent proteinuria Reduced GFR or CLcr Abnormal urinalysis Renal ultrasound shows reduced kidney mass... 

Although not a quantitative measure of renal function, urinary microalbuminuria has been identified as an early marker of renal disease in patients with diabetic nephropathy and numerous other conditions, such as hypertension and obesity. Patients with microalbuminuria (30 to 300 mg/day) on at least two occasions or overt albuminuria (>300 mg/day) should begin to receive pharmacotherapy. For children, microalbuminuria is considered present if albumin excretion exceeds 0.36 mg/kg per day, and overt albuminuria has been defined as an excretion rate that exceeds 4 mg/kg per day. The urinary albumin creatinine ratio is also an accurate predictor of 24-hour proteinuria, a marker of renal disease. Guidelines for monitoring indicate that a urine albumin creatinine ratio of >30 mg/g places the patient at increased risk of developing diabetic nephropathy and is an indication for the initiation of pharmacotherapeutic intervention. Microalbuminuria has also been suggested as a risk factor for renal dysfunction among patients with essential hypertension. ... 

Captopril 50 mg twice a day randomized, placebo-controlled trial Normotensive patients with microalbuminuria 143 Type 1 DM 2 years Risk reduction of 67.8% for clinical proteinuria with captopril treatment GFR reductions of 7.9 mL/min per 1.73 m per year in placebo while stable in captopril group North American Microalbuminuria Study Group ... 

It has been clearly recognized that one of the clinical hallmarks of diabetic nephropathy is proteinuria in excess of 500 mg/24 hours this can be easily detected by urine dipstick testing, which has a detection limit of 150-200 mg/liter of albumin. Such clinical proteinuria portends a progressive decline in kidney function leading to end-stage renal failure over an average 7-year period. This clinical proteinuria is not sudden but is preceded by years of microalbuminuria. Thus microalbuminuria represents an early manifestation of diabetic kidney disease. In fact, 6-20% of patients with IDDM present with microalbuminuria. Left uncontrolled, albumin excretion in microalbuminuric subjects can increase at the rate of 7-18.6% per year. 

Albumin excretion in the range 25-.300 mg/24h is termed microalbuminuria (p. 59). Tubular proteinuria is discussed on pages 28-29. 

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