Microalbuminuria: a Cardiovascular Risk Factor

Abstract

Albumin is a protein which is charged negatively. By correcting for the daily excretion of creatinine, the albumin creatinin ratio implicates the daily excretion of albumin in spot urine. Albuminuria is a cardiovascular risk factor in patients with diabetes, hypertension, and the general population. Urinary albumin excretion is independently associated with an increased risk of cardiovascular events, even after adjustment for risk factors. Risk has been shown to increase continuously with increasing urinary albumin levels. Urinary albumin excretion rate should be monitorized routinely in a group of patients with high cardiovascular risk. Albümin negatif yüklü bir proteindir. Albümin kreatinin oranı spot idrarda protein içeriğini değerlendirmek için kullanılır. Albüminüri genel populasyonda hipertansiflerde ve diabetiklerde yüksek risk göstergesidir. Albüminüri ve kardiyovasküler olaylar arasındaki ilişki risk faktörlerinin etkisi dışlanıldıktan sonra dahi devam etmektedir. Risk düzeyi idrar albümin miktarı ile doğru orantılı olarak artış göstermektedir. İdrar albümin atılım hızının takip edilmesi yüksek kardiyovasküler riske sahip olgularda önerilir.

Keywords

• Microalbuminuria, cardiovascular, risk

Mikroalbüminüri: Kardiyovasküler Risk Faktörü

Öz

Albümin negatif yüklü bir proteindir. Albümin kreatinin oranı spot idrarda protein içeriğini değerlendirmek için kullanılır. Albüminüri genel populasyonda hipertansiflerde ve diabetiklerde yüksek risk göstergesidir. Albüminüri ve kardiyovasküler olaylar arasındaki ilişki risk faktörlerinin etkisi dışlanıldıktan sonra dahi devam etmektedir. Risk düzeyi idrar albümin miktarı ile doğru orantılı olarak artış göstermektedir. İdrar albümin atılım hızının takip edilmesi yüksek kardiyovasküler riske sahip olgularda önerilir.

Anahtar Kelimeler

• Mikroalbüminüri, kardiyovasküler, risk

Kaynakça

1. Perkovic V, Verdon C, Ninomiya T, Barzi F, Cass A, Patel A, et al. The relationship between proteinuria and coronary risk: a systematic review and meta-analysis. PLoS Med 2008;5:e207.
2. Khosla N, Sarafidis PA, Bakris GL. Microalbuminuria. Clin Lab Med 2006;26:635-53.
3. Bakris GL. Microalbuminuria: prognostic implications. Curr Opin Nephrol Hypertens 1996;5:219-23.
4. Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Hypertension 2003;42:1050-65.
5. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296-305.
6. Böhm M, Reil JC, Danchin N, Thoenes M, Bramlage P, Volpe M. Association of heart rate with microalbuminuria in cardiovascular risk patients: data from I-SEARCH. J Hypertens 2008;26:18-25.
7. Bennett PH, Haffner S, Kasiske BL, Keane WF, Mogensen CE, Parving HH, et al. Screening and management of mic- roalbuminuria in patients with diabetes mellitus: recom- mendations to the Scientific Advisory Board of the National Kidney Foundation from an ad hoc committee of the Council on Diabetes Mellitus of the National Kidney Foundation. Am J Kidney Dis 1995;25:107-12.
8. Metcalf PA, Scragg RK. Epidemiology of microalbuminu- ria in the general population. J Diabetes Complications 1994;8:157-63.

9. Ruggenenti P, Gaspari F, Perna A, Remuzzi G. Cross sectio- nal longitudinal study of spot morning urine protein: crea- tinine ratio, 24 hour urine protein excretion rate, glomerular filtration rate, and end stage renal failure in chronic renal disease in patients without diabetes. BMJ 1998;316:504-9.
10. Mattix HJ, Hsu CY, Shaykevich S, Curhan G. Use of the albumin/creatinine ratio to detect microalbuminuria: imp- lications of sex and race. J Am Soc Nephrol 2002;13:1034-9.
11. Mogensen CE, Vestbo E, Poulsen PL, Christiansen C, Damsgaard EM, Eiskjaer H, et al. Microalbuminuria and potential confounders. A review and some observations on variability of urinary albumin excretion. Diabetes Care 1995;18:572-81.
12. Danziger J. Importance of low-grade albuminuria. Mayo Clin Proc 2008;83:806-12.
13. Viberti GC, Hill RD, Jarrett RJ, Argyropoulos A, Mahmud U, Keen H. Microalbuminuria as a predictor of clini
14. Hoy WE, Wang Z, VanBuynder P, Baker PR, Mathews JD. The natural history of renal disease in Australian Aborigines. Part 1. Changes in albuminuria and glomerular filtration rate over time. Kidney Int 2001;60:243-8.
15. Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001;286:421-6.
16. Klausen K, Borch-Johnsen K, Feldt-Rasmussen B, Jensen G, Clausen P, Scharling H, et al. Very low levels of micro- albuminuria are associated with increased risk of coronary heart disease and death independently of renal function, hypertension, and diabetes. Circulation 2004;110:32-5.
17. Romundstad S, Holmen J, Hallan H, Kvenild K, Ellekjaer H. Microalbuminuria and all-cause mortality in treated hyper- tensive individuals: does sex matter? The Nord-Trİndelag Health Study (HUNT), Norway. Circulation 2003;108:2783-9.
18. Yuyun MF, Khaw KT, Luben R, Welch A, Bingham S, Day NE, et al. Microalbuminuria, cardiovascular risk factors and cardiovascular morbidity in a British population: the EPIC-Norfolk population-based study. Eur J Cardiovasc Prev Rehabil 2004;11:207-13.
19. Romundstad S, Holmen J, Kvenild K, Hallan H, Ellekjaer H. Microalbuminuria and all-cause mortality in 2,089 apparently healthy individuals: a 4.4-year follow-up study. The Nord-Trİndelag Health Study (HUNT), Norway. Am J Kidney Dis 2003;42:466-73.
20. Peterson GE, de Backer T, Gabriel A, Ilic V, Vagaonescu T, Appel LJ, et al. Prevalence and correlates of left ventricular hypertrophy in the African American Study of Kidney Disease Cohort Study. Hypertension 2007;50:1033-9.
21. Palatini P, Mormino P, Mos L, Mazzer A, Dorigatti F, Zanata G, et al. Microalbuminuria, renal function and development of sustained hypertension: a longitudinal study in the early stage of hypertension. J Hypertens 2005;23:175-82.
22. Ingelsson E, Sundström J, Lind L, Risérus U, Larsson A, Basu S, et al. Low-grade albuminuria and the incidence of heart failure in a community-based cohort of elderly men. Eur Heart J 2007;28:1739-45.
23. Jİrgensen L, Jenssen T, Johnsen SH, Mathiesen EB, Heuch I, Joakimsen O, et al. Albuminuria as risk factor for initiation and progression of carotid atherosclerosis in non-diabetic persons: the Tromsİ Study. Eur Heart J 2007;28:363-9.
24. Bakker SJ, Gansevoort RT, Stuveling EM, Gans RO, de Zeeuw D. Microalbuminuria and C-reactive protein: similar messengers of cardiovascular risk? Curr Hypertens Rep 2005;7:379-84.
25. Stuveling EM, Bakker SJ, Hillege HL, Burgerhof JG, de Jong PE, Gans RO, et al. C-reactive protein modifies the rela- tionship between blood pressure and microalbuminuria. Hypertension 2004;43:791-6.
26. de Zeeuw D, Remuzzi G, Parving HH, Keane WF, Zhang Z, Shahinfar S, et al. Proteinuria, a target for renoprotection in patients with type 2 diabetic nephropathy: lessons from RENAAL. Kidney Int 2004;65:2309-20.
27. Wright JT Jr, Bakris G, Greene T, Agodoa LY, Appel LJ, Charleston J, et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hyperten- sive kidney disease: results from the AASK trial. JAMA 2002;288:2421-31.
28. Gosling P, Hughes EA, Reynolds TM, Fox JP. Microalbuminuria is an early response following acute myocardial infarction. Eur Heart J 1991;12:508-13.
29. Agrawal B, Berger A, Wolf K, Luft FC. Microalbuminuria screening by reagent strip predicts cardiovascular risk in
30. Med 1997;157:1413-8. The Insulin Resistance Atherosclerosis Study (IRAS). Stroke 1997;28:1710-6.
31. Ruilope LM, Redón J, Schmieder R. Cardiovascular risk reduction by reversing endothelial dysfunction: ARBs, ACE inhibitors, or both? Expectations from the ONTARGET Trial Programme. Vasc Health Risk Manag 2007;3:1-9.
32. Lebovitz HE, Wiegmann TB, Cnaan A, Shahinfar S, Sica DA, Broadstone V, et al. Renal protective effects of enalap- ril in hypertensive NIDDM: role of baseline albuminuria. Kidney Int Suppl 1994;45:S150-5.
33. Ibsen H, Wachtell K, Olsen MH, Borch-Johnsen K, Lindholm LH, Mogensen CE, et al. Does albuminuria predict cardio- vascular outcome on treatment with losartan versus ate- nolol in hypertension with left ventricular hypertrophy? A LIFE substudy. J Hypertens 2004;22:1805-11.
34. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ 1998;317:703-13.
35. Ravid M, Savin H, Jutrin I, Bental T, Katz B, Lishner M. Long-term stabilizing effect of angiotensin-converting enz- yme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med 1993;118:577-81.
36. Mangrum AJ, Bakris GL. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in chronic renal disease: safety issues. Semin Nephrol 2004;24:168-75.
37. Sierra C, de la Sierra A. Early detection and management of the high-risk patient with elevated blood pressure. Vasc Health Risk Manag 2008;4:289-96.
38. Luque M, de Rivas B, Alvarez B, Garcia G, Fernandez C, Martell N. Influence of target organ lesion detection (assessment of microalbuminuria and echocardiogram) in cardiovascular risk stratification and treatment of untreated hypertensive patients. J Hum Hypertens 2006;20:187-92.
39. ma-media thickness in nondiabetic and NIDDM subjects.