The presence of moderately increased albuminuria and/or proteinuria are
associated with increased incidence of progressive kidney disease, cardiovascular
events and death. Urine albumin-to-creatinine ratio is the preferred method of
screening for albuminuria and protein-to-creatinine ratio is preferred for proteinuria. A
random urine sample is accurate for diagnosis.
The presence of moderately increased albuminuria in type 1 diabetes is associated with
increased risk of all-cause mortality (relative risk 1.8) and also increased risk of
cardiovascular mortality (relative risk 1.8) compared with patients with type 1 diabetes
but normal albumin excretion. In type 2 diabetes, the relative risk for all-cause
mortality in patients with moderately increased albuminuria versus normal albumin
excretion was 1.9, while the relative risk for cardiovascular and coronary heart disease
mortality was 2.0 and 2.3 respectively.
Albuminuria is a robust, independent and continuous marker, with no lower limit, for
increased risk of cardiovascular disease and cardiovascular mortality in diabetes and
CKD patients as well as in the general population. The presence of moderately
increased albuminuria can signal the beginning of diabetic nephropathy and also
signals the presence of endothelial dysfunction.
In type 1 and type 2 diabetes, intensive glycemic control and blood pressure treatment
with angiotensin converting enzyme inhibitors (ACEI) or angiotensin II receptor
blockers (ARB) decrease the prevalence of moderately increased albuminuria and
prevent its progression to overt proteinuria.
The most effective treatment to prevent cardiovascular complications in diabetes and
CKD seems to be a comprehensive multifactorial risk factor reduction: glycemic control, aggressive blood pressure control, management of albuminuria with
angiotensin blockade, treatment of dyslipidemia, daily aspirin, exercise, weight loss
and smoking cessation.
Keywords: Albuminuria, Albumin excretion, All-cause mortality, Cardiovascular
risk, Chronic kidney disease, Diabetes, Glomerular filtration rate, Hypertension,
Microalbuminuria, Prevention, Screening.
