Microalbuminuria and Kidney Disease: An Evidence-based Perspective

In the early 1960s, microalbuminuria was noted as a predictor of nephropathy and higher cardiovascular risk in patients with type 1 diabetes mellitus. Over the past four decades, however, the epidemiological evidence has become far stronger, implicating it as a cardiovascular risk marker than a risk factor associated with nephropathy. Microalbuminuria is also a marker of endothelial dysfunction, increased vascular leakage of albumin, and a marker of inflammation. In this context, it is also a marker for risk of developing hypertension and making it more difficult to control blood pressure if hypertension is already present. This chapter reviews the role of microalbuminuria as a marker of cardiovascular risk and nephropathy identifier. It also reviews the association of microalbuminuria with other cardiovascular risk factors and the pathophysiological association between microalbuminuria and vascular damage. In addition, the chapter reviews trial data that evaluated microalbuminuria for its prognostic significance on cardiovascular outcomes, as well as existing therapeutic interventions for reducing urinary albumin excretion in patients with high cardiovascular risk.