Microalbuminuria as a marker of cardiovascular and renal risk in type 2 diabetes mellitus: a temporal perspective

Abstract

Microalbuminuria is a marker for diabetic nephropathy. It also signifies cardiovascular disease, as well as nephropathy, in type 2 diabetes (DM2). Microalbuminuria may precede DM2, occurring with the insulin resistance syndrome and its components, including obesity and hypertension. Other indicators of cardiovascular risk, such as markers of inflammation, are associated with microalbuminuria in populations of patients with and without diabetes. With the rising prevalence of DM2 in minority youth, especially in Native Americans, a marker for future disease risk would allow earlier prevention strategies to be tested. Before microalbuminuria can be used in a prevention strategy, more needs to be known about the mechanism(s) of the association between elevated excretion, its relationship to glucose intolerance, and its relative contribution to cardiovascular and renal disease. These questions are especially applicable as we begin to observe the long-term complications of diabetes in youth.

Roles of Angiopoietins in Kidney Development and Disease

“…46 An early sign is a small increase in the quantity of urinary protein, manifested by microalbuminuria, which correlates with and can predict the progression of renal damage and cardiovascular morbidity. 47 Microalbuminuria in individuals with diabetic nephropathy is considered to arise from increased protein losses in the glomerular filtrate caused by defects in the filtration barrier, which separates the blood circulation from the urinary space. 48 In human and animal diabetic nephropathy, glomerular expression of nephrin is downregulated, 49 and a similar change occurred when Ang-2 overexpression was induced in transgenic (nondiabetic) mice.…”

An insulin-like growth factor-I gene polymorphism modifies the risk of microalbuminuria in subjects with an abnormal glucose tolerance

“…The presence of microalbuminuria (MA) may be a marker of generalized vascular endothelial dysfunction reflecting generalized vascular disease (1,2). Development of MA is associated with glycaemic control, blood pressure, smoking, and male gender (3,4).…”

“…Development of MA is associated with glycaemic control, blood pressure, smoking, and male gender (3,4). MA may precede type 2 diabetes, occurring in parallel with the metabolic syndrome and its components, obesity and hypertension (1). MA is also considered to be a marker for diabetic nephropathy in type 2 diabetes (5 -7).…”

Development of multiple complications in type 2 diabetes is associated with the increase of multiple markers of chronic inflammation

“…For example, elevation of uMA is a risk signal for CVD but also alerts us to the impairment of renal glomerular filtration (12). These multiple markers can also be used to monitor treatment, lifestyle change, and nutritional modification, all of which impact chronic inflammation.…”

“…It is of special concern when life threatening diseases such as CVD, renal failure, and cancer are results of the dissemination from the local, primary inflammatory disease. Because patients with diabetic nephropathy are at risk for CVD, urinary microalbumin (uMA), an inflammatory risk marker associated with the severity of diabetic nephropathy, is now also considered as a risk marker for CVD (12). It should also be realized that the impact of chronic systemic inflammation is not limited to the development of these severe, fatal diseases.…”