Microalbuminuria Is a Predictor of Chronic Renal Insufficiency in Patients without Diabetes and with Hypertension

Abstract

Background and objectives: Increased urinary albumin excretion is a known risk factor for cardiovascular events and clinical nephropathy in patients with diabetes. Whether microalbuminuria predicts long-term development of chronic renal insufficiency (CRI) in patients without diabetes and with primary hypertension remains to be documented.Design, setting, participants, & measurements: We conducted an 11.8-year follow-up of 917 patients who did not have diabetes and had hypertension and were enrolled in the Microalbuminuria: A Genoa Investigation on Complications (MAGIC) cohort between 1993 and 1997. Urinary albumin-to-creatinine ratio (ACR) was assessed at baseline in untreated patients in a core laboratory. Microalbuminuria was defined as ACR >22 mg/g in men and ACR >31 mg/g in women.Results: A total of 10,268 person-years of follow-up revealed that baseline microalbuminuria was associated with an increased risk for developing CRI (relative risk [RR] 7.61; 95% confidence interval [CI] 3.19 to 8.16; P < 0.0001), cardiovascular events (composite of fatal and nonfatal cardiac and cerebrovascular events; RR 2.11; 95% CI 1.08 to 4.13; P < 0.028), and cardiorenal events (composite of former end points; RR 3.21; 95% CI 1.86 to 5.53; P < 0.0001). Microalbuminuria remained significantly related to CRI (RR 12.75; 95% CI 3.62 to 44.92; P < 0.0001) and cardiorenal events (RR 2.58; 95% CI 1.32 to 5.05; P ‫؍‬ 0.0056) even after adjustment for several baseline covariates.Conclusions: Microalbuminuria is an independent predictor of renal and cardiovascular complications in patients without diabetes and with primary hypertension.

A study in prevalence of diabetic nephropathy in recently detected cases of type 2 diabetes mellitus as evidenced by altered creatinine clearance, urinary albumin and serum creatinine, with special emphasis on hypertension, hypercholesterolemia and obesity

“…While final diagnosis may need a biopsy, diagnosis is usually done with measurement of urinary albumin/GFR/creatinine clearance/serum creatinine levels. 3 Microalbuminuria can be diagnosed from a 24-hour urine collection (between 30-299mg/24 hours) or, more commonly, from elevated concentrations in a spot sample (30 to 299mg/L) as done by us.…”

Aortic stiffness, blood pressure and renal dysfunction

“…Concordantly, it has been demonstrated that CV risk progressively increases in parallel with the renal function decline [17]. Early signs of renal damage, such as microalbuminuria, mild decrease in estimated glomerular filtration rate (eGFR), and increased renal vascular impedance, are relatively common conditions in patients with primary hypertension [18].…”

“…According with this, microalbuminuria, as well as a mild reduction in eGFR, have been indicated to be associated with a higher risk of CV disease as well as increased CV morbidity and mortality [17,18]. Further, increased renal vascular impedance has been demonstrated to correlate with early signs of CV and renal damage [19] and to predict the progression to end-stage renal disease in primary renal disease [20].…”

5-Hydroxyhexanoic Acid Predicts Early Renal Functional Decline in Type 2 Diabetes Patients with Microalbuminuria

“…DN is also the most common leading cause of end-stage renal disease (ESRD) worldwide [1-3]. Conventionally, microalbuminuria (MA; 30–300 mg/24 h) is considered a biomarker and a risk for DN and progressive renal dysfunction [4-10]. However, several studies have questioned the sensitivity and the specificity of MA for renal dysfunction [11].…”