Microalbuminuria 

• Although microalbuminuria is generally identified as an early maker of kidney disease it has now been firmly established as a potent predictor for the development of severe CAD (coronary artery disease) as well as a prognostic marker in people with pre-existing CAD. People with microalbuminuria usually have greater burden of atherosclerosis.

• Microalbuminuria is also an independent predictor of cardiovascular (CVD) and all-cause mortality in people with and without diabetes or hypertension.¹ As a result, patients with microalbuminuria need to be treated more aggressively especially in the presence of CAD.

• Microalbuminuria is a common accompaniment of metabolic syndrome, chronic kidney disease, and CAD. Recent research indicates that the three conditions appear to be intertwined. ^{2, 3 4}

• Overconsumption of calories and/or their underutilization is resulting in an explosion of metabolic syndrome world-wide. Because of its high prevalence, some experts have even recommended including microalbuminuria as one of the components of metabolic syndrome.⁵ Intensive exercise and weight loss in individuals with metabolic syndrome result in improvement of kidney function.⁶

• Hypertension and diabetes are associated with a 2 to 3-fold increase in microalbuminuria and it may be an early marker of renal disease in people with these conditions.^7-9 Treatment of hypertension and diabetes particularly with angiotensin converting enzyme inhibitors (ACEI) and AT1-receptor blockers (ARBS) improve insulin sensitivity and ameliorate microalbuminuria in addition to their well documented cardiac and renal protective effects.¹⁰

• Dyslipidemia, particularly high triglyceride and low HDL, are highly correlated with microalbuminuria and chronic kidney disease and treatment of dyslipidemia may reduce the progression of kidney disease.^11-13

• Statin use may retard the progression of renal dysfunction, which appears to be independent of their lipid-lowering effect.¹⁴

• Metformin is contraindicate in patients with impaired renal function, but has shown to be effective in preventing the development of diabetes in pre-diabetic individuals.¹⁵

• Clinical trials are clearly documented that changes in albuminuria over time with treatment translate to changes in cardiovascular risk. As a result, monitoring of albuminuria should be an integrated part of the management of hypertension and diabetes. If albuminuria is not decreased by the patient’s current treatment, further intervention with ACE-inhibitors or ARBS should be undertaken along with control and other modifiable risks factors.^{4, 16}

• Ramipril treatment has been shown to reduce coronary events and nephropathy in high risk patients.^{17, 18}  Likewise, treatment with fosinopril and losartan significantly decreased microalbuminuria as well as CVD events.^{19, 20}A target-driven, long-term, intensified intervention aimed at multiple risk factors in patients with diabetes and microalbuminuria has been shown to reduce CVD and microvascular events by about 50 percent.²¹

Sources 

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2. Borch-Johnsen K, Feldt-Rasmussen B, Strandgaard S, Schroll M, Jensen JS. Urinary albumin excretion. An independent predictor of ischemic heart disease. Arterioscler Thromb Vasc Biol. 1999;19(8):1992-1997.

3. Sukhija R, Aronow WS, Kakar P, et al. Relation of microalbuminuria and coronary artery disease in patients with and without diabetes mellitus. Am J Cardiol. Aug 1 2006;98(3):279-281.

4. Gobal F, Deshmukh A, Shah S, Mehta JL. Triad of metabolic syndrome, chronic kidney disease, and coronary heart disease with a focus on microalbuminuria death by overeating. J Am Coll Cardiol. Jun 7 2011;57(23):2303-2308.

5. Palaniappan L, Carnethon M, Fortmann SP. Association between microalbuminuria and the metabolic syndrome: NHANES III. Am J Hypertens. Nov 2003;16(11 Pt 1):952-958.

6. Lindstrom J, Louheranta A, Mannelin M, et al. The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care. Dec 2003;26(12):3230-3236.

7. Hodge AM, Dowse GK, Zimmet PZ. Microalbuminuria, cardiovascular risk factors, and insulin resistance in two populations with a high risk of type 2 diabetes mellitus. Diabet Med. May 1996;13(5):441-449.

8. Jiang X, Srinivasan SR, Radhakrishnamurthy B, Dalferes ER, Jr., Bao W, Berenson GS. Microalbuminuria in young adults related to blood pressure in a biracial (black-white) population. The Bogalusa Heart Study. Am J Hypertens. Sep 1994;7(9 Pt 1):794-800.

9. Srinivasan SR, Myers L, Berenson GS. Risk variables of insulin resistance syndrome in African-American and Caucasian young adults with microalbuminuria: the Bogalusa Heart Study. Am J Hypertens. Dec 2000;13(12):1274-1279.

10. Sharma AM. Is there a rationale for angiotensin blockade in the management of obesity hypertension? Hypertension. Jul 2004;44(1):12-19.

11. Manttari M, Tiula E, Alikoski T, Manninen V. Effects of hypertension and dyslipidemia on the decline in renal function. Hypertension. Oct 1995;26(4):670-675.

12. Fried L F, Orchard TJ, Kasiske BL. Effect of lipid reduction on the progression of renal disease: a meta- analysis. Kidney Int. 2001;59(1):260-269.

13. Muntner P, Coresh J, Smith JC, Eckfeldt J, Klag MJ. Plasma lipids and risk of developing renal dysfunction: the atherosclerosis risk in communities study. Kidney Int. Jul 2000;58(1):293-301.

14. Sukhija R, Bursac Z, Kakar P, et al. Effect of statins on the development of renal dysfunction. Am J Cardiol. Apr 1 2008;101(7):975-979.

15. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.

16. Ibsen H, Olsen MH, Wachtell K, et al. Reduction in albuminuria translates to reduction in cardiovascular events in hypertensive patients: losartan intervention for endpoint reduction in hypertension study. Hypertension. Feb 2005;45(2):198-202.

17.Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators [see comments] [published erratum appears in N Engl J Med 2000 Mar 9;342(10):748]. N Engl J Med. 2000;342(3):145-153.

18. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Heart Outcomes Prevention Evaluation Study Investigators. Lancet. Jan 22 2000;355(9200):253-259.

19. Asselbergs FW, Diercks GF, Hillege HL, et al. Effects of fosinopril and pravastatin on cardiovascular events in subjects with microalbuminuria. Circulation. Nov 2 2004;110(18):2809-2816.

20. Ibsen H, Wachtell K, Olsen MH, et al. Does albuminuria predict cardiovascular outcome on treatment with losartan versus atenolol in hypertension with left ventricular hypertrophy? A LIFE substudy. J Hypertens. Sep 2004;22(9):1805-1811.

21. Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. Jan 30 2003;348(5):383-393.