Microalbuminuria in type II diabetes.
OBJECTIVE
To emphasize the prognostic significance of microalbuminuria in patients with type II diabetes and to summarize interventional studies in patients with non-insulin-dependent diabetes mellitus and nephropathy.


METHODS
The definition of microalbuminuria is reviewed, the implications of its presence are discussed, and published trials of medical intervention to treat proteinuria in patients with type II diabetes are outlined.


RESULTS
Microalbuminuria--defined as the presence of 30 to 300 mg of protein in a 24-hour urine specimen or a urinary albumin excretion rate of 20 to 200 mg/min--is frequently present in patients with non-insulin-dependent diabetes mellitus. It has been shown to be an independent cardiovascular risk factor as well as a predictor for the eventual development of renal failure. Intervention trials indicate that treatment with "tight" blood glucose control and antihypertensive agents, especially angiotensin-converting enzyme inhibitors, may be beneficial in reversing early proteinuria or at least in preventing the progression to renal failure.


CONCLUSIONS
The presence of microalbuminuria in patients with type II diabetes mellitus is associated with premature death from cardiovascular disease and the development of renal failure. Thus, aggressive therapy should be instituted.
Murray
J E
JE
Department of Surgery, Case Western Reserve University School of Medicine, and MetroHealth Medical Center, Cleveland, Ohio, USA.