Proteinuria and microalbuminuria in adults: significance, evaluation, and treatment.
This paper reviews current concepts regarding the pathophysiology, diagnostic evaluation, and treatment of microalbuminuria and proteinuria in adults. Microalbuminuria (in diabetics) and proteinuria are early markers for potentially serious renal disease, and are associated with increased risk of atherosclerotic cardiovascular disease. Proteinuria also contributes to renal scarring, and accelerates the progression of chronic kidney disease to end-stage renal failure. Screening of diabetics for microalbuminuria, and the initial workup of proteinuria, should occur in the primary care setting. Reduction of microalbuminuria in diabetics may retard its progression to overt diabetic nephropathy. Therapy of renal diseases should aim for optimal blood pressure control and the maximum possible reduction in urinary protein excretion. Angiotensin-converting enzyme inhibitor (ACE-I) and/or angiotensin-receptor blocker (ARB) therapy is the most effective measure to achieve this. These drugs also provide protection against the cardiovascular problems that are highly prevalent in this patient population.
Venkat
K K
KK
Division of Nephrology, Department of Medicine, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI 48202, USA. kkvenkat@pol.net
D000328:Adult; D000419:Albuminuria / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002908:Chronic Disease; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000145:classification*; D011507:Proteinuria / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D012720:Severity of Illness Index
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors