title: Slowing progression along the renal disease continuum.
abstract: Patients in whom nephropathy develops as a result of hypertension or diabetes mellitus are more likely to die of cardiovascular disease (CVD) than of kidney disease. An early sign of impending nephropathy is microalbuminuria, defined as urinary excretion of albumin at a rate of 28.8 mg/24 h to 288 mg/24 h. Microalbuminuria is a marker of endothelial dysfunction, vascular injury, and renal disease and CVD, and it is associated with increased risk for myocardial infarction. Oxidative stress and endothelial dysfunction are unifying factors mediated by the renin-angiotensin system in renal disease and CVD. Clinical trials show reduced cardiovascular risk and a reversal of microalbuminuria with the use of agents that affect the renin-angiotensin system: angiotensin-receptor blockers in patients with type 2 diabetes mellitus and nephropathy, or angiotensin-converting enzyme inhibitors in patients with type 1 diabetes mellitus.
authors.affiliation: Temle University, Philadelphia, PA, USA. DrNPK@aol.com
authors.forename: Nelson P
authors.initials: NP
authors.lastname: Kopyt
mesh_terms: D000419:Albuminuria / Q000175:diagnosis / Q000209:etiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000652:urine; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control* / Q000652:urine; D003928:Diabetic Nephropathies / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D012084:Renin-Angiotensin System; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D015415:Biomarkers