title: Low-grade albuminuria and cardiovascular risk : what is the evidence?
abstract: Microalbuminuria (MA), conventionally defined as a urinary albumin excretion (UAE) of 30-300 mg/day, is recognised as a marker of endothelial dysfunction. Furthermore, it represents an established risk factor for cardiovascular morbidity and mortality and for end-stage renal disease in individuals with an adverse cardiovascular risk profile. It is common in the general population, particularly in patients with diabetes mellitus or arterial hypertension. There is growing evidence from prospective observational trials that UAE levels well below the current MA threshold ("lowgrade MA") are also associated with an increased risk of incident cardiovascular disease and allcause mortality. Even in apparently healthy individuals (without diabetes or hypertension), such an association has been shown. As albuminuria screening assays that are reliable even in the lower ranges are commercially available, there may be an important clinical role for MA in disease screening, comparable to the role of blood pressure and lipid screening. MA is modifiable, and the inhibition of the renin-angiotensin system by ACE inhibitors and AT1 receptor antagonists has been shown to result in a lower incidence of cardiovascular events.
authors: Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany. roland.schmieder@rzmail.uni-erlangen.de
authors: Roland E
authors: RE
authors: Schmieder
authors: Joachim
authors: J
authors: Schrader
authors: Walter
authors: W
authors: Zidek
authors: Ulrich
authors: U
authors: Tebbe
authors: W Dieter
authors: WD
authors: Paar
authors: Peter
authors: P
authors: Bramlage
authors: D
authors: D
authors: Pittrow
authors: Michael
authors: M
authors: Böhm
mesh_terms: D000419:Albuminuria / Q000150:complications*; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000652:urine; D003928:Diabetic Nephropathies / Q000652:urine; D004730:Endothelium, Vascular / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000652:urine; D011507:Proteinuria / Q000150:complications; D012307:Risk Factors