Microalbuminuria, insulin resistance, diabetes, hypertension, and kidney function: the latest concepts in pathology and pharmacologic treatment.
Microalbuminuria-increased urinary albumin excretion undetectable by traditional urinary dipstick-has been associated with insulin resistance, diabetes mellitus, obesity, and hypertension. It is also a powerful predictor for heart disease and all-cause mortality. In diabetic patients, microalbuminuria has been correlated with the progression of diabetic nephropathy and the development of renal insufficiency. Furthermore, its correlation with markers of inflammation such as C-reactive protein suggests that microalbuminuria may indicate generalized endothelial dysfunction rather than isolated nephropathy. Drugs that block the renin-angiotensin system, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have been shown to reduce albuminuria, resulting in renal protection. Recently, dualaction beta-adrenergic blockers such as carvedilol have been shown to exert favorable effects on albuminuria in diabetic patients with hypertension. Insulin resistance reflects a predictable risk for diabetes, and there appears to be a good correlation between insulin resistance, albuminuria, and progression of renal disease in diabetes with or without hypertension. As in microalbuminuria, ACE inhibitors, ARBs, and dual-action beta-blockers help improve insulin sensitivity.
Barri
Yousri M
YM
Dallas Nephrology Associates, Dallas, TX 75204, USA. barriy@dneph.com
Palmer
Biff F
BF
Ram
C Venkata S
CV
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000419:Albuminuria / Q000188:drug therapy / Q000652:urine*; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000652:urine*; D003928:Diabetic Nephropathies / Q000188:drug therapy; D006801:Humans; D006973:Hypertension / Q000652:urine*; D007333:Insulin Resistance
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors