title: Identification and management of albuminuria in the primary care setting.
abstract: Albuminuria is an important risk marker for adverse cardiovascular (CV) and renal outcomes and mortality. The relationship between albuminuria and risk is continuous and linear, like that of blood pressure and cardiovascular risk. Evidence now supports increased risk even at levels traditionally considered within normal limits. In high-risk patients, routine annual screening can detect changes in urine albumin excretion and improve the timely identification of albuminuria, and therefore should be considered in patients with diabetes, hypertension, and chronic kidney disease. Preferred simple screening methods appropriate for use in the primary care setting include microalbumin-specific dipsticks and urinary albumin:creatinine ratio determination (from a spot urine sample). Cornerstones of albuminuria treatment include risk factor management, ongoing monitoring, and, in patients with hypertension, chronic kidney disease, or diabetes, the use of renin-angiotensin-aldosterone system (RAAS)-blocking agents. Both angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have demonstrated utility in this regard; data from studies of direct renin inhibition are promising. The combined use of an ACE inhibitor and ARB was once considered a viable option for the treatment of albuminuria; however, results of the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET) raised important questions regarding the benefits and limitations of dual RAAS blockade. Ongoing studies should provide important insight into the effects of this approach on renal outcomes.
authors.affiliation: Division of Medicine, Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville, FL, USA. lkuritzky@aol.com
authors.forename: Louis
authors.initials: L
authors.lastname: Kuritzky
authors.forename: Robert
authors.initials: R
authors.lastname: Toto
authors.forename: Peter
authors.initials: P
authors.lastname: Van Buren
mesh_terms: D000418:Albumins / Q000378:metabolism; D000419:Albuminuria / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D000465:Algorithms; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers; D003920:Diabetes Mellitus / Q000473:pathology; D003937:Diagnosis, Differential; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000473:pathology*; D008403:Mass Screening; D058007:Physicians, Primary Care; D011320:Primary Health Care; D012084:Renin-Angiotensin System / Q000187:drug effects; D012307:Risk Factors
chemical_list: D000418:Albumins; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D015415:Biomarkers