Microalbuminuria in Type 2 Diabetics: An Important, Overlooked Cardiovascular Risk Factor

Matthew R. Weir, MD

In This Article

Abstract and Introduction

The presence of microalbumin in the urine of persons with type 2 diabetes is perhaps the most important early signal heralding the onset of systemic vasculopathy and associated target organ damage to the brain, the heart, and the kidneys. It is easily measured and, unfortunately, frequently overlooked as a screening tool in clinical medicine. If present, it identifies patients at risk for early cardiovascular death and progressive renal disease. Microalbuminuria also identifies patients who need more rigorous cardiovascular risk management, especially more intensive blood pressure control, preferably below 130/80 mm Hg, and strict attention to glycemic control and lipid levels. Therapeutic strategies to facilitate better blood pressure control and reduce microalbuminuria likely will prove to be the most effective way to retard not only the progression of renal disease but also cardiovascular disease. Consequently, the identification and normalization of urine microalbumin excretion should be an important consideration in patients with diabetes.

Diabetes is not only the single most common cause of end- stage renal disease (ESRD) in the Western world, but it is also a major risk factor for cardiovascular disease that often coexists in patients with high blood pressure.[1,2] Third National Health and Nutrition Examination Survey (NHANES III) data indicate that diabetes affects 7.8% of adults over age 20 years in the United States and that the risk of developing type 2 diabetes is more than two times greater in patients with high blood pressure than in their normotensive counterparts.[3] Moreover, 28.2% of patients with type 2 diabetes have micro-albuminuria, and 7.6% have clinical protein-uria.[3] Without specific intervention, 20%-40% of patients with type 2 diabetes and microalbuminuria will progress to overt nephropathy and ultimately ESRD.[2,3] Consequently, earlier screening techniques that identify patients at risk for progression of both renal disease and cardiovascular target organ damage are required. Screening for microalbuminuria may be one of the most important, simple clinical tools in practice.