An independent risk factor for cardiovascular disease.

More than 18 million adult patients in the U.S. have microalbuminuria.

Loss of 30 to 300 mg of albumin daily.

Describes a moderate increase in the level of urine albumin.

Occurs when the kidney leaks small amounts of albumin into the urine.

Occurs when there is an abnormally high permeability for albumin in the glomerulus of the kidney.

Normally the kidneys do not filter albumin.

If albumin is found in the urine it is a marker of kidney disease.

The term microalbuminuria is now discouraged and has been replaced by moderately increased albuminuria.

It is a marker of vascular endothelial dysfunction an important prognostic marker for kidney disease in diabetes mellitus, in hypertension, in post-streptococcal glomerulonephritis, increasing microalbuminuria during the first 48 hours after admission to an intensive care unit predicts elevated risk for acute respiratory failure, multiple organ failure, and overall mortality.

It is a risk factor for venous thromboembolism.

It is an important adverse predictor of glycemic outcomes in pre-diabetes.

Pre-diabetes individuals with increased microalbuminuria even is associated with increased progression to diabetes and decreased reversal to normoglycemia.

Hence prediabetes individuals with microalbuminuria warrant more aggressive intervention to prevent diabetes in them.

Higher dietary intake of animal protein, animal fat, and cholesterol may increase risk for microalbuminuria.

Generally diets higher in fruits, vegetables, and whole grains but lower in meat and sweets may be protective against kidney function decline.

The level of albumin protein produced by microalbuminuria can be detected by special albumin-specific urine dipsticks.

A microalbumin urine test determines the presence of the albumin in urine.

In a properly functioning body, albumin is not normally present in urine because it is retained in the bloodstream by the kidneys.

Microalbuminuria can be diagnosed from a 24-hour urine collection (between 30–300 mg/24 hours) or, more commonly, from elevated concentration in a spot sample (20 to 200 mg/L).

Both must be measured on at least two of three measurements over a two- to three-month period.

An albumin level above the upper limit values is called macroalbuminuria, or sometimes just albuminuria.

To compensate for variations in urine concentration in spot-check samples, it is helpful to compare the amount of albumin in the sample against its concentration of creatinine.

The albumin/creatinine ratio (ACR) and microalbuminuria is defined as ACR ≥3.5 mg/mmol (female) or ≥2.5 mg/mmol (male), or, with both substances measured by mass, as an ACR between 30 and 300 µg albumin/mg creatinine.

For the diagnosis of microalbuminuria, an early morning sample is pref2242ed.

The patient should refrain from heavy exercises 24 hours before the test.

A repeat test should be done 3 to 6 months after the first positive test for microalbuminuria.

The test is inaccurate in a person with too much or too little muscle mass.

Reported in approximately 30% of middle-aged patients with either type 1 or type 2 diabetes mellitus and in approximately 10-15% of middle-aged individuals who do not have diabetes mellitus.

Microalbuminuria has a lifetime cumulative incidence in type I diabetes of 20-40%.

It is an independent predictor of future strokes, death and myocardial infarction.

May predict for future congestive heart failure.

When treated early can be arrested or even reversed.

ACE inhibitors are the most effective class of agents in reducing proteinuria.

In the Randomized Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study this agent (Benicar) was tested at 40 mg a day, compared with placebo in type II diabetics, with one of cardiovascular risk factor, normoalbuminuria , to seek a target blood pressure of less than 130/80 mm of mercury:Olmesartan was associated with delayed onset of microalbuminuria with 8.2% versus 9.8% in the placebo group, the time to onset of microalbuminuria was increased by 23%, fewer nonfatal cardiovascular events 3.6% versus 4.1% but a greater number of fatal cardiovascular events 0.7% versus 0.1% (Haller H et al.).

Reducing microalbuminuria is associated with marked renal protection, or retardation of renal disease in diabetes mellitus.

A common presentation of thrombotic microangiopathy seen in the antiphospholipid syndrome.

Angiotensin-converting enzyme inhibitors reduce albumin excretion in both normotensive and hypertensive patients with type 1 or type diabetes.

First morning specimens are recommended for accuracy.

2 positive examinations over a 3-month period is recommended for the diagnosis of microalbuminuria.

An independent risk factor for venous thromboembolism.

Transient elevations of urine albumin may occur in the presence of fever, exercise and heart failure.

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