Microalbuminuria: Difference between revisions
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{{SignSymptom infobox | | {{SignSymptom infobox | | ||
Name = | Name = Microalbuminuria | | ||
Image = | | Image = | | ||
Caption = | | Caption = | | ||
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{{SI}} | {{SI}} | ||
{{CMG}} | |||
{{EH}} | {{EH}} | ||
==Overview== | ==Overview== | ||
'''Microalbuminuria''' occurs when | '''Microalbuminuria''' occurs when the kidney leaks small amounts of [[human serum albumin|albumin]] into the urine, in other words, when there is an abnormally high [[permeability]]{{dn}} for albumin in the [[renal glomerulus]]. | ||
==Diagnosis== | ==Diagnosis== | ||
The level of albumin [[protein]] produced by | The level of albumin [[protein]] produced by microalbuminuria cannot be detected by urine [[dipstick]] methods. 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 is diagnosed either | Microalbuminuria is diagnosed either from a 24-hour urine collection (between 30-300 mg/24 hours) or, more commonly, from elevated concentrations in a spot sample (30 to 300 mg/L). Both must be measured on at least two of three measurements over a two- to three-month period.<ref>{{cite web |url=http://meteor.aihw.gov.au/content/index.phtml/itemId/270336 |title=Person—microalbumin level (measured), total micrograms per minute N[NNN].N |accessdate=2007-07-05 |format= |work=}}</ref>. An albumin level above these values is called "macroalbuminuria", or sometimes just [[albuminuria]]. | ||
To compensate for | To compensate for variations in urine concentration in spot-check samples, it is more typical in the [[United Kingdom]] to compare the amount of albumin in the sample against its concentration of [[creatinine]]. This is termed the '''albumin/creatinine ratio''' ('''ACR''')<ref>PMID 10333950</ref> and microalbuminuria is defined as ACR ≥3.5 mg/mmol (female) or ≥2.5 mg/mmol(male),<ref>{{cite web |title=Proteinuria |date=December 15, 2005 |url=http://www.renal.org/eGFR/proteinuria.html |publisher= UK Renal Association}}</ref> or, with both substances measured by mass, as an ACR between 30 and 300 µg albumin/mg creatinine<ref>[http://www.clinlabnavigator.com/index.php?option=com_content&view=article&id=412:microalbumin&catid=35:test-interpretations clinlabnavigator.com > Test Interpretations] Last Updated on Saturday, 19 June 2010</ref>. | ||
==Significance== | ==Significance== | ||
| Line 33: | Line 36: | ||
** in [[diabetes mellitus]] | ** in [[diabetes mellitus]] | ||
** in [[hypertension]] | ** in [[hypertension]] | ||
* increasing microalbuminuria | * 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 | ||
* a risk factor for venous thromboembolism <ref>http://www.ncbi.nlm.nih.gov/pubmed/19417196</ref> | |||
==See also== | |||
* [[albuminuria]] | |||
==References== | ==References== | ||
* {{cite journal |author=Abid O, Sun Q, Sugimoto K, Mercan D, Vincent JL |title=Predictive value of microalbuminuria in medical ICU patients: results of a pilot study |journal=Chest |volume=120 |issue=6 |pages= | * {{cite journal |author=Abid O, Sun Q, Sugimoto K, Mercan D, Vincent JL |title=Predictive value of microalbuminuria in medical ICU patients: results of a pilot study |journal=Chest |volume=120 |issue=6 |pages=1984–8 |year=2001 |pmid=11742932 |doi=10.1378/chest.120.6.1984}} | ||
* {{cite journal |author=Andersen S, Blouch K, Bialek J, Deckert M, Parving HH, Myers BD |title=Glomerular permselectivity in early stages of overt diabetic nephropathy |journal=Kidney Int. |volume=58 |issue=5 |pages=2129–37 |year=2000 |pmid=11044234 |doi=10.1111/j.1523-1755.2000.00386.x}} | |||
* {{cite journal |author=Andersen S, Blouch K, Bialek J, Deckert M, Parving HH, Myers BD |title=Glomerular permselectivity in early stages of overt diabetic nephropathy |journal=Kidney Int. |volume=58 |issue=5 |pages= | * {{cite journal |author=Heart Outcomes Prevention Evaluation Study Investigators |title=Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. |journal=Lancet |volume=355 |issue=9200 |pages=253–9 |year=2000 |pmid=10675071 |doi=10.1016/S0140-6736(99)12323-7}} | ||
* {{cite journal |author=Lemley KV, Abdullah I, Myers BD, ''et al.'' |title=Evolution of incipient nephropathy in type 2 diabetes mellitus |journal=Kidney Int. |volume=58 |issue=3 |pages=1228–37 |year=2000 |pmid=10972685 |doi=10.1046/j.1523-1755.2000.00223.x}} | |||
* {{cite journal |author=Heart Outcomes Prevention Evaluation Study Investigators |title=Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. |journal=Lancet |volume=355 |issue=9200 |pages= | * {{cite journal |author=Lièvre M, Marre M, Chatellier G, ''et al.'' |title=The non-insulin-dependent diabetes, hypertension, microalbuminuria or proteinuria, cardiovascular events, and ramipril (DIABHYCAR) study: design, organization, and patient recruitment. DIABHYCAR Study Group |journal=Controlled clinical trials |volume=21 |issue=4 |pages=383–96 |year=2000 |pmid=10913814 |doi=10.1016/S0197-2456(00)00060-X}} | ||
* {{cite journal |author=Parving HH, Lehnert H, Bröchner-Mortensen J, Gomis R, Andersen S, Arner P |title=The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes |journal=N. Engl. J. Med. |volume=345 |issue=12 |pages=870–8 |year=2001 |pmid=11565519 |doi=10.1056/NEJMoa011489}} | |||
* {{cite journal |author=Lemley KV, Abdullah I, Myers BD, ''et al'' |title=Evolution of incipient nephropathy in type 2 diabetes mellitus |journal=Kidney Int. |volume=58 |issue=3 |pages= | |||
* {{cite journal |author=Lièvre M, Marre M, Chatellier G, ''et al'' |title=The non-insulin-dependent diabetes, hypertension, microalbuminuria or proteinuria, cardiovascular events, and ramipril (DIABHYCAR) study: design, organization, and patient recruitment. DIABHYCAR Study Group |journal=Controlled clinical trials |volume=21 |issue=4 |pages= | |||
* {{cite journal |author=Parving HH, Lehnert H, Bröchner-Mortensen J, Gomis R, Andersen S, Arner P |title=The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes |journal=N. Engl. J. Med. |volume=345 |issue=12 |pages= | |||
==Footnotes== | ==Footnotes== | ||
{{reflist|2}} | |||
== External | ==External links== | ||
* [http://www.pace-med-apps.com/uAlbCalc. | * [http://www.pace-med-apps.com/uAlbCalc.htm Online Microalbumin Urine Calculator] | ||
* [http://www.roadmapstudy.org/ first-ever large-scale clinical trial to evaluate whether an ARB can prevent the initial development of Microalbuminuria] | |||
{{Abnormal clinical and laboratory findings}} | {{Abnormal clinical and laboratory findings for urine}} | ||
[[Category:Abnormal clinical and laboratory findings for urine]] | |||
[[Category:Nephrology]] | [[Category:Nephrology]] | ||
Revision as of 12:58, 7 December 2010
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Overview
Microalbuminuria occurs when the kidney leaks small amounts of albumin into the urine, in other words, when there is an abnormally high permeability[disambiguation needed] for albumin in the renal glomerulus.
Diagnosis
The level of albumin protein produced by microalbuminuria cannot be detected by urine dipstick methods. 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 is diagnosed either from a 24-hour urine collection (between 30-300 mg/24 hours) or, more commonly, from elevated concentrations in a spot sample (30 to 300 mg/L). Both must be measured on at least two of three measurements over a two- to three-month period.[1]. An albumin level above these values is called "macroalbuminuria", or sometimes just albuminuria.
To compensate for variations in urine concentration in spot-check samples, it is more typical in the United Kingdom to compare the amount of albumin in the sample against its concentration of creatinine. This is termed the albumin/creatinine ratio (ACR)[2] and microalbuminuria is defined as ACR ≥3.5 mg/mmol (female) or ≥2.5 mg/mmol(male),[3] or, with both substances measured by mass, as an ACR between 30 and 300 µg albumin/mg creatinine[4].
Significance
- an indicator of subclinical cardiovascular disease
- marker of vascular endothelial dysfunction
- an important prognostic marker for kidney disease
- 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
- a risk factor for venous thromboembolism [5]
See also
References
- Abid O, Sun Q, Sugimoto K, Mercan D, Vincent JL (2001). "Predictive value of microalbuminuria in medical ICU patients: results of a pilot study". Chest. 120 (6): 1984–8. doi:10.1378/chest.120.6.1984. PMID 11742932.
- Andersen S, Blouch K, Bialek J, Deckert M, Parving HH, Myers BD (2000). "Glomerular permselectivity in early stages of overt diabetic nephropathy". Kidney Int. 58 (5): 2129–37. doi:10.1111/j.1523-1755.2000.00386.x. PMID 11044234.
- Heart Outcomes Prevention Evaluation Study Investigators (2000). "Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy". Lancet. 355 (9200): 253–9. doi:10.1016/S0140-6736(99)12323-7. PMID 10675071.
- Lemley KV, Abdullah I, Myers BD; et al. (2000). "Evolution of incipient nephropathy in type 2 diabetes mellitus". Kidney Int. 58 (3): 1228–37. doi:10.1046/j.1523-1755.2000.00223.x. PMID 10972685.
- Lièvre M, Marre M, Chatellier G; et al. (2000). "The non-insulin-dependent diabetes, hypertension, microalbuminuria or proteinuria, cardiovascular events, and ramipril (DIABHYCAR) study: design, organization, and patient recruitment. DIABHYCAR Study Group". Controlled clinical trials. 21 (4): 383–96. doi:10.1016/S0197-2456(00)00060-X. PMID 10913814.
- Parving HH, Lehnert H, Bröchner-Mortensen J, Gomis R, Andersen S, Arner P (2001). "The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes". N. Engl. J. Med. 345 (12): 870–8. doi:10.1056/NEJMoa011489. PMID 11565519.
Footnotes
- ↑ "Person—microalbumin level (measured), total micrograms per minute N[NNN].N". Retrieved 2007-07-05.
- ↑ PMID 10333950
- ↑ "Proteinuria". UK Renal Association. December 15, 2005.
- ↑ clinlabnavigator.com > Test Interpretations Last Updated on Saturday, 19 June 2010
- ↑ http://www.ncbi.nlm.nih.gov/pubmed/19417196