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Treatment of microalbuminuria in patients with type 2 diabetes mellitus.

Abstract

The incidence of type 2 diabetes mellitus is increasing world-wide, and is now one of the leading causes of end-stage renal disease in Western countries. Type 2 diabetes mellitus is also a major risk factor for cardiovascular events. Therefore, the early identification of patients at greatest risk, and the subsequent initiation of renal and cardiovascular protective treatments, are of the utmost importance. Microalbuminuria refers to a subclinical increase in urinary albumin excretion. By definition it corresponds to an albumin excretion rate of 20 to 200 microg/min (30 to 300 mg/day) or an albumin to creatinine ratio (mg/mmol) of 2.5 to 25 in males and 3.5 to 35 in females. Microalbuminuria is an important clinical finding because it is not only associated with an increased risk of progression to overt proteinuria (macroalbuminuria) and renal failure, but also cardiovascular events. In patients who progress to overt nephropathy, microalbuminuria usually precedes macroalbuminuria by an interval of 5 to 10 years. In patients with type 1 diabetes mellitus, blood pressure increases and renal function declines after the onset of macroalbuminuria. However, in patients with type 2 diabetes mellitus, hypertension and a decline in renal function may occur when albumin excretion is still in the microalbuminuric range. Large clinical trials have demonstrated that achieving tight glycemic (i.e. glycosylated hemoglobin < 7.0%) and blood pressure (i.e. < 130/85mm Hg) control retards the progression of renal disease. There is accumulating evidence to suggest that the use of antihypertensive agents which target the renin-angiotensin system (RAS) can slow the progression of renal disease and provide cardioprotection in patients with type 2 diabetes mellitus and microalbuminuria. Antihypertensive agents which target the RAS also appear to have advantages over and above reductions in systemic blood pressure. In summary, the annual screening of patients with type 2 diabetes mellitus for microalbuminuria, and the initiation of measures to retard the progression of renal and cardiovascular disease, are now considered part of routine clinical practice. In particular, the finding of microalbuminuria should provoke an intensified modification of the common risk factors for renal and cardiovascular disease, that is hyperglycemia, hypertension, dyslipidemia and smoking. Antihypertensive therapy in patients with microalbuminuria and type 2 diabetes mellitus should be initiated with angiotensin converting enzyme (ACE) inhibitors or angiotensin-II type 1 receptor antagonists.

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  • Authors+Show Affiliations

    ,

    Endocrinology Unit, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia. endo@austin.unimelb.edu.au

    Source

    Treatments in endocrinology 1:3 2002 pg 163-73

    MeSH

    Albuminuria
    Angiotensin-Converting Enzyme Inhibitors
    Blood Pressure
    Cardiovascular Diseases
    Diabetes Mellitus, Type 2
    Diabetic Nephropathies
    Diet, Protein-Restricted
    Female
    Glycated Hemoglobin A
    Humans
    Hyperlipidemias
    Male
    Renin-Angiotensin System

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    15799209

    Citation

    Jerums, George, and Richard J. MacIsaac. "Treatment of Microalbuminuria in Patients With Type 2 Diabetes Mellitus." Treatments in Endocrinology, vol. 1, no. 3, 2002, pp. 163-73.
    Jerums G, MacIsaac RJ. Treatment of microalbuminuria in patients with type 2 diabetes mellitus. Treat Endocrinol. 2002;1(3):163-73.
    Jerums, G., & MacIsaac, R. J. (2002). Treatment of microalbuminuria in patients with type 2 diabetes mellitus. Treatments in Endocrinology, 1(3), pp. 163-73.
    Jerums G, MacIsaac RJ. Treatment of Microalbuminuria in Patients With Type 2 Diabetes Mellitus. Treat Endocrinol. 2002;1(3):163-73. PubMed PMID: 15799209.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Treatment of microalbuminuria in patients with type 2 diabetes mellitus. AU - Jerums,George, AU - MacIsaac,Richard J, PY - 2005/4/1/pubmed PY - 2005/4/20/medline PY - 2005/4/1/entrez SP - 163 EP - 73 JF - Treatments in endocrinology JO - Treat Endocrinol VL - 1 IS - 3 N2 - The incidence of type 2 diabetes mellitus is increasing world-wide, and is now one of the leading causes of end-stage renal disease in Western countries. Type 2 diabetes mellitus is also a major risk factor for cardiovascular events. Therefore, the early identification of patients at greatest risk, and the subsequent initiation of renal and cardiovascular protective treatments, are of the utmost importance. Microalbuminuria refers to a subclinical increase in urinary albumin excretion. By definition it corresponds to an albumin excretion rate of 20 to 200 microg/min (30 to 300 mg/day) or an albumin to creatinine ratio (mg/mmol) of 2.5 to 25 in males and 3.5 to 35 in females. Microalbuminuria is an important clinical finding because it is not only associated with an increased risk of progression to overt proteinuria (macroalbuminuria) and renal failure, but also cardiovascular events. In patients who progress to overt nephropathy, microalbuminuria usually precedes macroalbuminuria by an interval of 5 to 10 years. In patients with type 1 diabetes mellitus, blood pressure increases and renal function declines after the onset of macroalbuminuria. However, in patients with type 2 diabetes mellitus, hypertension and a decline in renal function may occur when albumin excretion is still in the microalbuminuric range. Large clinical trials have demonstrated that achieving tight glycemic (i.e. glycosylated hemoglobin < 7.0%) and blood pressure (i.e. < 130/85mm Hg) control retards the progression of renal disease. There is accumulating evidence to suggest that the use of antihypertensive agents which target the renin-angiotensin system (RAS) can slow the progression of renal disease and provide cardioprotection in patients with type 2 diabetes mellitus and microalbuminuria. Antihypertensive agents which target the RAS also appear to have advantages over and above reductions in systemic blood pressure. In summary, the annual screening of patients with type 2 diabetes mellitus for microalbuminuria, and the initiation of measures to retard the progression of renal and cardiovascular disease, are now considered part of routine clinical practice. In particular, the finding of microalbuminuria should provoke an intensified modification of the common risk factors for renal and cardiovascular disease, that is hyperglycemia, hypertension, dyslipidemia and smoking. Antihypertensive therapy in patients with microalbuminuria and type 2 diabetes mellitus should be initiated with angiotensin converting enzyme (ACE) inhibitors or angiotensin-II type 1 receptor antagonists. SN - 1175-6349 UR - https://www.unboundmedicine.com/medline/citation/15799209/Treatment_of_microalbuminuria_in_patients_with_type_2_diabetes_mellitus_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=15799209.ui DB - PRIME DP - Unbound Medicine ER -