Microalbuminuria, an integrated marker of cardiovascular risk in essential hypertension

Pedrinelli, Roberto; Dell’Omo, Giulia; Bello, Vitantonio Di; Pontremoli, Roberto; Mariani, Mario

doi:10.1038/sj.jhh.1001316

Cited by 121 publications

(84 citation statements)

References 152 publications

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“…Among factors such as more extensive coronary atherosclerosis in diabetic subjects, alterations in the fibrinolytic system that facilitate reocclusion after fibrinolysis [21,22], diabetic cardiomyopathy with systolic or diastolic dysfunction [23], and autonomic imbalance [24], particular emphasis has been placed on endothelial dysfunction leading to impaired myocardial perfusion [25]. Albuminuria is considered to be a marker of widespread endothelial dysfunction enhancing atherogenesis, and several studies have shown that the mortality risk is 2.3 to 4 times higher in diabetic patients with microalbuminuria than in those without [26,27,28]. Thus, it is possible that the glomerular albumin leak reflects a widespread atherosclerosis-mediated capillary vasculopathy [25,26,27,29].…”

Section: Discussionmentioning

confidence: 99%

“…Albuminuria is considered to be a marker of widespread endothelial dysfunction enhancing atherogenesis, and several studies have shown that the mortality risk is 2.3 to 4 times higher in diabetic patients with microalbuminuria than in those without [26,27,28]. Thus, it is possible that the glomerular albumin leak reflects a widespread atherosclerosis-mediated capillary vasculopathy [25,26,27,29]. Although we have no ACR values for the patients prior to AMI, it is reasonable to assume that the large difference in ACR between the diabetic AMI group and the diabetic control group is accounted for by AMI.…”

Section: Discussionmentioning

confidence: 99%

“…Albuminuria has been associated with adverse changes in several cardiovascular risk factors [27,29]. A critical question within this context is whether the relationship between increased ACR and mortality merely reflects the association between albuminuria and other predictors of mortality.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Albumin excretion in diabetic patients in the setting of acute myocardial infarction: association with 3-year mortality

Berton¹,

Cordiano²,

Palmieri³

et al. 2004

Diabetologia

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Aims/hypothesis. Diabetes mellitus is associated with increased mortality in subjects with acute myocardial infarction (AMI). We aimed to estimate the risk of mortality in AMI patients with and without diabetes using the urinary albumin : creatinine ratio (ACR).Methods. This is a prospective study of 121 consecutive, non-selected diabetic AMI patients, 121 age-and sex-matched non-diabetic AMI patients and 61 diabetic non-AMI outpatients as control subjects. All data were obtained during the first 7 days of hospitalisation and each AMI patient was followed for a period of exactly 3 years. Baseline ACR RIA measurements were made on the 1st, 3rd and 7th days of admission. Results. Adjusted ACR values were significantly higher in the diabetic AMI patients than in the diabetic control outpatients (p<0.0001), and a significant difference was observed between the weekly ACR slopes for these two groups (p<0.0001). Microalbuminuria was more prevalent in the diabetic AMI patients than in the non-diabetic AMI patients on the 1st day (62% vs 46%, p=0.01) and 3rd day (41% vs 29%, p=0.04). Among the AMI patients with normoalbuminuria (ACR <30 µg/mg), the mortality rate was 11.6% for the patients without diabetes and 33.8% for those with diabetes (p=0.001). The mortality rate was much higher among the AMI patients with microalbuminuria (ACR ≥30 µg/mg) and similar for the diabetic (68.0%) and non-diabetic patients (74.3%). In a multivariable Cox model, ACR (p<0.0001) and diabetes status (p=0.01) were associated with adverse outcome even when several other clinical variables were included in the model. Furthermore, a negative interaction was found between diabetes and ACR (p=0.01). Conclusions/interpretation. Microalbuminuria frequently occurs in diabetic and non-diabetic AMI patients during the first 3 days of admission to hospital and can be used to identify subjects at high risk of mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Albumin excretion in diabetic patients in the setting of acute myocardial infarction: association with 3-year mortality

Berton¹,

Cordiano²,

Palmieri³

et al. 2004

Diabetologia

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“…3 Increased urinary albumin excretion (UAE), namely either micro-or macroalbuminuria, is a well-established marker of hypertensive renal target-organ damage (TOD), mainly characterized by glomerular vasculature involvement. 4 An increase in both hsCRP and UAE occurs in a large proportion of nondiabetic essential hypertensive patients, 5 and a strict direct association between high hsCRP levels and increased UAE were found. 6,7 The ultrasound measurement of the renal resistive index (RRI) has been proposed in adjunct to UAE to assess the severity of renal TOD in hypertension.…”

Section: Introductionmentioning

confidence: 99%

Renal resistive index and low-grade inflammation in patients with essential hypertension

et al. 2011

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In essential hypertension, increased renal resistive index (RRI) is associated to a reduction of renal function and microalbuminuria, and to renal tubulo-interstitial damage. A tubulo-interstitial inflammatory infiltration was found in experimental models of hypertension, and serum high-sensitive C-reactive protein (hsCRP) levels correlated with urinary markers of tubulointerstitial damage in humans. We studied the relationship between RRI and serum hsCRP in hypertensives with preserved renal function, without microalbuminuria. We investigated hypertensive patients without diabetes, renal failure, microalbuminuria or major inflammatory disease. Serum levels of hsCRP were assayed. RRI was calculated by intrarenal Doppler ultrasound and considered pathologic when X0.70 or 495% of upper confidence limit expected for age decade. The renal volume-to-resistive index ratio (RV/RRI) was also calculated. We evaluated 85 patients (57 ± 14 years, 61 males). Patients with pathologic RRI (n ¼ 21) were older and had significantly higher hsCRP levels (4.70 ± 2.30 vs 2.93 ± 2.09 mg l À1 , Po0.01) compared with patients with normal RRI, as well as patients with decreased RV/RRI (n ¼ 43). HsCRP was directly related with RRI (r ¼ 0.41, Po0.001) and inversely with RV/RRI (r ¼ À0.35, Po0.001). HsCRP proved to be a significant predictor of both pathologic RRI and decreased RV/RRI, even after adjustment. In essential hypertension low-grade inflammation is associated with tubulo-interstitial damage evaluated by Doppler ultrasonography.

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“…In our survey, we included the search for microalbuminuria using a dipstick test that measures albumin in the range of 20-200 mg/l. Microalbuminuria has been reported associated with increased cardiovascular risk 2,3 and severity of essential hypertension, but in an extensive review, Bianchi et al 4 quote several studies with controversial results on this association. We explore it here in several thousand people of our national survey.…”

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confidence: 99%

Blood pressure levels and microalbuminuria in a national survey

et al. 2003

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Microalbuminuria, an integrated marker of cardiovascular risk in essential hypertension

Cited by 121 publications

References 152 publications

Albumin excretion in diabetic patients in the setting of acute myocardial infarction: association with 3-year mortality

Albumin excretion in diabetic patients in the setting of acute myocardial infarction: association with 3-year mortality

Renal resistive index and low-grade inflammation in patients with essential hypertension

Blood pressure levels and microalbuminuria in a national survey

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