ABSTRACT
Carl Erik Mogensen Medical Department M, Diabetes and Endocrinology, Aarhus Kommunehospital, Aarhus University Hospital, Aarhus, Denmark (Modified from Diabetologia, 1999; 42: 263-285, with permission – And based upon the Claude Bernard Lecture, Helsinki, 1998)
INTRODUCTION
Microalbuminuria and diabetic renal disease are closely linked [1-14] and are associated with hyperglycemia, increasing, blood pressure and often antecedent hyperfiltration [1, 2]. Microalbuminuria usually indicates the beginning of diabetic nephropathy as opposed to overt nephropathy characterized by clinical proteinuria and most often reduced GFR according to generally defined standards [14-15] but it has even broader implications because it is also often found in cardiovacsular disease [9] and in essential hypertension as first described by Parving et al. [16]. This indicates that microalbuminuria is involved in early renal and vascular disorders, which can predict advancing renal disease as well as the progression of cardiovascular disease [17]. This concept of exact prediction however is becoming increasingly complex because many patients are treated with anti-hypertensive drugs and other types of interventions when microalbuminuria is diagnosed; such measures often return albumin excretion to normal [18-19]. Further in population-based studies microalbuminuria is not uncommon, especially in elderly people where it is also strongly related to cardiovascular disease and mortality, as in both in Type 1 (insulin-dependent) and Type 2 (non-insulin-dependent) diabetes mellitus [2029]. Whether it should be considered as a part of the metabolic syndrome is
still doubtful as it relates more specifically to high blood pressure and glucose intolerance rather than to dyslipedimia and obesity [30]. In diabetic pregnancy, an increase of microalbuminuria predicts complications [31].
