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The spectrum of albuminuria as a predictor of cardiorenal outcomes

Ivana Lazich, and George L Bakris

Albuminuria is a consequence of vascular inflammation and injury but also podocyte dysfunction and damage. In respect to current practice, albuminuria levels of <29 mg/g are considered normal, between 30–299 mg/g high and >300 mg/g very high, with lower levels representing disease markers rather than disease cause. This concept refers to albuminuria as a continuum that reflects high cardiovascular risk at lower levels and high kidney disease risk at levels of >200 mg/day. Assessment of urinary albumin could therefore help with timely detection and improvement of vascular inflammatory process, with spot albumin:creatinine ratio currently being used for this purpose. The most common comorbidities related to albuminuria are diabetes mellitus with hyperinsulinemia, hypertension, dyslipidemia and obesity. Control of these risk factors is essential for patients with high levels of albuminuria. However, the therapeutic intervention for very high albuminuria is aimed at cardiovascular and renal risk reduction by improving blood pressure control to <130/80 mmHg and favors the use of renin angiotensin aldosterone system blockers as an initial approach.