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Published online before print July 6, 2006 , doi: 10.1681/ASN.2006010097

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Abstract

Microalbuminuria is an early sign of progressive cardiovascular and renal disease in individuals with and without diabetes. Despite compelling data, at present only a minority of patients with diabetes and rarely individuals without diabetes are screened for albuminuria in a systematic way. All of the criteria to implement systematic albuminuria screening are fulfilled in diabetes, and most are nearly fulfilled for microalbuminuria screening in individuals without diabetes. Because of the growing evidence that treatment of microalbuminuria in individuals without diabetes may offer a cost-effective benefit to prevent cardiovascular disease, nephrologists and other health care providers should pay more attention to the early detection and subsequent treatment of individuals with microalbuminuria.

Microalbuminuria is an early sign of progressive cardiovascular and renal disease. We discuss whether screening for albuminuria is warranted and, if so, how screening and subsequent monitoring could be carried out.

The criteria that a screening program should fulfill have been described by Wilson and Jungner ( 1 ) and are given in Table 1 . As more data are available on the impact of elevated albuminuria on renal and cardiovascular prognosis in individuals with diabetes than in individuals without diabetes, we discuss separately the evidence that is available for the need for albuminuria testing in these two groups.

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Table 1.

The Wilson-Jungner criteria

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Albuminuria screening first may be used as a tool to detect individuals with undiagnosed chronic kidney disease (CKD). Elevated albuminuria (30 to 300 mg/d albumin is the definition of microalbuminuria) is an early predictor of progressive renal function loss in type 1 ( 2 , 3 ) and type 2 diabetes ( 4 , 5 ). At the time that microalbuminuria becomes manifest, GFR typically is normal or elevated or only modestly impaired (stage 1 or 2 CKD). Increased urinary albumin excretion (UAE) also may indicate a worse renal prognosis in individuals without diabetes. In a Japanese study, >100,000 individuals were tested for dipstick proteinuria. After a period of >17 yr, the likelihood of being on dialysis increased according to the degree of dipstick proteinuria at baseline ( 6 ). A similar finding was reported from the Prevention of Renal and Vascular End Stage Disease (PREVEND) study: After a 4.2-yr follow-up, the number of individuals who de novo had developed stage 3 or worse CKD was related to baseline albuminuria ( 7 ) ( Figure 1 ). By screening for elevated albuminuria, one of course will not only detect individuals with microalbuminuria but also individuals with macroalbuminuria (>300 mg/d), who most likely are already in stage 3 or 4 CKD.

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