Identification and Management of Albuminuria in the Primary Care Setting

摘要: Albuminuria is an important risk marker for adverse cardiovascular (CV) and renal outcomes mortality. The relationship between albuminuria continuous linear, like that of blood pressure risk. Evidence now supports increased even at levels traditionally considered within normal limits. In high-risk patients, routine annual screening can detect changes in urine albumin excretion improve the timely identification albuminuria, therefore should be patients with diabetes, hypertension, chronic kidney disease. Preferred simple methods appropriate use primary care setting include microalbumin-specific dipsticks urinary albumin:creatinine ratio determination (from a spot sample). Cornerstones treatment factor management, ongoing monitoring, and, disease, or renin-angiotensin-aldosterone system (RAAS)–blocking agents. Both angiotensin-converting enzyme (ACE) inhibitors angiotensin receptor blockers (ARBs) have demonstrated utility this regard; data from studies direct renin inhibition are promising. combined ACE inhibitor ARB was once viable option albuminuria; however, results Ongoing Telmisartan Alone Combination With Ramipril Global Endpoint Trial (ONTARGET) raised questions regarding benefits limitations dual RAAS blockade. provide insight into effects approach on outcomes. J Clin Hypertens (Greenwich). 2011;13:438–449. ©2011 Wiley Periodicals, Inc.