Identification and Management of Albuminuria in the Primary Care Setting
Version of Record online: 1 FEB 2011
© 2011 Wiley Periodicals, Inc.
The Journal of Clinical Hypertension
Volume 13, Issue 6, pages 438–449, June 2011
How to Cite
Kuritzky, L., Toto, R. and Van Buren, P. (2011), Identification and Management of Albuminuria in the Primary Care Setting. The Journal of Clinical Hypertension, 13: 438–449. doi: 10.1111/j.1751-7176.2010.00424.x
- Issue online: 7 JUN 2011
- Version of Record online: 1 FEB 2011
- Manuscript received: April 13, 2010; Revised: November 30, 2010; Accepted: December 1, 2010
Albuminuria is an important risk marker for adverse cardiovascular (CV) and renal outcomes and mortality. The relationship between albuminuria and risk is continuous and linear, like that of blood pressure and cardiovascular risk. Evidence now supports increased risk even at levels traditionally considered within normal limits. In high-risk patients, routine annual screening can detect changes in urine albumin excretion and improve the timely identification of albuminuria, and therefore should be considered in patients with diabetes, hypertension, and chronic kidney disease. Preferred simple screening methods appropriate for use in the primary care setting include microalbumin-specific dipsticks and urinary albumin:creatinine ratio determination (from a spot urine sample). Cornerstones of albuminuria treatment include risk factor management, ongoing monitoring, and, in patients with hypertension, chronic kidney disease, or diabetes, the use of renin-angiotensin-aldosterone system (RAAS)–blocking agents. Both angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have demonstrated utility in this regard; data from studies of direct renin inhibition are promising. The combined use of an ACE inhibitor and ARB was once considered a viable option for the treatment of albuminuria; however, results of the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET) raised important questions regarding the benefits and limitations of dual RAAS blockade. Ongoing studies should provide important insight into the effects of this approach on renal outcomes. J Clin Hypertens (Greenwich). 2011;13:438–449. ©2011 Wiley Periodicals, Inc.