MICROALBUMINURIA IN PATIENTS WITH NIDDM - AN OVERVIEW

The introduction of the concept of microalbuminuria, i.e., elevated bu t clinically undetectable urinary albumin excretion, has unveiled new and exciting information with profound clinical implications for the c are of diabetic patients. For largely historical reasons, however, pro gress in this area has been confined predominantly to patients with ID DM. Important issues such as definition, natural history, and clinical significance of microalbuminuria as well as merits of therapeutic int ervention have been extensively addressed in the case of patients with IDDM. Far less recognition and dedication, however, has been awarded to the study of microalbuminuria in NIDDM until very recently. Emergin g new facts are slowly changing the scene, gradually restoring the spo tlight in favor of NIDDM. To begin with, NIDDM is ten times more commo n than IDDM in the community at large and its toll in terms of morbidi ty and mortality is disturbing. Thus, while the proportion of NIDDM pa tients who will ultimately develop end-stage renal failure is much sma ller than that for patients with IDDM, the sheer numerical superiority of NIDDM ensures that the human and economic burden of diabetic end-s tage renal disease is at least equally distributed between the two typ es of diabetes. Secondly, it has been demonstrated in numerous studies over the past decade that microalbuminuria is not only an independent predictor of progressive renal disease (as has been the case in patie nts with IDDM) but also an important marker of atherosclerotic disease and premature death in people with NIDDM. Indeed, the development of microalbuminuria in patients with NIDDM is closely related to abnormal ities of hemostasis, coagulation, and glucose and lipid metabolism. Mi croalbuminuria may precede and even predict later onset of NIDDM. Fina lly, the recent revelations that microalbuminuria per se may represent an independent manifestation of the cardiometabolic disorder syndrome X have added a new dimension to the study of microalbuminuria in NIDD M. Thus, the clinical importance of microalbuminuria in patients with NIDDM cannot be overstated, and greater awareness of its significance by clinicians and health care providers should be actively reinforced. In this article, therefore, I will review the topic of microalbuminur ia as it pertains to NIDDM, placing emphasis on past difficulties, rec ent developments, and the rationale and limitations of medical interve ntion.