PROGNOSTIC-SIGNIFICANCE OF MICROALBUMINURIA

Diabetic nephropathy is the only increasing cause of renal failure in the Western world. It affects a large proportion of both insulin-depen dent (IDDM) and non-insulin-dependent diabetic (NIDDM) patients. A cri tical stage in the development of diabetic renal disease is the onset of microalbuminuria, defined as an albumin excretion rate of 30 to 300 mg/day. Microalbuminuria predicts progression to renal failure and ea rly cardiovascular mortality in both IDDM and NIDDM patients. Microalb uminuria is associated with a constellation of other risk factors for small and large vessel damage which include raised blood pressure, poo r glycemic control, plasma lipid and clotting factor abnormalities, le ft ventricular hypertrophy, and insulin resistance. Treatment with ang iotensin-converting enzyme inhibitors corrects microalbuminuria and pr events progression to persistent proteinuria. Good blood glucose contr ol significantly reduces the risk of progression from normoalbuminuria to microalbuminuria. The treatment of microalbuminuria appears highly cost-beneficial and substantially increases life expectancy. The deve lopment of microalbuminuria, for which all diabetic patients aged 12 t o 70 years should be screened, should alert the physician to set in mo tion a program of assessment, monitoring, and correction of all risk f actors for renal and cardiovascular disease.