Redon Josep, Pascual Jose M
Hypertension Clinic, Internal Medicine, Hospìtal Clinico, Avda Blasco Ibañez, 17, 46010 Valencia, Spain.
Curr Hypertens Rep. 2006 May;8(2):171-7. doi: 10.1007/s11906-006-0015-x.
During the past few years, microalbuminuria has become a prognostic marker for cardiovascular and/or renal risk in diabetic and nondiabetic subjects. In essential hypertensives, an increased transglomerular passage of albumin may result from several mechanisms--hyperfiltration, glomerular basal membrane abnormalities, endothelial dysfunction, and nephrosclerosis. Cross-sectional studies have demonstrated that the main factors related to microalbuminuria are blood pressure (BP) values and hyperinsulinemia, as an expression of insulin resistance. Genetics, obesity, and smoking, however, have also been implicated as determinants of microalbuminuria in some of the studies. Follow-up studies support the role of BP values and subtle alterations in glucose metabolism, although contributing roles need to be assessed in further studies. It seems that the significance of microalbuminuria in essential hypertension is much broader than expected, and several factors may influence the presence of microalbuminuria. Thus, to reverse microalbuminuria, and to reduce urine albumin excretion and cardiovascular and renal risk, a strategy of multiple approaches may be needed. Whether or not the multiple approaches need to be implemented from the beginning or step by step in an individual approach should be established in the near future.
在过去几年中，微量白蛋白尿已成为糖尿病和非糖尿病患者心血管和/或肾脏风险的预后标志物。在原发性高血压患者中，白蛋白经肾小球滤过增加可能由多种机制引起，包括超滤、肾小球基底膜异常、内皮功能障碍和肾硬化。横断面研究表明，与微量白蛋白尿相关的主要因素是血压（BP）值和高胰岛素血症，后者是胰岛素抵抗的一种表现。然而，在一些研究中，遗传、肥胖和吸烟也被认为是微量白蛋白尿的决定因素。随访研究支持血压值和葡萄糖代谢细微改变的作用，尽管其具体作用还需进一步研究评估。原发性高血压中微量白蛋白尿的意义似乎比预期的更为广泛，多种因素可能影响微量白蛋白尿的存在。因此，为了逆转微量白蛋白尿，减少尿白蛋白排泄以及心血管和肾脏风险，可能需要采取多种方法的策略。多种方法是应从一开始就实施，还是应根据个体情况逐步实施，这一问题应在不久的将来得以确定。
