Chugh Atul, Bakris George L
Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago, Pritzker School of Medicine, IL 60637, USA.
J Clin Hypertens (Greenwich). 2007 Mar;9(3):196-200. doi: 10.1111/j.1524-6175.2007.06445.x.
Microalbuminuria (MA) is defined as a persistent elevation of albumin in the urine of >30 to <300 mg/d (>20 to <200 microg/min). Use of the morning spot urine test for albumin-to-creatinine measurement (mg/g) is recommended as the preferred screening strategy for all patients with diabetes and with the metabolic syndrome and hypertension. MA should be assessed annually in all patients and every 6 months within the first year of treatment to monitor the impact of antihypertensive therapy. It is an established risk marker for the presence of cardiovascular disease and predicts progression of nephropathy when it increases to frank microalbuminuria>300 mg/d. Data support the concept that the presence of MA is the kidney's warning that there is a problem with the vasculature. The presence of MA is a marker of endothelial dysfunction and a predictor of increased cardiovascular risk. MA can be reduced, and progression to overt proteinuria prevented, by aggressive blood pressure reduction, especially with a regimen based on medications that block the renin-angiotensin-aldosterone system, and control of diabetes. The National Kidney Foundation recommends that blood pressure levels be maintained at or below 130/80 mm Hg in anyone with diabetes or kidney disease.
微量白蛋白尿（MA）定义为尿中白蛋白持续升高，超过30至<300mg/d（超过20至<200μg/min）。对于所有糖尿病、代谢综合征和高血压患者，推荐使用晨尿点检测法测量白蛋白与肌酐比值（mg/g）作为首选筛查策略。所有患者应每年评估MA，治疗第一年应每6个月评估一次，以监测抗高血压治疗的效果。MA是心血管疾病存在的既定风险标志物，当它增加到明显微量白蛋白尿>300mg/d时，可预测肾病进展。数据支持这样的概念，即MA的存在是肾脏发出的血管系统存在问题的警告。MA的存在是内皮功能障碍的标志物，也是心血管风险增加的预测指标。通过积极降低血压，尤其是采用基于阻断肾素-血管紧张素-醛固酮系统的药物方案以及控制糖尿病，可降低MA并预防进展为显性蛋白尿。美国国家肾脏基金会建议，任何糖尿病或肾病患者血压水平应维持在130/80mmHg或以下。
