de Jong Paul E, Gansevoort Ron T, Bakker Stephan J L
Department of Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
J Nephrol. 2007 Jul-Aug;20(4):375-80.
Until recently, most attention given to patients with macroalbuminuria has focused on their worse renal prognosis, while in contrast, patients with microalbuminuria were mostly considered to be at increased cardiovascular risk. In recent years, however, evidence has been accumulating that this distinction between the 2 -- either large or small quantities of albumin in the urine -- is not that clear. On the one hand, various studies have reported that macroalbuminuria also bears an increased cardiovascular risk. Interestingly, the extent to which albumin loss can be reduced in patients with macroalbuminuria is associated not only with a better renal prognosis, but also similarly with a better cardiovascular prognosis. On the other hand, patients with microalbuminuria not only have an impaired cardiovascular, but also an impaired renal, prognosis. These latter findings in microalbuminuria are especially of importance for the renal community, as screening for albuminuria is not carried out systematically even in patients with increased risk for microalbuminuria, such as those with diabetes and those with essential hypertension. When promoting routine screening for albuminuria, one should realize, moreover, that such projects will most likely be much more cost-effective when directed to preventing not only renal end points, but also CV end points.
直到最近，大多数针对大量白蛋白尿患者的关注都集中在其较差的肾脏预后上，而相比之下，微量白蛋白尿患者大多被认为心血管风险增加。然而近年来，越来越多的证据表明，这两者之间的区别——即尿中白蛋白量的多少——并非那么清晰。一方面，多项研究报告称大量白蛋白尿也伴有心血管风险增加。有趣的是，大量白蛋白尿患者中白蛋白丢失能够减少的程度不仅与更好的肾脏预后相关，而且同样与更好的心血管预后相关。另一方面，微量白蛋白尿患者不仅心血管预后受损，肾脏预后也受损。微量白蛋白尿的这些最新发现对肾脏学界尤为重要，因为即使在微量白蛋白尿风险增加的患者中，如糖尿病患者和原发性高血压患者，也没有系统地进行蛋白尿筛查。此外，在推广蛋白尿常规筛查时，应该认识到，此类项目如果不仅旨在预防肾脏终点事件，还旨在预防心血管终点事件，很可能会更具成本效益。
