Rademacher Erin R, Sinaiko Alan R
Division of Pediatric Nephrology, Department of Pediatrics, University of Rochester, Rochester, New York 14642, USA.
Curr Opin Nephrol Hypertens. 2009 May;18(3):246-51. doi: 10.1097/MNH.0b013e3283294b98.
Albuminuria is a marker of present and future cardiovascular and renal morbidity, and mortality, in adults. Because the roots of these diseases extend back into childhood, assessment of albuminuria has become relevant to child and adolescent clinical care.
Normal levels of albumin excretion in children are well below the cut-off for microalbuminuria. In healthy children, albuminuria relates to fasting insulin, but not blood pressure, BMI, lipid levels, fasting glucose, or insulin resistance. In obese children, albuminuria relates to multiple measures of insulin resistance. In children with type 1 diabetes, hemoglobin A1c seems to be the most consistent clinical predictor of microalbuminuria although multiple mechanisms seem to be involved, including genetic polymorphisms. Children with type 2 diabetes and hypertension already exhibit microalbuminuria.
When considering the population as a whole, children make ideal subjects in which to study the natural history of albuminuria given their relative lack of multiple morbidities commonly seen in adults. The unfortunate rise in 'adult' diseases in the pediatric age group makes this especially relevant. There is a need for longitudinal studies examining predictors of elevated urinary albumin levels as well as potential treatment strategies.
蛋白尿是成人当前及未来心血管和肾脏疾病发病及死亡的一个标志物。由于这些疾病的根源可追溯到儿童时期，蛋白尿评估已与儿童及青少年临床护理相关。
儿童正常的白蛋白排泄水平远低于微量蛋白尿的临界值。在健康儿童中，蛋白尿与空腹胰岛素有关，但与血压、体重指数、血脂水平、空腹血糖或胰岛素抵抗无关。在肥胖儿童中，蛋白尿与多种胰岛素抵抗指标有关。在1型糖尿病儿童中，糖化血红蛋白似乎是微量蛋白尿最一致的临床预测指标，尽管似乎涉及多种机制，包括基因多态性。2型糖尿病和高血压儿童已出现微量蛋白尿。
从总体人群来看，鉴于儿童相对缺乏成人常见的多种疾病，他们是研究蛋白尿自然史的理想对象。儿科年龄组中“成人”疾病令人遗憾的增加使得这一点尤为重要。需要进行纵向研究，以检查尿白蛋白水平升高的预测因素以及潜在的治疗策略。
