Ruilope L M, Rodicio J L
Hypertension Unit, 12 de Octubre Hospital, Madrid, Spain.
Curr Opin Nephrol Hypertens. 1993 Nov;2(6):962-7. doi: 10.1097/00041552-199311000-00017.
Proteinuria (protein excretion > 300 mg/d) is an independent risk factor for the development of cardiovascular disease and renal failure. The finding of persistent proteinuria in otherwise asymptomatic patients often precedes the development of arterial hypertension and renal failure. When proteinuria is accompanied by arterial hypertension, blood pressure control can decrease the quantity of protein excretion but not the incidence of proteinuria. In this sense, converting enzyme inhibitors seem to possess a higher capacity to reduce proteinuria. Nevertheless, the effects of reducing proteinuria on renal function and cardiovascular risk remain to be elucidated. Microalbuminuria (urine albumin excretion oscillating between 30 and 300 mg/d) seems to be a predictor of cardiovascular disease in diabetic and nondiabetic subjects and has been established as a predictor for the development of diabetic nephropathy. Blood pressure levels and urinary albumin excretion correlate positively, and antihypertensive therapy of any kind decreases the quantity of albumin present in the urine. The role of increased albumin excretion in essential hypertension and in renal failure remains to be elucidated.
蛋白尿（蛋白质排泄量>300mg/天）是心血管疾病和肾衰竭发生的独立危险因素。在无症状患者中发现持续性蛋白尿往往先于动脉高血压和肾衰竭的发生。当蛋白尿伴有动脉高血压时，控制血压可减少蛋白质排泄量，但不能降低蛋白尿的发生率。从这个意义上说，转换酶抑制剂似乎具有更高的降低蛋白尿的能力。然而，降低蛋白尿对肾功能和心血管风险的影响仍有待阐明。微量白蛋白尿（尿白蛋白排泄量在30至300mg/天之间波动）似乎是糖尿病和非糖尿病患者心血管疾病的预测指标，并已被确立为糖尿病肾病发生的预测指标。血压水平与尿白蛋白排泄量呈正相关，任何类型的抗高血压治疗均可减少尿中白蛋白的含量。白蛋白排泄增加在原发性高血压和肾衰竭中的作用仍有待阐明。
