Microalbuminuria Testing in Patients with Hypertension and Renal Dysfunction

Introduction to Microalbuminuria

The European Society of Hypertension and Cardiology recommends that the estimated glomerular filtration rate (eGFR) be calculated and a microalbuminuria test be performed on a spot urine sample in all hypertensive patients 1
The presence of reduced renal function (elevated serum creatinine or low eGFR) combined with increased urinary albumin excretion indicates a higher risk of cardiovascular and renal events than any isolated abnormality, making these factors independent and cumulative risk factors 1

Microalbuminuria indicates generalized vascular dysfunction and endothelial damage beyond renal involvement 2
Microalbuminuria is a potent predictor of future cardiovascular events and death, even in treated patients 1, 2

Microalbuminuria is defined as an albumin-to-creatinine ratio of 30-299 mg/g of creatinine 2
Diagnosis requires confirmation with 2 of 3 abnormal samples collected over a period of 3-6 months due to significant variability in urinary albumin excretion 2, 3

The test should be performed on a spot urine sample, calculating the albumin-to-creatinine ratio 1, 2
First-morning urine samples are preferred to minimize the effects of orthostatic proteinuria 2

If microalbuminuria is present, consider starting an ACE inhibitor or angiotensin receptor blocker, even in normotensive patients, to reduce the progression of nephropathy and cardiovascular risk 3, 4
Target blood pressure <130/80 mmHg in patients with albuminuria 3, 4
Monitor the albumin-to-creatinine ratio every 6 months to evaluate the response to treatment 3