Relationship Between Cardiac Hypertrophy and Microalbuminuria

  • Luis M. Ruilope
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 432)


The term microalbuminuria was coined in 1982 at Guy’s Hopsital in London (1) to define an abnormally elevated urinary albumin excretion (UAE) in absence of clinical proteinuria as measured by standard laboratory methods. A positive standard test for proteinuria appears when the quantity of proteins in urine exceeds 300 mg/day (2). Table 1 contains the definition of microalbuminuria as excretion rate in 24 hours or overnight urine collection, as albumin/creatinine ratio and as albumin concentration in morning or random urine sample. Determination of UAE in morning urine sample constitutes the ideal test for screening and overnight urine collection might be the best choice for monitoring microalbuminuria.


Diabetic Nephropathy Essential Hypertension Cardiac Hypertrophy Blood Pressure Level Ambulatory Blood Pressure Monitoring 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Viberti GC, Mackintosh D, Bilous RW, Pickup JC, Keen H. Proteinuria in diabetes mellitus: role of spontaneous and experimental variations of glycemia. Kidney Int 1982, 21: 714–720.CrossRefPubMedGoogle Scholar
  2. 2.
    Ruilope LM, Rodicio JL. Clinical relevance of proteinuria and microalbuminuria. Curr Opin Nephrol Hypertens 1993, 2: 962–967.CrossRefPubMedGoogle Scholar
  3. 3.
    Poulsen PE. Microalbuminuria-techniques of measurement. In Microalbuminuria a marker for organ damage. Edited by CE Mogensen. London. Science Press Ltd. 1993: 10–19.Google Scholar
  4. 4.
    Mogensen CE. Microalbuminuria as a predictor of clinical diabetic nephropathy. Kidney Int 1987, 31: 673–689.CrossRefPubMedGoogle Scholar
  5. 5.
    Pedersen EB, Mogensen CE, Larsen JS. Effects of exercise on urinary excretion of albumin and beta2-microglobulin in young patients with mild essential hypertension without treatment and during long-term propranolol treatment. Scand J Clin Lab Invest 1981, 41: 493–498.CrossRefPubMedGoogle Scholar
  6. 6.
    Yudkin JS. Microalbuminuria in vascular disease. In Microalbuminuria a marker for organ damage. Edited by CE Mogensen. London. Science Press Ltd. 1993: 69–80.Google Scholar
  7. 7.
    Yudkin JS, Forrest RD, Jackson CA. Microalbuminuria as predictor of vascular disease in non-diabetic subjects. Islington Diabetes Survey. Lancet 1988, ii: 530–533.CrossRefGoogle Scholar
  8. 8.
    Damsgaard EM, Froland A, Jorgensen OD, Mogensen CE. Microalbuminuria as predictor of increased mortality in elderly people. Br Med J 1990, 300: 297–300.CrossRefGoogle Scholar
  9. 9.
    Hahhner SM, Stern MP, Gruber MKK. Microalbuminuria-potential marker for increased cardiovascular risk factors in nondiabetic subjects?. Arteriosclerosis 1990, 10: 727–731.CrossRefGoogle Scholar
  10. 10.
    Winocour PH et al. Microalbuminuria and associated cardiovascular risk factors in the community. Atherosclerosis 1992, 93: 71–81.CrossRefPubMedGoogle Scholar
  11. 11.
    Ferrannini E. The Metabolic Syndrome. In Target Organ Damage in the Mature Hypertensive. Part 2. Edited by Mogensen CE. London. Science Press Ltd. 1993: 31–49.Google Scholar
  12. 12.
    Metcalf P, Baker J, Scott A, Wild C, Scragg R, Dryson E. Albuminuria in people at least 40 years old: effect of obesity, hypertension and hyperlipidemia. Clin Che 1992, 38: 1802–1808.Google Scholar
  13. 13.
    Vestbo E, Damsgaard EM, Froland A, Mogensen CE. Microalbuminuria in a population based cohort. J Diab Compl 1994, (in press).Google Scholar
  14. 14.
    Ticket J, Vol S, Hallab M, Caces F, Marre M. Epidemiology of microalbuminuria in a french population. J Diab Compl 1994, 8: 294–295.Google Scholar
  15. 15.
    Metcalf PA, Baker JR, Scragg RKR, Dryson E, Scott AJ, Wild CJ. Albuminuria in people at least 40 years old: effect of alcohol consumption, regular exercise and cigarrette smoking. Clin Che 1993, 39: 1793–1797.Google Scholar
  16. 16.
    Mogensen CE. Systemic blood pressure and glomerular leakage with particular reference to diabetes and hypertension. J Int Med 1994, 235: 297–316.CrossRefGoogle Scholar
  17. 17.
    Jiang X, Srinivasan SR, Radhakrishnamurthy B, Dalferes ER, Bao Weihang B, Berenson GS. Microalbuminuria in young adults related to blood pressure in a biracial (black-white) population. Am J Hypertens 1994, 7:794–800.PubMedGoogle Scholar
  18. 18.
    Stehouwer CD, Nauta JJ, Zeldenrust GC, Hackeng WH, Donker AJ, den Ottolander GJ. Urinary albumin excretion, cardiovascular disease, and endothelial dysfunction in non-insulin-dependent diabetes mellitus. Lancet 1992, 340: 319–323.CrossRefPubMedGoogle Scholar
  19. 19.
    Pedrinelli R, Giampietro O, Carmassi F, Melillo E, Dell’Olmo G, Catapano G, Matteucci E, Talarico L, Morale M, De Negri F, Di Bello V. Microalbuminuria and endothelial dysfunction in essential hypertension. Lancet 1994, 344: 14–18.CrossRefPubMedGoogle Scholar
  20. 20.
    Hales CN, Barker DJ, Clark PM, Cox LJ, Fall C, Osmond C, Winter PD. Fetal and infant growth and impaired glucose tolerance at age 64. Br Med J 1991, 303: 1019–1022.CrossRefGoogle Scholar
  21. 21.
    Barker DJP, ed. Fetal and infant origins of adult disease. British Medical Journal Press. London. 1992.Google Scholar
  22. 22.
    Mogensen CE, Hansen KW, Sommer S, Klebe J, Christensen CK, Marshall S, Schmitz A, Pedersen MM, Christiansen JS, Pedersen EB, Jespersen B, Petersen RS, Schmitz O, Damsgaard EM, Froland A. Microalbuminuria: studies in diabetes, essential hypertension and renal diseases as compared with a background population. Adv Nephrol 1991, 20: 191–228.Google Scholar
  23. 23.
    Hostetter TH. Diabetic nephropathy. In The Kidney. Edited by Brenner BM & Rector FC. Philadelphia. WB Saunders Company. 1991: 1695–1727.Google Scholar
  24. 24.
    Jensen T, Borch-Johnsen K, Kofoed-Enevoldeen A, Deckert T. Coronary heart disease in young type 1 (insulin-dependent) diabetic patients with and without diabetic nephropathy: incidence and risk factors. Diabetologia 1987, 30: 144–148.CrossRefPubMedGoogle Scholar
  25. 25.
    Borch-Johnsen K, Kreiner S. Proteinuria: value as predictor of cardiovascular mortality in insulin dependent diabetes mellitus. Br Med J 1987, 294: 1651–1654.CrossRefGoogle Scholar
  26. 26.
    Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldeen A. Albuminuria reflects widespread vascular damage. The Steno hypothesis. Diabetologia 1988, 32: 219–226.CrossRefGoogle Scholar
  27. 27.
    Deckert T. Nephropathy and coronary death-the fatal twins in diabetes mellitus. Nephrol Dial Transplant 1994, 9: 1069–1071.PubMedGoogle Scholar
  28. 28.
    Mangili R, Bending JJ, Scott G, Lil K, Gupta A, Viberti GC. Increased sodium-lithium countertransport activity in red cells of patients with insulin-dependent diabetes and nephropathy. N Eng J Med 1988, 318: 146–150.CrossRefGoogle Scholar
  29. 29.
    Yip J, Mattock M, Morocutti A, Sethi M, Trevisan R, Viberti GC. Insulin resistance in insulin-dependent diabetic patients with microalbuminuria. Lancet 1993, 342: 883–887.CrossRefPubMedGoogle Scholar
  30. 30.
    Marre M, Bernadet P, Gallois Y, Savagner F, Guyenne TT, Hallab M, Cambien F, Passa Ph, Alhenc-Gelas F. Relationships between angiotensin I converting enzyme gene polymorphism, plasma levels, and diabetic retinal and renal complications. Diabetes 1994, 43: 384–388.CrossRefPubMedGoogle Scholar
  31. 31.
    Doria A, Warram JH, Krolewski AS. Genetic predisposition to diabetic nephropathy. Evidence for a role of the angiotensin I-converting enzyme gene. Diabetes 1994, 43: 690–695.CrossRefPubMedGoogle Scholar
  32. 32.
    Cambien F, Poirier O, Lecerf L, Evans A, Cambou JP, Arveiler D, Luc G, Bard JM, Bara L, Ricard S, Tiret L, Amouyel Ph, Alhenc-Gelas F, Soubrier F. Deletion polymorphism in the gene for angiotensin converting enzyme is a potent risk factor for myocardial infarction. Nature 1992, 359: 641–644.CrossRefPubMedGoogle Scholar
  33. 33.
    Microalbuminuria Collaborative Study Group, United Kingdom. Risk factors for development of microalbuminuria in insulin dependent diabetic patients: a cohort study. Br Med J 1993, 306: 1235–1239.CrossRefGoogle Scholar
  34. 34.
    Lurbe A, Redon J, Pascual JM, Tacons J, Alvarez V, Batlle D. Altered blood pressure during sleep in normotensive subjects with type I diabetes. Hypertension 1993, 21: 227–235.CrossRefPubMedGoogle Scholar
  35. 35.
    Hansen KW, Poulsen PL, Mogensen CE. Ambulatory blood pressure and abnormal albuminuria in type I diabetic patients. Kidney Int 45(suppl 45): S-134–S-140.Google Scholar
  36. 36.
    Beirut G, Hallab M, Bouhanick B, Chameau AM, Marre M, Fressinaud Ph. Value of ambulatory blood pressure monitoring in type I (insulin-dependent) diabetic patients with incipient diabetic nephropathy. Am J Hypertens 1994, 7: 222–227.Google Scholar
  37. 37.
    Kimball TR, Daniels SR, Khoury PR, Magnotti RA, Turner AM, Dolan LM. Cardiovascular status in young patients with insulin-dependent diabetes mellitus. Circulation 1994, 90: 357–361.CrossRefPubMedGoogle Scholar
  38. 38.
    Cruickshanks KJ, Ritter LL, Klein R, Moss SE. The association of microalbuminuria with diabetic retinopathy: the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Ophtalmology 1993, 100: 862–867.Google Scholar
  39. 39.
    Bell DSH, Ketchum CH, Robinson CA, Wagenknecht LE, Williams BT. Microalbuminuria associated with diabetib neuropathy. Diab Care 1992, 15: 528–531.CrossRefGoogle Scholar
  40. 40.
    The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment on longterm complications in insulin-dependent diabetes mellitus. N Eng J Med 1993, 329: 977–986.CrossRefGoogle Scholar
  41. 41.
    Viberti GC, Mogensen CE, Groop LC, Pauls JF, for the European Microalbuminuria Study Group. Effect of Captopril on progression to clinical proteinuria in patients with insulin-dependent diabetes mellitus and microalbuminuria. JAMA 1994: 271: 275–279.CrossRefPubMedGoogle Scholar
  42. 42.
    Paulsen EP, Burke BA, Vernier RL, Mallare MJ, Innes Jr DJ, Sturgill BC. Juxtaglomerular body abnormalities in youth-onset diabetic subjects. Kidney Int 1994, 45: 1132–1139.CrossRefPubMedGoogle Scholar
  43. 43.
    Daneman D, Crompton CH, Balfe JW, Sochett EB, Chatzilias A, Cotter BR, Osmond DH. Plasma prorenin as an early marker of nephropathy in diabetic (IDDM) adolescents. Kidney Int 1994, 46: 1154–1159.CrossRefPubMedGoogle Scholar
  44. 44.
    Mogensen CE, Poulsen PL. Epidemiology of microalbuminuria in diabetes and in the background population. Curr Opin Nephrol Hypertens 1994, 3: 248–256.CrossRefPubMedGoogle Scholar
  45. 45.
    Mogensen CE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Eng J Med 1984, 310: 356–360.CrossRefGoogle Scholar
  46. 46.
    Jarrett RJ, Viberti GC, Argyropoulos A, Hill RD, Mahmud U, Murreis TJ. Microalbuminuria predicts mortality in non-insulin-dependent diabetics. Diabet Med 1984, 1: 17–19.CrossRefPubMedGoogle Scholar
  47. 47.
    Mattock MB, Morrish NJ, Viberti GC, Keen H, Fitzgerald AP, Jackson G. Prospective study of microalbuminuria as predictor of mortality in NIDDM. Diabetes 1992, 41: 736–741.CrossRefPubMedGoogle Scholar
  48. 48.
    Klein R, Klein BEK, Moss SE. Prevalence of microalbuminuria in older-onset diabetes. Diab Care 1993, 16: 1325–1329.CrossRefGoogle Scholar
  49. 49.
    Groop L, Ekstrand A, Forsblom C, Widen E, Groop PH, Teppo AM, Briksson J. Insulin resistance, hypertension and microalbuminuria in patients with type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 1993, 36: 642–647.CrossRefPubMedGoogle Scholar
  50. 50.
    Olivarius NF, Andreasen AH, Keiding N, Mogensen CE. Epidemiology of renal involvement in newlydiagnosed middle-aged and elderly diabetic patients. Cross-sectional data from the population-based study “Diabetes Care in General Practice”. Denmark. Diabetologia 1993, 36: 1007–1016.Google Scholar
  51. 51.
    Nelson RG, Pettitt DJ, Baird HR, Charles MA, Liu QZ, Bennett PH, Knowler WC. Pre-diabetic blood pressure predicts urinary albumin excretion after the onset of type (non-insulin-dependent) diabetes mellitus in Pima indians. Diabetologia 1993, 36: 998–1001.CrossRefPubMedGoogle Scholar
  52. 52.
    Nosadini R, Solini A, Velussi M, Muollo B, Frigato F, Sambataro M, Cipollina MR, de Riva F, Brocco E, Crepaldi G. Impaired insulin-induced glucose uptake by extrahepatic tissue is hallmark of NIDDM patients who have or will develop hypertension and microalbuminuria. Diabetes 1994, 43: 491–494.CrossRefPubMedGoogle Scholar
  53. 53.
    Niskanen L, Laakso M. Insulin resistance is related to albuminuria in patients with type II (non-insulin-dependent) diabetes mellitus. Metabolism 1993, 42: 1541–1545.CrossRefPubMedGoogle Scholar
  54. 54.
    Mykkänen L, Haffner SM, Kuusisto J, Pyorälä K, Laakso M. Microalbuminuria precedes the development of NIDDM. Diabetes 1994, 43: 552–557.CrossRefPubMedGoogle Scholar
  55. 55.
    Haffner SM, Gonzales C, Valdez RA, Mykkänen L, Hazuda HP, Mitchell BD, Monterrosa A. Is microalbuminuria part of the prediabetic state?. Diabetologia 1993, 36: 1002–1006.CrossRefPubMedGoogle Scholar
  56. 56.
    Ravid M, Savin H, Jutrin I, Bental T, Katz B, Lishner M. Long-term stabilizing effect of angiotensin-con-verting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med 1993, 118: 577–581.PubMedGoogle Scholar
  57. 57.
    Parving HH, Jensen HAE, Mogensen CE, Evrin PE. Increased urinary albumin excretion rate in benign essential hypertension. Lancet 1974, i: 1190–1192.CrossRefGoogle Scholar
  58. 58.
    Ljungman S. Microalbuminuria in essential hypertension. Am J Hypertens 1990, 3: 956–960.PubMedGoogle Scholar
  59. 59.
    Gerber LM, Shmukler C, Alderman MH. Differences in urinary albumin excretion rate between normotensive and hypertensive, white and nonwhite subjects. Arch Intern Med 1992, 152: 373–377.CrossRefPubMedGoogle Scholar
  60. 60.
    Bigazzi R, Bianchi S, Campese V, Baldari G. Prevalence of microalbuminuria in a large population of patients with mild to moderate essential hypertension. Nephron 1992, 61: 94–97.CrossRefPubMedGoogle Scholar
  61. 61.
    Agewall S, Persson B, Samuelsson O, Ljungman S, Herlitz H, Fagerberg B, on behalf of The Risk Factor Intervention Study Group. Microalbuminuria in treated hypertensive men at high risk of coronary disease. J Hypertens 1993, 11: 461–459.CrossRefPubMedGoogle Scholar
  62. 62.
    Ruilope LM, Alcazar JM, Rodicio JL. Renal consequences of arterial hypertension. J Hypertens 1992, 10(suppl 7): S85–S90.Google Scholar
  63. 63.
    Cottone S, Cerasola G. Microalbuminuria fractional clearance and early renal permselectivity changes in essential hypertension. Am J Nephrol 1992, 12: 326–329.CrossRefPubMedGoogle Scholar
  64. 64.
    Redon J, Pascual JM, Miralles A, Sanz C, Gutierrez M, Ros MJ, Baldo E, Michavila J, Sanchez C, Alegre B. Microalbuminuria in essential hypertension (in Spanish). Med Clin (Barc) 1991, 96: 525–529.Google Scholar
  65. 65.
    Hoegholm A, Bang LE, Kristensen KS, Nielsen JW, Holm J. Microalbuminuria in 411 untreated individuals with established hypertension, white coat hypertension and normotension. Hypertension 1994, 24: 101–105.CrossRefPubMedGoogle Scholar
  66. 66.
    Bianchi S, Bigazzi R, Baldari G, Sgherri G, Campese VM. Diurnal variations of blood pressure and microalbuminuria in essential hypertension. Am J Hypertens 1994, 7: 23–29.PubMedGoogle Scholar
  67. 67.
    Redon J, Liao Y, Lozano JV, Miralles A, Pascual JM, Cooper RS. Ambulatory blood pressure and microalbuminuria in essential hypertension: role of circadian variability. J Hypertens 1994, 12: 947–953.CrossRefPubMedGoogle Scholar
  68. 68.
    Cerasola G, Cottone S, D’Ignoto G, Grasso L, Mangano MT, Carapelle E, Nardi E, Andronico G, Fulantelli MA, Marcellino T, Seddio G. Microalbuminuria as a predictor of cardiovascular damage in essential hypertension. J Hypertens 1989, 7(suppl 6): S332–S333.Google Scholar
  69. 69.
    Redon J, Gomez-Sanchez MA, Baldo E, Casal MC, Fernandez ML, Miralles MA, Gomez-Pajuelo C, Rodicio JL, Ruilope LM. Microalbuminuria is correlated with left ventricular hypertrophy in male hypertensive patients. J Hypertens 1994, 9(suppl 6): S148–S149.Google Scholar
  70. 70.
    Agrawal B, Berger A, Wolf K, Luft FC. Microalbuminuria screening by reagent strip predicts cardiovascular risk in hypertension. J Hypertens 1996, 14:223–228CrossRefPubMedGoogle Scholar
  71. 71.
    Biesenbach G, Zazgornik J. High prevalence of hypertensive retinopathy and coronary heart disease in hypertensive patients with persistent microalbuminuria under short intensive antihypertensive therapy. Clin Nephrol 1994, 41: 211–218.PubMedGoogle Scholar
  72. 72.
    Palatini P, Graniero GR, Mormino P, Mattarei M, Sanzuol F, Cignacco GB, Gregori S, Garavelli G, Pegoraro F, Maraglino G, Bortolazzi A, Accurso V, Dorigatti F, Graniero F, Gelisio R, Businaro R, Vriz O, Dal-Follo M, Camarotto A, Pessina AC. Prevalence and clinical correlates of microalbuminuria in stage I hypertension. Results from the Hypertension and Ambulatory Recording Venetia Study (HARVEST Study). Am J Hypertens 1996, 9:334–341CrossRefPubMedGoogle Scholar
  73. 73.
    Losito A, Fortunati F, Zampi I, del Favero A. Impaired renal functional reserve and albuminuria in essential hypertension. Br Med J 1988, 296: 1562–1564.CrossRefGoogle Scholar
  74. 74.
    Minram A, Ribstein J, DuCalair G. Is microalbuminuria a marker of early intrarenal vascular dysfunction in essential hypertension? Hypertension 1994, 23 (part 2): 1018–1021.CrossRefGoogle Scholar
  75. 75.
    Ruilope LM, Lahera V, Rodicio JL, Romero JC. Are renal hemodynamics a key factor in the development and maintenance of arterial hypertension in humans. Hypertension 1994, 23: 3–9.CrossRefPubMedGoogle Scholar
  76. 76.
    Cerasola G, Cottone S, Mule G, Nardi E, Mangano MT, Andronico G, Contorno A, Galione P, LaMilia D, Renda F, Piazza G, Volpe V, Lisi A, Ferrara L, Panepinto N. Relationship between microalbuminuria, blood pressure and cardiovascular changes in essential hypertension. Contrib-Nephrol 1996, 119: 130–134.PubMedGoogle Scholar
  77. 77.
    Bianchi S, Bigazzi R, Valtriani C, Chiapponi I, Sgherri G, Baldari G, Natali A, Ferrannini E, Campese VM. Elevated serum insulin levels in patients with essential hypertension and microalbuminuria. Hypertension 1994, 23 (part 1): 681–687.CrossRefPubMedGoogle Scholar
  78. 78.
    Redon J, Liao Y, Lozano JV, Miralles A, Baldo E, Cooper RS. Factors related to the presence of microalbuminuria in essential hypertension. Am J Hypertens 1994, 7: 801–807.PubMedGoogle Scholar
  79. 79.
    Bigazzi R, Bianchi S, Baldari D, Sgherri G, Baldari G, Campese VM. Microalbuminuria in salt-sensitive patients: marker for renal and cardiovascular disease. Hypertension 1994, 23: 195–199.CrossRefPubMedGoogle Scholar
  80. 80.
    Ruilope LM, Alcazar JM, Hernandez E, Praga M, Lahera V, Rodicio JL. Long-term influences of antihypertensive therapy on microalbuminuria in essential hypertension. Kidney Int 1994, 45(suppl 45): S–171–S–173.Google Scholar
  81. 81.
    Fauvel JP, Hadj-Aissa A, Laville M, Fadat G, Labeeuw M, Zech P, Pozet N. Microalbuminuria in normotensives with genetic risk of hypertension. Nephron 1991, 57: 375–376.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Luis M. Ruilope
    • 1
  1. 1.Insalud, Unidad de HipertensiónHospital “12 de Octubre”MadridSpain

Personalised recommendations