Subklinische Albuminurie, Mikroalbuminurie und Proteinurie - akzeptierte kardiovaskuläre Risikomarker?

Zusammenfassung

Die Mikroalbuminurie kommt in der Allgemeinbevölkerung häufig vor, insbesondere bei Patienten mit Diabetes mellitus oder arteriellem Bluthochdruck. Sie gilt als Indikator für eine endotheliale Dysfunktion. Bei Vorliegen einer Mikroalbuminurie ist nicht nur das Risiko für die Progression von Nierenerkrankungen erhöht, sondern auch das für kardiovaskuläre Ereignisse und Todesfälle. Aktuelle Studienergebnisse belegen, dass letztere schon bei einer Albuminausscheidung, die deutlich unterhalb der Grenze zur Mikroalbuminurie liegt, gehäuft auftreten. Man findet also eine kontinuierliche Risikoerhöhung bei ansteigenden Albuminwerten. Somit bietet die Bestimmung der Albuminausscheidung im Urin eine einfache, schnelle, und kostengünstige Methode zur Identifizierung von Personen mit einem erhöhten kardiovaskulären Risiko. Aus therapeutischer Sicht geht eine Reduktion der Mikroalbuminurie durch die Hemmung des Renin-Angiotensin-Systems (RAS) durch ACE-Hemmer oder AT1-Blocker mit einer Abnahme des Risikos für kardiovaskuläre Ereignisse einher.

Summary

Microalbuminuria is regarded as a marker of endothelial dysfunction. It is common in the general population, particularly in patients with diabetes mellitus or arterial hypertension. Microalbuminuria not only increases the risk for the progression of chronic nephropathy, but also for cardiovascular complications and death. According to recent study results, a slightly elevated urinary albumin excretion within the normal range is already associated with an increased risk for cardiovascular events. Thus there is a continous rise in risk with rising albumin excretion determination of urinary albumin excretion offers an easy, rapid, and cheap approach to identify subjects with elevated cardiovascular risk. From a therapeutic perspective, reduction of microalbuminuria by inhibition of the renin-angiotensin system (RAS) with ACE inhibitors or AT₁ blockers is accompanied by a lower incidence of cardiovascular events.

Schlüsselwörter

Mikroalbuminurie - Albuminurie - Proteinurie - endotheliale Dysfunktion - kardiovaskuläres Risiko - Renin-Angiotensin-System - Albumin-Kreatinin-Quotient - Screening - Prävention

Key words

microalbuminuria - albuminuria - proteinuria - endothelial dysfunction - cardiovascular risk - renin angiotensin system - urinary albumin creatinine ratio - screening - prevention

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