Microalbuminuria: control diabetes and BP and use care with NSAIDs

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Microalbuminuria: control the diabetes and BP and use care with NSAIDs

It is cost-effective to screen for microalbuminuria (the new term is moderately increased albuminuria) in patients with diabetes and hypertension.1

The presence of microalbuminuria was associated with 17.5 times the risk of developing proteinuria in the 4.5-year follow-up of 7,674 persons in the HOPE trial.2  Microalbuminuria is when there is albumin in the urine between 30 to 300 mg/l. Above that is macroalbuminuria.

Controlling blood pressure and blood sugars and avoiding non-steroidal anti-inflammatory drugs (NSAIDs) is needed to improve CVD outcomes.  

In the recent SPRINT trial there was a benefit in lowering blood pressure below 130 mm Hg in any of the following: those who were ≥75 years, those with a previous positive history for CVD and those with microalbuminuria.3

NSAIDs should be avoided in older patients, patients with type 2 diabetes and/or CVD and patients with chronic kidney disease as they are at increased risk of NSAID-related complications.4

References:

  1. A health policy model of CKD: 2. The cost-effectiveness of microalbuminuria screening Am J Kidney Dis. 2010 Click here 
  2. Development of renal disease in people at high cardiovascular risk: results of the HOPE randomized study. J Am Soc Nephrol. 2003 Click here
  3. Usefulness of a Simple Algorithm to Identify Hypertensive Patients Who Benefit from Intensive Blood Pressure Lowering. Am J Cardiol. 2018 Click here
  4. Non-steroidal anti-inflammatory drugs (NSAIDs): Making safer treatment choices BPAC 2013. Click here

Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.

 
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As published in NZ Doctor 24/04/2019