Microalbuminuria and prevention of renal insufficiency and cardiovascular diseases.

Microalbuminuria, a slightly elevated urinary albumin excretion, predicts renal failure in insulin-dependent diabetic patients and premature cardiovascular mortality in non-insulin-dependent diabetic patients and in the general population. It can be related to all currently established cardiovascular risk factors. Regarding the relationship between urinary albumin and blood pressure, microalbuminuria seems to be an early indicator of renal disease, causing high blood pressure in some instances, whereas it looks like the consequences of renal damage produced by severe hypertension in other instances. To establish whether microalbuminuria is an integrated risk marker for renal and cardiovascular events, or truly a risk factor, and to validate the usefulness of some peculiar treatment strategies, clinical trials are required, taking microalbuminuria as a selection criteria, and renal and cardiovascular events as endpoints.