Blog | Friday, April 20, 2012

The microimportance of microalbuminuria


During a lecture on risk factors for diabetic nephropathy, nephrologist George Bakris, MD, FACP, slapped his Internal Medicine 2012 audience in the face. No, not literally. It's just how he described the news that microalbuminuria is NOT a predictor of renal disease in diabetics.

The idea that is was, and therefore necessitated treatment with an ACE inhibitors or an ARB, got started in the 80s, but has since been rescinded by even the group that initially proposed it. “There is no evidence that ACEs or ARBs protect you from developing diabetic nephropathy,” he said. “Only our friends at the ADA who think Moses wrote the guideline are sticking to this.” That doesn't mean you shouldn't ever measure albuminuria. Dramatic changes (with the caveat that even a healthy person can have day-to-day variations as high as 20%) are predictive. “What you should be looking for is the delta change over time, not yes or no,” Dr. Bakris said.

Oh, you know what you can really do to help your patients avoid kidney disease? Get them to drink more water and eat less salt. Aiming for 2 to 2.5 grams of sodium a day is fine, Dr. Bakris said. Which might be a challenge in New Orleans restaurants, he conceded.