Should Cardiologists Be Interested in Albuminuria?
Should Cardiologists Be Interested in Albuminuria?
Excretion of excess urinary albumin is a marker of generalised endothelial dysfunction and both progressive renal disease and cardiovascular events in those with and without diabetes; its detection provides a simple way of identifying patients at particularly high risk. Effective management of cardiovascular risk factors and the use of angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors have been shown to retard or prevent progression of microalbuminuria to more profound albuminuria. Microalbuminuria can be reversed by such therapy and recently an ACE inhibitor has been shown to prevent the development of microalbuminuria in hypertensive patients with type 2 diabetes. Given the increasing prevalence of type 2 diabetes and the corresponding ascendancy of ensuing cardiovascular disease and renal failure, strict control of multiple risk factors, including microalbuminuria, is to be encouraged.
Cardiologists have an ambivalent view of renal impairment. They recognise the association between chronic kidney disease and cardiovascular events, and are aware that risk factors (e.g. diabetes and hypertension) are shared. They appreciate that renal impairment is a marker of adverse outcomes in both acute cor-onary syndrome and following coronary surgery, and that some cardiological interventions can be nephrotoxic (e.g. radio-contrast induced nephropathy). A more detailed knowledge of the natural history of renal diseases is unusual and as the practice of cardiology moves increasingly towards interventional approaches, it's possible that an understanding of the importance of kidney disorders, their presentation and management, will be designated the responsibility of other specialists.
Furthermore, while most cardiologists are well aware of the details of the National Service Framework (NSF) for Coronary Heart Disease (CHD), their knowledge of the content (or even the existence) of the NSF for Diabetes and the NSF for Renal Services is lacking. This is important because the former recommends regular surveillance for diabetic complications (including renal dysfunction) and the latter advises routine screening, using existing diabetes and CHD networks of 'at-risk' patients with single (early morning) urine protein detection and formula-based estimation of glomerular filtration rate (GFR) (see table 1 ). This might seem removed from cardiological practice until the 'at-risk' group are defined those treated for hypertension, diabetes, heart failure or vascular disease, and those taking diuretics, angiotensin-converting enzyme (ACE) inhibitors and/or angiotensin II receptor blockers (ARBs); i.e. the bulk of a general cardiology out-patient clinic. So cardiologists are ideally placed to identify those at risk of developing chronic kidney disease and to play an important role in the prevention or palliation of renal impairment; hoping that by so doing they can intervene to reduce associated cardiovascular morbidity.
Abstract and Introduction
Abstract
Excretion of excess urinary albumin is a marker of generalised endothelial dysfunction and both progressive renal disease and cardiovascular events in those with and without diabetes; its detection provides a simple way of identifying patients at particularly high risk. Effective management of cardiovascular risk factors and the use of angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors have been shown to retard or prevent progression of microalbuminuria to more profound albuminuria. Microalbuminuria can be reversed by such therapy and recently an ACE inhibitor has been shown to prevent the development of microalbuminuria in hypertensive patients with type 2 diabetes. Given the increasing prevalence of type 2 diabetes and the corresponding ascendancy of ensuing cardiovascular disease and renal failure, strict control of multiple risk factors, including microalbuminuria, is to be encouraged.
Introduction
Cardiologists have an ambivalent view of renal impairment. They recognise the association between chronic kidney disease and cardiovascular events, and are aware that risk factors (e.g. diabetes and hypertension) are shared. They appreciate that renal impairment is a marker of adverse outcomes in both acute cor-onary syndrome and following coronary surgery, and that some cardiological interventions can be nephrotoxic (e.g. radio-contrast induced nephropathy). A more detailed knowledge of the natural history of renal diseases is unusual and as the practice of cardiology moves increasingly towards interventional approaches, it's possible that an understanding of the importance of kidney disorders, their presentation and management, will be designated the responsibility of other specialists.
Furthermore, while most cardiologists are well aware of the details of the National Service Framework (NSF) for Coronary Heart Disease (CHD), their knowledge of the content (or even the existence) of the NSF for Diabetes and the NSF for Renal Services is lacking. This is important because the former recommends regular surveillance for diabetic complications (including renal dysfunction) and the latter advises routine screening, using existing diabetes and CHD networks of 'at-risk' patients with single (early morning) urine protein detection and formula-based estimation of glomerular filtration rate (GFR) (see table 1 ). This might seem removed from cardiological practice until the 'at-risk' group are defined those treated for hypertension, diabetes, heart failure or vascular disease, and those taking diuretics, angiotensin-converting enzyme (ACE) inhibitors and/or angiotensin II receptor blockers (ARBs); i.e. the bulk of a general cardiology out-patient clinic. So cardiologists are ideally placed to identify those at risk of developing chronic kidney disease and to play an important role in the prevention or palliation of renal impairment; hoping that by so doing they can intervene to reduce associated cardiovascular morbidity.
