МНОГОГРАННАЯ АЛЬБУМИНУРИЯ: АСПЕКТЫ КЛИНИЧЕСКОГО ЗНАЧЕНИЯ
https://doi.org/10.24884/1561-6274-2009-13-3-33-38
Аннотация
Диагностика хронической болезни почек (ХБП) может базироваться на выявлении любых морфологических и клинических маркёров почечного повреждения в зависимости от клинической ситуации. К рутинным лабораторным маркёрам почечного повреждения можно отнести протеинурию, изменения в осадке мочи, данные анализов крови и мочи, изменения при функциональных и визуализирующих методах исследования. В клинической практике при отсутствии любых других признаков хронического повреждения почек уровень альбуминурии является единственным и относительно ранним показателем, позволяющим исключить или подтвердить наличие субклинического течения ХБП, особенно в условиях сохранной скорости клубочковой фильтрации. Повышение отдаленных почечных и кардиоваскулярных рисков также ассоциируется с наличием микроальбуминурии (30–299 мг/сут). Тем не менее, имеющиеся данные позволяют признать целесообразным снижение верхнего порога нормальных значений мочевого альбумина до 15 мг/сут, а не до 30 мг/сут, как это сейчас общепринято в обычной клинической практике. Обсуждается необходимость использования в клинической практике индексации стадий ХБП в зависимости от уровня альбуминурии/протеинурии, которая в компактной форме позволяет иметь важную информацию для оценки прогноза течения дисфункции почек и планирования соответствующих профилактических мероприятий.
Об авторах
В. А. Добронравов
Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова
Россия
Россия
Научно-исследовательский институт нефрологии,
кафедра пропедевтики внутренних болезней
А. В. Смирнов
Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова
Россия
Россия
Научно-исследовательский институт нефрологии,
кафедра пропедевтики внутренних болезней
И. Г. Каюков
Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова
Россия
Россия
Научно-исследовательский институт нефрологии,
кафедра нефрологии и диализа
197022, Санкт-Петербург, ул. Л. Толстого, 17, СПбГМУ им. акад. И.П. Павлова, Нефрокорпус; тел.: (812)-346-39-26; факс: (812)-234-91-91.
Список литературы
1. Winocour P, Marshall S. Microalbuminuria. Cambridge University Press, Cambridge (UK), 1998, 1–10
2. Russo L, Bakris G, Comper W. Renal handling of albumin: A critical review of basic concepts and perspective. Am J Kidney Dis 2002 39: 899–919
3. National Kidney Foundation: K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Am J Kidney Dis 2002: S1–S266
4. Shlipak MG, Katz R, Sarnak MJ et al. Cystatin C and prognosis for cardiovascular and kidney outcomes in elderly persons without chronic kidney disease. Ann Intern Med 2006; 145: 237–246
5. Jaar BC, Khatib R, Plantinga L, Boulware LE, Powe N: Principles of screening of chronic kidney disease. Clin J Am Soc Nephrol 2008; 3:601–609
6. Stuveling EM, Bakker SJ, Hilige HX et al. Biochemical risk markers: a novel area for better prediction of renal risk? Nephrol Dial Transplant 2005; 20: 497–508
7. Смирнов АВ, Добронравов ВА, Бодур-Ооржак АШ и др. Эпидемиология и факторы риска хронических болезней почек: региональный уровень общей проблемы. Тер арх 2005; 77(6): 20–27
8. Halimi JM, Forhan A, Balkan B et al. Ig microalbuminuria an integrated risk marker for cardiovascular disease and insulin resistance in both men and women? J Cardiovasc Risk 2001; 8: 139–146
9. Orth SR. Smoking and the kidney. J Am Soc Nephrol 2002; 13: 1663–1672
10. Saweirs WWM, Goddard J. What are the best treatment for early chronic disease. Nephrol Dial Transplant 2007; 22 [suppl 9]: ix31–ix39
11. Williams PS, Fass G, Bone JM. Renal pathology and proteinuria determine progression in untreated mild/moderate chronic renal failure. Q J Med 1988 67: 343–354
12. Remuzzi G, Bertani T. Is glomerulosclerosis a consequence of altered glomerular permeability to macromolecules? Kidney Int 1990 38: 384–394
13. Iseki K, Ikemiya Y, Iseki C, Takishita S. Proteinuria and the risk of developing end-stage renal disease. Kidney Int 2003 63: 1468–1474
14. Jafar TH, Stark PC, Schmid CH et al. Proteinuria as a modifiable risk factor for the progression of non-diabetic renal disease. Kidney Int 2001 60: 1131–1140
15. Jafar TH, Stark PC, Schmid CH et al. Progression of chronic kidney disease: The role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition. Ann Int Med 2003 139: 244–252
16. Campese VM, Bianchi S, Bigazzi R. Is microalbuminuria a predictor of cardiovascular and renal disease in patients with essential hypertension? Curr Opin Nephrol Hypertens 2000 9: 143–147
17. Keane WF, Brenner BM, De Zeeuw D et al. The risk of developing end-stage renal disease in patients with type 2 diabetes and nephropathy: The RENAAL Study. Kidney Int 2003 63: 1499–1507
18. de Zeeuw D, Remuzzi G, Parving HH et al. Proteinuria, a target for renoprotection in patients with type 2 diabetic nephropathy: Lessons from RENAAL. Kidney Int 2004; 65: 2309–2320
19. Hunsicker LG, Atkins RC. Impact of irbesartan, blood pressure control, and proteinuria on renal outcomes in the Irbesartan Diabetic Nephropathy Trial. Kidney Int 2004; 66 [suppl 92]: 99–101
20. Mogensen CE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med 1984 310: 356–360
21. Mogensen CE. Microalbuminuria as a predictor of clinical diabetic nephropathy. Kidney Int 1987 31: 673–689
22. Verhave JC, Ganesvoort RT, Hillege HL et al. An elevated urinary albumin excretion predicts de novo development of renal function impairment in the general population. Kidney Int 2004; 66 [suppl 92]:18–21
23. Kannel WB, Stampfer MJ, Castelli WP, Verter J. The prognostic significance of proteinuria: The Framingham study. Am Heart J 1984 108: 1347–1352
24. Samuelsson O, Wilhelmsen L, Elmfeldt D et al. Predictors of cardiovascular morbidity in treated hypertension: Results from the primary preventive trial in Goteborg, Sweden. J Hypertens 1985 3: 167–176
25. de Zeeuw D, Remuzzi G, Parving HH et al. Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation 2004 110: 921–927
26. Anavekar NS, Gans DJ, Berl T et al. Predictors of cardiovascular events in patients with type 2 diabetic nephropathy and hypertension: A case for albuminuria. Kidney Int 2004 66 [suppl 92]: 50–55
27. Hillege HL, Janssen WM, Bak AA et al. Microalbuminuria is common, also in a nondiabetic, nonhypertensive population, and an independent indicator of cardiovascular risk factors and cardiovascular morbidity. J Intern Med 2001 249: 519–526
28. Hillege HL, Fidler V, Diercks GF et al. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in the general population. Circulation 2002 106: 1777–1782
29. Romundstad S, Holmen J, Kvenild K et al. Microalbuminuria and all-cause mortality in 2,089 apparently healthy individuals: A 4.4-year follow-up study. The Nord-Trшndelag Health Study (HUNT), Norway. Am J Kidney Dis 2003 42: 466–473
30. Yuyun MF, Khaw KT, Luben R et al. Microalbuminuria independently predicts all-cause and cardiovascular mortality in a British population: The European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) population study. Int J Epidemiol 2004 33: 189–198
31. Mann JF, Yi QL, Gerstein HC. Albuminuria as a predictor of cardiovascular and renal outcomes in people with known atherosclerotic cardiovascular disease. Kidney Int 2004; 66 [suppl 92]:59–62
32. Wachtell K, IbseN H, Olsen MH et al. Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: The LIFE study. Ann Intern Med 2003 139: 901–906
33. Toto RD. Proteinuria and hypertensive nephrosclerosis in African-Americans. Kidney Int 66 [suppl 92]:102–104
34. Weir MR. Microalbuminuria in type 2 diabetes: An important, overlooked cardiovascular risk factor. J Clin Hypertens 2004 6: 134–143
35. Dinneen, SF, Gerstein, HC. The association of microalbuminuria and mortality in non–insulin-dependent diabetes mellitus. A systematic overview of the literature. Arch Med Intern 1997 157: 1413–1418
36. Asselbergs FW, Hillege HL, van Gilst WH. Framingham score and microalbuminuria: Combined future targets for primary prevention? Kidney Int 66 [suppl 92]: 111–114
37. Смирнов АВ, Добронравов ВА, Каюков ИГ. Кардиоренальный континуум: патогенетические основы превентивной нефрологии. Нефрология 2005; 9(3): 7–15
38. Pedrinelli R, Dell’omo G, Penno G, Mariani M et al. Non-diabetic microalbuminuria, endothelial dysfunction and cardiovascular disease. Vasc Med 2001 6: 257–264
39. Russo LM, Osicka TM, Brammar GC et al. Renal processing of albumin in diabetes and hypertension in rats. Possible role of TGF-1. Am J Nephrol 2003 23: 61–70
40. Russo LM, Osicka TM, Bonnet F et al. Albuminuria in hypertension is linked to altered lysosomal activity and TGF-beta1 expression. Hypertension 2002 39: 281–286
41. Смирнов АВ, Добронравов ВА, Бодур-Ооржак АШ и др. Эпидемиология и факторы риска хронических болезней почек: региональный уровень общей проблемы. Тер арх 2005; 77(6): 20–27
42. Schmieder RE Schrader J, Zidek W et al. Low-grade albuminuria and cardiovascular risk: what is the evidence? Clin Res Cardiol 2007; 96(5):247–257
43. Klausen KP Scharling H, Jensen G, Jensen JS. New definition of microalbuminuria in hypertensive subjects: association with incident coronary heart disease and death. Hypertension 2005; 46(1): 33–37
44. Borch-Johnsen K, Feldt-Rasmussen B, Strandgaard S, Schroll M, Jensen JS. Urinary albumin excretion: an independent predictor of ischemic heart disease. Arterioscler Thromb Vasc Biol 1999; 19: 1992–1997
45. Klausen K, Borch-Johnsen K, Feldt-Rasmussen B et al. Very low levels of microalbuminuria are associated with increased risk of coronary heart disease and death independently of renal function, hypertension, and diabetes. Circulation 2004; 110:32–35
46. Romundstad S, Holmen J, Kvenild K, Hallan H, Ellekjaer H. Microalbuminuria and all-cause mortality in 2,089 apparently healthy individuals: a 4.4-year follow-up study: The Nord-Trondelag Health Study (HUNT), Norway. Am J Kidney Dis 2003; 42:466–473
47. Ruggenenti P, Perna A, Gherardi G, Gaspari F, Benini R, Remuzzi G: Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). Ramipril Efficacy in Nephropathy. Lancet 1998; 352: 1252 –1256
48. Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia). Lancet 1997; 349: 1857 –1863
49. Atkins RC, Briganti EM, Lewis JB et al. Proteinuria reduction and progression to renal failure in patients with type 2 diabetes mellitus and overt nephropathy. Am J Kidney Dis 2005; 45: 281–287
50. Romundstad S, Holmen J, Hallan H, Kvenild K, Ellekjaer H. Microalbuminuria and all-cause mortality in treated hypertensive individuals: does sex matter? The Nord-Trondelag Health Study (HUNT), Norway. Circulation 2003; 108: 2783–2789
51. Jager A, Kostense PJ, Ruhe HG et. al. Microalbuminuria and peripheral arterial disease are independent predictors of cardiovascular and all-cause mortality, especially among hypertensive subjects: five-year follow-up of the Hoorn Study. Arterioscler Thromb Vasc Biol 1999; 19:617–624
52. Viberti G, Wheeldon NM. Microalbuminuria reduction with valsartan in patients with type 2 diabetes mellitus: a blood pressure-independent effect. Circulation 2002; 106: 672–678
53. Parving HH, Lehnert H, Brochner-Mortensen J, Gomis R, Andersen S, Arner P. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001; 345: 870–878
54. Rossing K, Schjoedt KJ, Jensen BR, Boomsma F, Parving HH. Enhanced renoprotective effects of ultrahigh doses of irbesartan in patients with type 2 diabetes and microalbuminuria. Kidney Int 2005; 68:1190–1198
55. Ruggenenti P, Perna A, Loriga G et al. Blood-pressure control for renoprotection in patients with non-diabetic chronic renal disease (REIN-2): Multicentre, randomised controlled trial. Lancet 2005; 365: 939–946
56. Wright JT Jr, Bakris G, Greene T et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: Results from the AASK trial. JAMA 2002; 288: 2421–2431
57. Peterson JC, Adler S, Burkart JM et al. Blood pressure control, proteinuria, and the progression of renal disease. The Modification of Diet in Renal Disease Study. Ann Intern Med 1995; 123: 754–762
58. Lewis JB, Berl T, Bain RP, Rohde RD, Lewis EJ. Effect of intensive blood pressure control on the course of type 1 diabetic nephropathy. Collaborative Study Group. Am J Kidney Dis 1999; 34: 809–817
59. Eijkelkamp WB, Zhang Z, Remuzzi G et al. Albuminuria is a target for renoprotective therapy independent from blood pressure in patients with type 2 diabetic nephropathy: post hoc analysis from the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial. J Am Soc Nephrol 2007 18(5): 1540–1546
60. Redon J, Rovira E, Miralles A, Julve R, Pascual JM. Factors related to the occurrence of microalbuminuria during antihypertensive treatment in essential hypertension. Hypertension 2002; 39:794–798
61. Estacio RO, Jeffers BW, Gifford N, Schrier RW. Effect of blood pressure control on diabetic microvascular complications in patients with hypertension and type 2 diabetes. Diabetes Care 2000; 23 [suppl 2]: B54–B64
62. Ruggenenti P, Fassi A, Ilieva AP et al. for the Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) Investigators: Preventing microalbuminuria in type 2 diabetes. N Engl J Med2004; 351: 1941–1951
63. Ruggenenti P, Perna A, Ganeva M, Ene-Iordache B, Remuzzi G. BENEDICT Study Group. Impact of blood pressure control and angiotensin-converting enzyme inhibitor therapy on new-onset microalbuminuria in type 2 diabetes: a post hoc analysis of the BENEDICT trial. J Am Soc Nephrol 2006; 17(12): 3472–3481
64. Rossing K, Schjoedt KJ, Jensen BR, Boomsma F, Parving HH. Enhanced renoprotective effects of ultrahigh doses of irbesartan in patients with type 2 diabetes and microalbuminuria. Kidney Int 2005; 68: 1190–119
65. Ibsen H, Olsen MH, Wachtell K et al. Reduction in albuminuria translates to reduction in cardiovascular events in hypertensive patients: losartan intervention for endpoint reduction in hypertension study. Hypertension 2005; 45:198–202
66. Asselbergs FW, Diercks GF, Hillege HL et al. Prevention of Renal and Vascular Endstage Disease Intervention Trial (PREVEND IT) Investigators. Effects of fosinopril and pravastatin on cardiovascular events in subjects with microalbuminuria. Circulation 2004; 110: 2809–2816
67. Atthobari J, Asselbergs FW, Boersma C et al. PREVEND IT Study Group. Cost-effectiveness of screening for albuminuria with subsequent fosinopril treatment to prevent cardiovascular events: a pharmaco-economic analysis linked to the PREVEND study and the PREVEND Intervention Trial. Clin Ther 2006; 28: 432–444
68. Postma MJ, Boersma C, Gansevoort RT. Pharmacoeconomics in nephrology: considerations on cost-effectiveness of screening for albuminuria. Nephrol Dial Transplant 2008; 23(4): 1103–1106
69. Bauer C, Melamed ML, Hostetter TH. Staging of chronic kidney disease: Time for a course correction. J Am Soc Nephrol 2008; 19: 844–846
70. Hallan SI, Ritz E, Lydersen S. et al. Combining GFR and albuminuria to classify CKD improves prediction of ESRD. J Am Soc Nephrol 2009; 20(5): 1069–1077
71. Трофименко ИИ, Добронравов ВА, Быстрова НН и др. Распространенности снижения скорости клубочковой фильтрации у больных сахарным диабетом. Тер арх 2008; (6): 48–52
72. Смирнов АВ, Добронравов ВА, Каюков ИГ и др. Рекомендации научно-исследовательского института нефрологии Санкт-Петербургского государственного медицинского университета им. акад. И.П. Павлова: определение, классификация, диагностика и основные направления профилактики хронической болезни почек у взрослых. «Левша», СПб., 2008; 3–51
73. Gansevoort RT, de Jong PE. The case for using albuminuria in staging chronic kidney disease. J Am Soc Nephrol 2009; 20: 465–468
74. Ikizler TA. CKD classification: Time to move beyond KDOQI. J Am Soc Nephrol 2009; 20(5): 929–930
Рецензия
Для цитирования:
Добронравов В.А., Смирнов А.В., Каюков И.Г. МНОГОГРАННАЯ АЛЬБУМИНУРИЯ: АСПЕКТЫ КЛИНИЧЕСКОГО ЗНАЧЕНИЯ. Нефрология. 2009;13(3):33-38. https://doi.org/10.24884/1561-6274-2009-13-3-33-38
For citation:
Dobronravov V.A., Smirnov A.V., Kayukov I.G. MANYSIDED ALBUMINURIA: ASPECTS OF CLINICAL VALUE. Nephrology (Saint-Petersburg). 2009;13(3):33-38. (In Russ.) https://doi.org/10.24884/1561-6274-2009-13-3-33-38
Просмотров:
423
Послать статью по эл. почте 