From the Guidelines
Treatment of Albuminuria
The treatment of albuminuria involves using Angiotensin-Converting Enzyme Inhibitors (ACEIs) or Angiotensin II Receptor Blockers (ARBs) as first-line therapy to reduce proteinuria and slow disease progression 1.
- ACEIs, such as lisinopril, at a dose of 20-40 mg daily, or
- ARBs, like losartan, at a dose of 50-100 mg daily, are recommended 1. Additionally, tight blood pressure control, with a target systolic blood pressure of less than 130 mmHg, and lipid management with statins, such as atorvastatin 10-20 mg daily, are also essential components of albuminuria treatment 1. Duration of treatment is typically long-term, with regular monitoring of urine protein levels and renal function to assess efficacy and adjust therapy as needed 1. It is also important to monitor serum potassium levels for the development of hyperkalemia when using ACEIs or ARBs 1. In cases where ACEIs or ARBs are not tolerated, non-DCCBs, β-blockers, or diuretics can be considered for the management of blood pressure 1. Protein restriction to 0.8 g kg-1 body wt day-1 (10% of daily calories) may be useful in slowing the decline of GFR in selected patients 1. Referral to a physician experienced in the care of diabetic renal disease should be considered when the GFR has fallen to 60 ml min-1 1.73 m-2 or difficulties have occurred in the management of hypertension or hyperkalemia 1.
From the FDA Drug Label
Losartan is indicated for the treatment of diabetic nephropathy with an elevated serum creatinine and proteinuria (urinary albumin to creatinine ratio ≥300 mg/g) in patients with type 2 diabetes and a history of hypertension Treatment with losartan resulted in a 16% risk reduction in the primary endpoint of doubling of serum creatinine, end-stage renal disease (ESRD) (need for dialysis or transplantation), or death. Compared with placebo, losartan significantly reduced proteinuria by an average of 34%, an effect that was evident within 3 months of starting therapy
The treatment for albuminuria (proteinuria) is losartan, which has been shown to reduce proteinuria by an average of 34% in patients with type 2 diabetes and a history of hypertension 2. Losartan is indicated for the treatment of diabetic nephropathy with an elevated serum creatinine and proteinuria (urinary albumin to creatinine ratio ≥300 mg/g) in patients with type 2 diabetes and a history of hypertension 2.
From the Research
Treatment for Albuminuria
The treatment for albuminuria involves several approaches, including:
- Risk factor management
- Ongoing monitoring
- Use of renin-angiotensin-aldosterone system (RAAS)-blocking agents, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) 3, 4, 5, 6
- Lifestyle modifications, including walking, weight loss, low-protein diet, and adherence to a healthy diet 7
- Control of hypertension and diabetes mellitus, with a goal blood pressure of <140/90 mmHg in patients without albuminuria and <130/80 mmHg in patients with albuminuria 7
Medications for Albuminuria
Several medications have been shown to be effective in reducing albuminuria, including:
- ACE inhibitors, such as enalapril and lisinopril 3, 4, 6
- ARBs, such as telmisartan, valsartan, and irbesartan 3, 4, 5, 6
- Sodium-glucose cotransporter-2 (SGLT2) inhibitors, pentoxifylline, and finerenone 7
- Endothelin receptor antagonists (ERAs), such as atrasentan 7
Monitoring and Follow-up
Regular monitoring of albuminuria is important to assess the effectiveness of treatment and to adjust therapy as needed 3, 4, 5. This can be done using microalbumin-specific dipsticks or urinary albumin:creatinine ratio determination from a spot urine sample 3.