From the Guidelines
Microalbuminuria treatment should begin with lifestyle modifications and medication therapy, with first-line treatment including angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) titrated to the maximum tolerated dose, as recommended by the most recent guidelines 1. The treatment approach should prioritize reducing intraglomerular pressure, decreasing inflammation, and improving endothelial function to protect kidney function and reduce the progression to macroalbuminuria and overt nephropathy. Key aspects of treatment include:
- Medication: ACEIs such as enalapril or lisinopril, or ARBs like losartan or valsartan, should be used as first-line treatment, with the goal of titrating to the maximum tolerated dose 1.
- Lifestyle modifications:
- Monitoring:
- Kidney function and potassium levels should be monitored 1-2 weeks after starting or adjusting ACEI/ARB therapy 1.
- Microalbuminuria should be reassessed every 3-6 months to evaluate treatment effectiveness 1. These interventions are supported by clinical trials and guidelines, which demonstrate their effectiveness in reducing the progression of nephropathy and improving outcomes in patients with microalbuminuria 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 In this population, losartan reduces the rate of progression of nephropathy as measured by the occurrence of doubling of serum creatinine or end stage renal disease (need for dialysis or renal transplantation) Compared with placebo, losartan significantly reduced proteinuria by an average of 34%, an effect that was evident within 3 months of starting therapy, and significantly reduced the rate of decline in glomerular filtration rate during the study by 13%, as measured by the reciprocal of the serum creatinine concentration
Microalbuminuria treatment: Losartan is used to treat diabetic nephropathy with microalbuminuria (urinary albumin to creatinine ratio ≥300 mg/g) in patients with type 2 diabetes and a history of hypertension. It reduces the rate of progression of nephropathy and proteinuria by an average of 34%. 2 2 2
From the Research
Microalbuminuria Treatment
- Microalbuminuria (MA) is defined as a persistent elevation of albumin in the urine of >30 to <300 mg/d (>20 to <200 microg/min) 3, 4
- The presence of MA is a marker of endothelial dysfunction and a predictor of increased cardiovascular risk 3, 4
- MA can be reduced, and progression to overt proteinuria prevented, by aggressive blood pressure reduction, especially with a regimen based on medications that block the renin-angiotensin-aldosterone system, and control of diabetes 3, 4
Treatment Options
- Angiotensin-converting enzyme inhibitors (ACE-i), such as lisinopril, have been shown to reduce microalbuminuria in patients with diabetes and hypertension 5, 6
- Angiotensin receptor blockers (ARBs) and beta blockers may also be effective in reducing microalbuminuria 3
- Calcium channel blockers, such as amlodipine, may not be as effective in reducing microalbuminuria as ACE-i or ARBs 6
Screening and Monitoring
- The albumin-to-creatinine ratio is recommended as the preferred screening strategy for all patients with diabetes and hypertension 3, 4
- MA should be assessed annually in all patients and every 6 months within the first year of treatment to monitor the impact of antihypertensive therapy 3, 4
- Systematic albuminuria screening is important for early detection and treatment of individuals with microalbuminuria, especially in those with diabetes 7