Department of Clinical Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
Address correspondence to: Dr. Dick de Zeeuw, Department of Clinical Pharmacology, Ant Deusinglaan 1, 9713 AV Groningen, The Netherlands. Phone: +31-50-3632810; Fax: +31-50-3632812; E-mail: d.de.zeeuw{at}med.umcg.nl
Proteins in the urine are classically associated with renaldisease. In the past, it was considered to be the result ofrenal damage, in particular a filtration defect. Later, theconcept of proteinuria being a marker, a mediator, or even acause of renal damage was entertained. Apart from the pathophysiology,proteinuria can be used as a marker for therapeutic efficacyas far as renal protection is concerned, particularly in patientswith diabetes.
Recently, albuminuria has gained considerable interest outsidethe arena of nephrology or "diabetology." Epidemiologists andcardiologists found that proteinuria, from high levels to evenvery small quantities of urinary albumin, are a very sensitiverisk marker for cardiovascular (CV) disease. This supposedly"reno-cardiovascular interaction" has been the topic of manystudies that have tried to unravel the mechanism by which urinary(renal?) albumin loss can predict CV disease. As such, albuminuriahas to compete with existing CV risk markers such as hypertension,cholesterol, smoking, etc. More important, albuminuria competeswith other new biochemical CV risk markers such as C-reactiveprotein and atrial or brain natriuretic peptide or even withrenal filtration markers such as creatinine or cystatin-C.
This issue’s Frontiers in Nephrology deals with the evidenceof albuminuria’s being an important CV risk marker andpossibly a target for CV protecive therapy. However, beforealbuminuria can serve as such a target, one needs to establishthe "mechanistic" connection between albuminuria (or albuminurialowering) and CV risk (or CV protection). This Frontiers inNephrology deals with the current evidence that links albuminuriato vascular (dys)function and even to a measure of CV vulnerabilityat young age. Finally, this Frontiers in Nephrology addressesthe important question, if one accepts albuminuria to be a riskmarker as well as a treatment target, of whether screening andtreating albuminuria would be a cost-effective approach.
Dr. Dick deZeeuw, MD, PhD, is Professor and Head of the Department of ClinicalPharmacology, with a joint appointment in the Department ofInternal Medicine, Division of Nephrology, at the UniversityMedical Center Groningen, in Groningen, The Netherlands.
Footnotes
Published online ahead of print. Publication date availableat www.jasn.org.
