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| COMMENTARY |
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| Year : 2014 | Volume
: 60
| Issue : 2 | Page : 158 |
Microalbuminuria: Nature, importance, significance, and limitations
SS Emara
Department of Surgery, Plastic Surgery Unit, Al-Hada Military Hospital, Taif, Saudi Arabia
| Date of Web Publication | 13-May-2014 |
Correspondence Address:
Dr. S S Emara
Department of Surgery, Plastic Surgery Unit, Al-Hada Military Hospital, Taif
Saudi Arabia
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Emara S S. Microalbuminuria: Nature, importance, significance, and limitations. J Postgrad Med 2014;60:158 |
The article by Bhadade and colleagues is an important article [1] elucidating the value of microalbuminuria (MAU) in the field of the care of critically ill patients. We have been investigating MAU for the last seven years in our Burn Intensive Care Unit (ICU) and we believe that it is a good tool when used appropriately. Microalbuminuria simply refers to the excretion of pathologically significant amounts of normal molecular weight albumin in the range of 30-299 mg/L. [2] In sepsis, there is a generalized capillary leak with the same effect occurring in the renal glomeruli and tubular cells., [3] This leads to leakage of significant amounts of albumin into the urine. Thus, the term MAU is misleading, and a more accurate term would be hypoalbuminuria (HAU), as it represents diminution in the amount and not the size of the protein molecule. [4]
Hypoalbuminuria is the only simple, noninvasive, bedside, immediate, and cost-effective test to indicate the occurrence of the systemic inflammatory response syndrome (SIRS) - if the other variables are stabilized. It can be measured with every urine void or even every minute, with a catheter in place. It represents a useful tool in developing countries with limited resources. [4]
Hypoalbuminuria is a consistent finding in inflammatory states, including an ischemia-reperfusion injury, pancreatitis, SIRS, sepsis, and certain metabolic syndromes. [4] Transient HAU has also been associated with surgical stress. [5] In addition, HAU is an early indicator of acute respiratory distress syndrome (ARDS), sepsis, and mortality in critical illness. [6]
Some limitations are usually confronted. On a review of the literature, we know now that that there is no accepted basis on which studies can be pursued. HAU can be affected with alcohol or drug intoxication, [2] nephrotoxic antibiotics, and body mass index. [7] It is interesting to know that the prevalence of MAU in the general population is in the range of 5 to 7%; this is according to several large cohort studies. [8] All these indicate that we need to address the issue of MAU to set appropriate protocols for its management.
| :: References | |  |
| 1. | Bhadade RR, deSouza R, Harde MJ, Sridhar B. Microalbuminuria: A biomarker of sepsis and efficacy of treatment in patients admitted to a medical intensive care unit of a tertiary referral center. J Postgrad Med 2014;60:145-50. 
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| 2. | Vlachou E, Gosling P, Moiemen NS. Microalbuminuria: A marker of endothelial dysfunction in thermal injury. Burns 2006;32:1009-16.
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| 3. | Fleck A, Raines G, Hawker F, Trotter J, Wallace PI, Ledingham IM, et al. Increased vascular permeability: A major cause of hypoalbuminaemia in disease and injury. Lancet 1985;1:781-4.
[PUBMED] |
| 4. | Emara SS, Aboulwafa AM, Alzaylai AA, Farag MM. Detection of Microalbuminria: A simple test for prognosis in severe burns. Burns 2013;39:723-8.
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| 5. | Sarti A, De Gaudio R, Messineo A, Cuttini M, Ventura A. Glomerular permeability after surgical trauma in children: Relationship between microalbuminuria and surgical stress score. Crit Care Med 2001;29:1626-9.
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| 6. | Gosling P, Brudney S, McGrath L, Riseboro S, Manji M. Mortality prediction at admission to intensive care: A comparison of microalbuminuria with acute physiology scores after 24 hrs. Crit Care Med 2003;31:98-103.
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| 7. | Wiwanitkit V. Microalbuminuria and BMI. Indian J Nephrol 2009;19:174.
[PUBMED] |
| 8. | 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-Trøndelag Health Study (HUNT), Norway. Am J Kidney Dis 2003;42:466-73.
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