Tuesday, February 18, 2014

Clinical Case 80: Answers and Summary

Which statement best describes the relationship of microalbuminuria and cardiovascular disease?

Microalbuminuria causes cardiovascular disease
Atherothrombosis causes microalbuminuria
A common risk factor causes both microalbuminuria and cardiovascular disease
A common pathophysiological process such as endothelial dysfunction might lead to 
both microalbuminuria and cardiac disease

Most of you got this one correct. The age old question is " is microalbuminuria cardio toxic?" This is tough. Is it a surrogate marker of inflammation as some believe it is the ESR for the kidney or is it truly a risk factor for cardiac disease?  A paper in JASN many years ago looked at 4 potential mechanism of how these two might be related. The 4 mechanisms are listed above as your 4 choices. 

There is no direct evidence that supports statement " microalbuminuria causes cardiovascular disease".  The second statement may be partially true based on the authors argument but not many times hence atherothrombosis causing microalbuminuria might not be the problem either. Clearly common risk factors do exist with these two condition such as insulin resistance and or metabolic syndrome, and no one has looked at whether the association of the two conditions disappears when adjusted for insulin resistance and or other variables that are common risk factors. 

Hence, the most likely statement that makes sense is a common process that leads to endothelial damage leads to both microalbuminuria and cardiac disease.  Endothelial damage makes most sense as we as nephrologist see this all the time:- both diabetics get proteinuria and then the SLE patients with endothelial damage and then the pre eclamptics with endothelial damage. 

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