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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/12/01 11:39:03」(JST)

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Microalbuminuria is a term to describe a moderate increase in the level of urine albumin. It occurs when the kidney leaks small amounts of albumin into the urine, in other words, when there is an abnormally high permeability for albumin in the renal glomerulus. The term 'microalbuminuria' is now discouraged by KDIGO(Kidney disease improving global outcomes) and has been replaced by 'moderately increased albuminuria'.

Diagnosis

The level of albumin protein produced by microalbuminuria can be detected by special albumin-specific urine dipsticks. A microalbumin urine test determines the presence of the albumin in urine. In a properly functioning body, albumin is not normally present in urine because it is retained in the bloodstream by the kidneys.

Microalbuminuria can be diagnosed from a 24-hour urine collection (between 30–300 mg/24 hours) or, more commonly, from elevated concentrations in a spot sample (30 to 300 mg/L). Both must be measured on at least two of three measurements over a two- to three-month period.^[1]

An albumin level above the upper limit values is called "macroalbuminuria", or sometimes just albuminuria. Sometimes, the upper limit value is given as one less (such as 300 being given as 299) to mark that the higher value (here 300) is defined as macroalbuminuria.^[2]

To compensate for variations in urine concentration in spot-check samples, it is helpful to compare the amount of albumin in the sample against its concentration of creatinine. This is termed the albumin/creatinine ratio (ACR)^[3] and microalbuminuria is defined as ACR ≥3.5 mg/mmol (female) or ≥2.5 mg/mmol (male),^[4] or, with both substances measured by mass, as an ACR between 30 and 300 µg albumin/mg creatinine.^[5] For the diagnosis of microalbuminuria, care must be taken when collecting sample for the urine ACR. An early morning sample is preferred. The patient should refrain from heavy exercises 24 hours before the test. A repeat test should be done 3 to 6 months after the first positive test for microalbuminuria. Lastly, the test is inaccurate in a person with too much or too little muscle mass. This is due to the variation in creatinine level which is produced by the muscle.^[6]

Definitions of microalbuminuria
	Individual	Lower limit	Upper limit	Unit
24h urine collection		30^[2]	300^[2]	mg/24h (milligram albumin per 24 hours)
Short-time urine collection		20^[2]	200^[2]	µg/min (microgram albumin per minute)
Spot urine albumin sample		30^[7]	300^[7]	mg/L (milligram albumin per liter of urine)
Spot urine albumin/creatinine ratio	Women	3.5^[8]	25^[8] or 35^[8]	mg/mmol (milligram albumin per millimole creatinine)
	Women	30^[8]	400^[8]	μg/mg (microgram albumin per milligram creatinine)
	Men	2.5^[8] or 3.5^[8]	25^[8] or 35^[8]	mg/mmol
	Men	30^[8]	300^[8]	μg/mg

Significance

an indicator of subclinical cardiovascular disease
marker of vascular endothelial dysfunction
an important prognostic marker for kidney disease
- in diabetes mellitus
- in hypertension
- in post-streptococcal glomerulonephritis
increasing microalbuminuria during the first 48 hours after admission to an intensive care unit predicts elevated risk for acute respiratory failure, multiple organ failure, and overall mortality
a risk factor for venous thromboembolism ^[9]

References

Abid O, Sun Q, Sugimoto K, Mercan D, Vincent JL (2001). "Predictive value of microalbuminuria in medical ICU patients: results of a pilot study". Chest 120 (6): 1984–8. doi:10.1378/chest.120.6.1984. PMID 11742932.
Andersen S, Blouch K, Bialek J, Deckert M, Parving HH, Myers BD (2000). "Glomerular permselectivity in early stages of overt diabetic nephropathy". Kidney Int. 58 (5): 2129–37. doi:10.1111/j.1523-1755.2000.00386.x. PMID 11044234.
Heart Outcomes Prevention Evaluation Study Investigators (2000). "Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy". Lancet 355 (9200): 253–9. doi:10.1016/S0140-6736(99)12323-7. PMID 10675071.
Lemley KV, Abdullah I, Myers BD et al. (2000). "Evolution of incipient nephropathy in type 2 diabetes mellitus". Kidney Int. 58 (3): 1228–37. doi:10.1046/j.1523-1755.2000.00223.x. PMID 10972685.
Lièvre M, Marre M, Chatellier G et al. (2000). "The non-insulin-dependent diabetes, hypertension, microalbuminuria or proteinuria, cardiovascular events, and ramipril (DIABHYCAR) study: design, organization, and patient recruitment. DIABHYCAR Study Group". Controlled Clinical Trials 21 (4): 383–96. doi:10.1016/S0197-2456(00)00060-X. PMID 10913814.
Parving HH, Lehnert H, Bröchner-Mortensen J, Gomis R, Andersen S, Arner P (2001). "The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes". N. Engl. J. Med. 345 (12): 870–8. doi:10.1056/NEJMoa011489. PMID 11565519.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney inter., Suppl. 2013; 3: 1-150.

Footnotes

^ "Person—microalbumin level (measured), total micrograms per minute N[NNN].N". Retrieved 2007-07-05.
^ ^a ^b ^c ^d ^e Page 291 in: Basic Skills in Interpreting Laboratory Data. ISBN 978-1-58528-180-0
^ Bakker AJ (February 1999). "Detection of microalbuminuria. Receiver operating characteristic curve analysis favors albumin-to-creatinine ratio over albumin concentration". Diabetes Care 22 (2): 307–13. doi:10.2337/diacare.22.2.307. PMID 10333950.
^ "Proteinuria". UK Renal Association. December 15, 2005.
^ clinlabnavigator.com > Test Interpretations Last Updated on Saturday, 19 June 2010
^ Microalbuminura in diabetes
^ ^a ^b Person—microalbumin level (measured) at Australian Institute of Health and Welfare. 01/03/2005
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k [1] Justesen, T.; Petersen, J.; Ekbom, P.; Damm, P.; Mathiesen, E. (2006). "Albumin-to-creatinine ratio in random urine samples might replace 24-h urine collections in screening for micro- and macroalbuminuria in pregnant woman with type 1 diabetes". Diabetes Care 29 (4): 924–925. doi:10.2337/diacare.29.04.06.dc06-1555. PMID 16567839. edit
^ Mahmoodi, BK; Gansevoort, RT; Veeger, NJ; Matthews, AG; Navis, G; Hillege, HL; Van Der Meer, J; Prevention of Renal Vascular End-stage Disease (PREVEND) Study Group (2009). "Microalbuminuria and risk of venous thromboembolism". JAMA: the Journal of the American Medical Association 301 (17): 1790–7. doi:10.1001/jama.2009.565. PMID 19417196.

External links

Microalbumin and Urine Albumin/Creatinine Ratio – Lab Tests Online
Online Microalbumin Urine Calculator

UpToDate Contents

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1. 2型糖尿病における微量アルブミン尿 microalbuminuria in type 2 diabetes mellitus
2. 高アルブミン尿（微量アルブミン尿）および心血管疾患 high albuminuria microalbuminuria and cardiovascular disease
3. 1型糖尿病における微量アルブミン尿 microalbuminuria in type 1 diabetes mellitus
4. 成人における尿蛋白排泄量の評価および非ネフローゼ域蛋白尿のみの評価 assessment of urinary protein excretion and evaluation of isolated non nephrotic proteinuria in adults
5. 成人腎移植レシピエントの診療の概要 overview of care of the adult kidney transplant recipient

English Journal

Microalbuminuria in the paediatric age: current knowledge and emerging questions.

Tsioufis C, Mazaraki A, Dimitriadis K, Stefanidis CJ, Stefanadis C.SourceFirst Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece P. & A. Kyriakou Children's Hospital, Athens, Greece.
Acta paediatrica (Oslo, Norway : 1992).Acta Paediatr.2011 Sep;100(9):1180-4. doi: 10.1111/j.1651-2227.2011.02291.x. Epub 2011 Apr 12.
The prevalence of microalbuminuria (MA) in children and adolescents differs from the one in adults, and it is estimated to be about 5.7-7.3% in boys and 12.7-15.1% in girls. The percentage is greater in smaller age group, whereas a positive association is found between albumin excretion rate and pub
PMID 21443530

Japanese Journal

糖尿病患者におけるメタボリックシンドロームあるいは肥満と腎症進展との関連に関する前向き観察研究

木内由香,馬場園哲也,花井豪,岩本安彦
東京女子医科大学雑誌 81(E2), E197-E205, 2011-03-31
近年メタボリックシンドロームあるいは肥満と慢性腎臓病との関連が注目されている.本研究は、2型糖尿病患者におけるメタボリックシンドロームと腎症の発症および進展との関連を明らかにすることを目的とし、前向きの観察研究を行った.,1999年に東京女子医科大学糖尿病センターを初診した成人2型糖尿病患者のうち、腎症病期が正常あるいは微量アルブミン尿期であった375名、女性133名、男性 242名、年齢55±1 …
NAID 110008441468

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リンク元	「微量アルブミン尿」「ミクロアルブミン尿」「微量アルブミン尿症」「ミクロアルブミン尿症」「アルブミン尿」