Maxwell M. Nwegbu
Microalbuminuria, a subtle increase in the urinary excretion of albumin that cannot be detected by the conventional urinalysis method, is an early marker of cardiovascular complications and increased cardiovascular risk in hypertension. The prevalence of microalbuminuria (MAU) is prone to modification by factors such as age, race, and severity of the disease process and presence of co-morbid factors. In view of this, a range of rates abound from various studies. In addition the methodologies of evaluation of MAU also contribute to the observed differences in prevalence reported in literature. Due to the challenges of 24-hour urine estimation, albumin excretion rate (AER) methods using spot urine has gained wide clinical acceptance. In our environment however, AER methods are not in widespread routine use and patients are still assessed by conventional dipsticks for urinalysis with the consequence outcome of not identifying patients with MAU. In this study, we evaluated sixty-four newly diagnosed hypertensives for MAU using a semi-quantitative urine test strip based on the immunoassay principle (ChemstripMicralTM-Roche). The prevalence of MAU was 47% in our study and these subjects had all been evaluated with the conventional urine dipsticks. Of our study subjects, only a third was on reno-protective medications such as angiotensin-converting enzyme inhibitors. These findings indicate the need for the introduction of screening for MAU using these types of strips in lieu of the current conventional urinalysis in the assessment of hypertensives. This can be used for stratification of the patients to allow for subsequent AER evaluation in those detected as having MAU by this screening tool. This is important as it will guide treatment choices for the patients, especially given the challenges of cost in our resource-poor environment.
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