Is Microalbuminuria a Disease?

Abstract

Debate has arisen as to the proper timing of starting angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB) therapy to mitigate nephropathy in patients with diabetes mellitus. In April 2012, an article published in both the Pharmacist’s Letter and the Prescriber’s Letter advocated the withholding of these therapies in patients with diabetes who have microalbuminuria in the absence of hypertension. This practice is contrary to the 2012 American Diabetes Association (ADA) guidelines, which were acknowledged by both the Pharmacist’s Letter and the Prescriber’s Letter. As a past member of the ADA’s Professional Practice Oversight Committee (the committee that updates the ADA guidelines annually) and a current member of the advisory board for both publications (the Pharmacist’s Letter and the Prescriber’s Letter), I thought it would be worthwhile to revisit the data used by these publications to create their recommendation. The debate involves two primary questions: What is the general role of ACE inhibitor or ARB therapy in vascular disease, and when is it appropriate to begin these therapies to slow the progression of nephropathy?