THERAPY FOR ALBUMINURIA AND PROTEINURIA. WHERE ARE WE NOW?

Recently, there have been an increase interest, generally of diabetes, and also more specifically on albuminuria and proteinuria. There is also the entity called micro-albuminuria. This is partly because of the undisputed fact that albuminuria is a risk marker for cardiovascular disease in diabetics. If you have diabetes melitus and albuminuria, your chance of having cardiac and cerebral events are higher.
Recently, 3 clinical studies have been either presented, which seemed to throw some light into this problem and also what can be done. In the subsequent write up, albuminuria is used as a term to also include micro-albuminuria and also gross proteinuria.
Firstly, at the ESH European Meeting on Hypertension 2010, Dr Cesar Cerezo, presented a paper that showed that chronic ACE-I / ARB therapy dose not seem to help albuminuria. This group in Madrid, spain, studied 1433 patients on ACE-I / ARB for the management of hypertension and albuminuria. All th patients had been on ACE-I / ARB for a least 2 years. The were continued on ACE-I / ARB and monitored for an addition 3 years. The group found that while therapy did improve blood pressure control and also lowered albuminuria, the efect did not seem to last after two years. After two years, although the BP control became better, the albuminin excretion seem to rise. This is puzzling. Of course we are all concern, because albuminuria is a risk marker for CVS events. Does this also mean that CV risk also rises with ACE-I / ARB therapy, after two years of therapy.
The second presentation involved the use of statins in patients with and without diabetes, called the PLANET I and PLANET II study. These two papers were presented at the European Renal Association-European Dialysis + Transplantation Association Congress. It was presented by Dr Dick Zeeuw of Groningen, Netherlands. PLANET I was a study of diabetic patients with albuminuria and PLANET II were patients with albuminuria but not diabetic. The study compared high dose atorvastatin with high and medium dose rosuvastatin, and their effects on these two groups of patients. Both therapy were given for a period of 52 weeks after an initial run-in period of 8 weeks. The researchers found that whilest atorvastatin lowered albiminuria in diabetics, it did not improve renal function. Rosuvastatin, on the other hand did neither. There was no improvement in albuminuria and also some deterioration in renal function. It is obvious then that we should not use rosuvastatin in patients with albuminuria as it may worsen renal function. It would appear that the control of albuminuria by statins, is not a class effect and rosuvastatin is not kidney friendly. The studies were however small, 325 patients in PLANET I and 220 patients in PLANET II.
Looks like much work still needs to be done in the area of albuminuria, hypertension and diabetes. For the moment, these are the facts.