Microalbuminuria; Risk Predictive Tool and Determinant of Early Treatment in Diabetic Nephropathy

In people diagnosed with diabetes mellitus (DM), microalbuminuria (MAU) is thought to be the first indication of diabetic nephropathy. Early identification of microalbuminuria is essential, to properly manage diabetic nephropathy and its complications. Patients with DM, both newly and previously diagnosed, should be screened for microalbuminuria. A pivotal question in diabetes management is whether diabetic patients with microalbuminuria should be considered for early prophylactic treatment. However, current evidence strongly supports the use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) as effective therapeutic strategies. Also, nonsteroidal mineralocorticoid receptor antagonist (ns-MRA) with proven kidney and cardiovascular benefit is recommended for patients with T2DM, eGFR ≥25 mL/min/1.73 m2, normal serum potassium concentration, and albuminuria (albumin-to-creatinine ratio [ACR] ≥30 mg/g) despite the maximum tolerated dose of the renin-angiotensin system (RAS) inhibitor. Therefore, recent clinical guidelines have increasingly emphasized the necessity of routine screening for microalbuminuria in diabetic patients, particularly among those with both type 1 and type 2 diabetes mellitus. Thus, this review aims to reiterate the significance of early detection of microalbuminuria in the early treatment commencement of diabetic nephropathy among patients diagnosed with diabetes mellitus.