Albuminuria: Chasing the message not the messenger

Abstract

The presence of abnormal amounts of albumin in the urine has evolved from a diagnostic marker in kidney disease into a prognostic marker important for establishing prognosis and treatment options not only in kidney disease, but also in a number of other conditions including diabetes and cardiovascular disease. Treatment of albuminuria is based on clinical trials that have established the benefit of blood pressure control and inhibition of the reninangiotensin system. Despite greater understanding emerging evidence for a significant role of renal proximal tubule cell function. of the molecular mechanisms regulating urinary excretion of albumin, the fundamental changes that lead to increased albumin excretion in such a variety of different condition are still poorly understood. This review will focus on some of the potential pathophysiological mechanisms involved emphasising the emerging evidence for a significant role of renal proximal tubule cell function.