Macroalbuminuria and microalbuminuria: do both predict renal and cardiovascular events with similar strength?

Until recently, most attention given to patients with macroalbuminuria has focused on their worse renal prognosis, while in contrast, patients with microalbuminuria were mostly considered to be at increased cardiovascular risk. In recent years, however, evidence has been accumulating that this distinction between the 2 -- either large or small quantities of albumin in the urine -- is not that clear. On the one hand, various studies have reported that macroalbuminuria also bears an increased cardiovascular risk. Interestingly, the extent to which albumin loss can be reduced in patients with macroalbuminuria is associated not only with a better renal prognosis, but also similarly with a better cardiovascular prognosis. On the other hand, patients with microalbuminuria not only have an impaired cardiovascular, but also an impaired renal, prognosis. These latter findings in microalbuminuria are especially of importance for the renal community, as screening for albuminuria is not carried out systematically even in patients with increased risk for microalbuminuria, such as those with diabetes and those with essential hypertension. When promoting routine screening for albuminuria, one should realize, moreover, that such projects will most likely be much more cost-effective when directed to preventing not only renal end points, but also CV end points.