Clinical Case 76: Answer and Summary

A 35 y old male with BMI of 38 has microalbuminuria. He has hyperlipidemia and no history of DM or HTN. What do you do next?

Start ACEI/ARB	8 (10%)
Weight loss and observe microalbuminuria	63 (79%)
Observer microalbuminuria	6 (7%)
Kidney biopsy	2 (2%)

With 79 responses, most of you would just recommend weight loss( given BMI) and observe the microalbuminuria. Close second was starting ACEI/ARB.  Given no DMII or HTN, many thinkers in nephrology on "microalbuminuria" say that observing might be a better option. Chronic illnesses such as obesity, hyperlipidemia, rheumactic illnesses, etc. all can lead to microalbuminuria. In other words, it can thought of as "ESR" test rather than real renal disease. Observing is important as if rises to significant proteinuria, then certain action might be needed ( as new disease might have developed or meds might be indicated). Data on this is still skim and perhaps we shall hear about this soon in the literature.