Proteinuria y microalbuminuria / Proteinuria and microalbuminuria

Resumen:La barrera de filtración glomerular está formada por tres capas: el endotelio fenestrado, la membrana basal glomerular y las células epiteliales especializadas, llamadas podocitos. El contenido de proteínas en la orina es muy bajo y consiste primariamente de albúmina y de otras proteínas. La alteración de los componentes de la barrera de filtración puede resultar en la proteinuria clínica. La proteinuria usualmente refleja un incremento de la permeabilidad glomerular para la albúmina y otras proteínas. Hay varios tipos de proteinuria.Las relaciones albumina/creatinina (RAC) y proteína/creatinina (RPC) en orina son marcadores importantes de daño renal. No obstante, varias guías de manejo recomiendan la identificación y cuantificación de la proteinuria usando RAC de preferencia a RPC. Además, algunas guías de manejo recomiendan repetir la medición de RAC en la identificación inicial de la albuminuria para evitar el sobrediagnóstico debido a cambios transitorios en la albuminuria.

Abstract:The glomerular filtration barrier is made up of three layers: the fenestrated endothelium, the glomerular basement membrane and the specialized epitelial cells, podocytes. The final urine protein content is very low and consists primarily of plasma albumin and other proteins. Perturbation of the components of the filtration barrier can results in the clinical proteinuria. Proteinuria usually reflects an increase in glomerular permeability for albumin and other proteins. There are several types of proteinuria.Urine albumin/creatinine ratio (ACR) and protein/creatinine (PCR) are important markers of kidney damage,However several management guidelines recommend identification and quantification of proteinuria using ACR in preference to PCR. In addition, some guidelines recommend repeating ACR measurements for initial identification of albuminuria to avoid over diagnosis due to transient albuminuria changes.

Tratamiento antihipertensivo diurno y nocturno: efecto en la función endotelial de pacientes con patrón non-dipper / Day and night antihypertensive treatment: effect on endothelial function in patients with non-dipper pattern

Analizar el efecto del tratamiento antihipertensivo diurno y nocturno sobre la función endotelial en pacientes con patrón non-dipper identificados en la consulta de la Unidad Cardiometabólica del Departamento de Medicina Interna del Hospital Militar Dr. Carlos Arvelo durante el segundo cuatrimestre (Mayo – Agosto) del año 2012. Se realizó un estudio abierto, prospectivo, descriptivo y analítico durante un período de 8 semanas comparando la respuesta de la hiperemia reactiva y microalbuminuria con el horario de administración del tratamiento antihipertensivo, independientemente del tipo y número de drogas utilizadas. La muestra fue constituida por pacientes hipertensos con patrón non-dippersin otras comorbilidades que fueron diagnosticados en la Unidad Cardiometabólica del Hospital Militar Dr. Carlos Arvelo durante el segundo cuatrimestre del año 2012. La media de edades fue 57,84 ± 5,01DE para el grupo diurno y 55,07 ± 3,77DE para el grupo nocturno. Predominó el sexo femenino 69,23% y 92,3% respectivamente. Se observó mayor caída sistólica y mayor cambio de patrón non-dipper a dipper en el grupo con tratamiento nocturno que en aquel con tratamiento diurno (p=0,016 y p=0,011 respectivamente). No se observaron diferencias significativas con el resto de las variables. Se demostró una relación estadísticamente significativa entre la administración nocturna del tratamiento antihipertensivo y la caída nocturna de presión sistólica, condicionando el cambio del patrón non-dipper a dipper.

To analyze the effect of diurnal and nocturnal anti-hypertensive treatment on endothelial function in patients with a non-dipper pattern identified at the Cardio-metabolic Unit of the Internal Medicine Department, Military Hospital Dr. Carlos Arvelo, Caracas, Venezuela during the second quarter (May – August) of 2012. An open-label, prospective, descriptive and analytical study, was conducted over a period of 8 weeks comparing the reactive hyperemia and microalbuminuria to the schedule of administration of the anti-hypertensive treatment, regardless of the type and number of drugs used. The sample was composed of hypertensive patients with a non-dipper pattern without other comorbidities who consulted at the Cardiometabolic Unit of the Internal Medicine Department at the Military Hospital Dr. Carlos Arvelo during the second quarter of 2012. The average age was 57.84 ± 5.01SD for the day-time group and 55.07 ± 3.77SD for the nocturnal group. Females were predominant over males with 69.23% and 92.3% respectively. There was a greater systolic drop and a greater change from non-dipperto a dipper pattern in the group receiving nocturnal treatment than in the diurnal group (p=0.016 and p=0.011 respectively). No significant differences were observed in the rest of the variables. There was a statistically significant relationship between the nocturnal administration of anti-hypertensive treatment and the night systolic pressure drop, conditioning a change from non-dipper to a dipper pattern.

Renal function in children with congenital neurogenic bladder

AIMS: Preservation of renal function in children with congenital neurogenic bladder is an important goal of treatment for the disease. This study analyzed the evolution of renal function in patients with congenital neurogenic bladder. METHODS: We reviewed the records of 58 pediatric patients with respect to the following attributes: gender, age, etiology of neurogenic bladder, reason for referral, medical/surgical management, episodes of treated urinary tract infections, urodynamics, DMSA scintigraphy, weight, height, blood pressure, glomerular filtration rate, microalbuminuria and metabolic acidosis. Statistical analysis was performed, adopting the 5 percent significance level. RESULTS: The mean age at presentation was 4.2 ± 3.5 years. Myelomeningocele was the most frequent etiology (71.4 percent). Recurrent urinary tract infection was the reason for referral in 82.8 percent of the patients. Recurrent urinary tract infections were diagnosed in 84.5 percent of the patients initially; 83.7 percent of those patients experienced improvement during follow-up. The initial mean glomerular filtration rate was 146.7 ± 70.1 mL/1.73 m²/min, and the final mean was 193.6 ± 93.6 mL/1.73 m²/min, p = 0.0004. Microalbuminuria was diagnosed in 54.1 percent of the patients initially and in 69 percent in the final evaluation. Metabolic acidosis was present in 19 percent of the patients initially and in 32.8 percent in the final assessment. CONCLUSIONS: Patient referral to a pediatric nephrologist was late. A reduction in the number of urinary tract infections was observed with adequate treatment, but microalbuminuria and metabolic acidosis occurred frequently despite adequate management.

Recuperación renal de la enfermedad hipertensiva / Renal repercutions of hypertensive disease

La enfermedad renal crónica representa una causa mayor de morbilidad y mortalidad y la naturaleza de este fenómeno refleja el hecho de que la misma no existe aisladamente. Más aun, las múltiples comorbilidades y los factores de riesgos concurrentes, comúnmente asociados, hacen difícil su manejo, la intricada y relación bidireccional entre la fisiología cardíaca y renal demanda que ambos sistemas sean tomados en cuenta. Los estudios prospectivos y epidemiológicos han demostrado que la microalbuminuria es predictiva con independencia de los factores tradicionales de riesgo, de la mortalidad total y cardiovascular así como de eventos cardiovasculares dentro del grupo de pacientes con diabetes o hipertensión arterial. La inhibición del sistema renina angiotensina ha demostrado consistentemente reducir o detener el deterioro progresivo de la función renal a través de la reducción en la presión arterial y proteinuria, los dos principales determinantes de la declinación de la función renal. Los beneficios de la inhibición del sistema renina angiotensina por medio de los inhibidores de la enzima de conversión de la angiotensina (IECA), de los bloqueadores del receptor AT1 de angiotensina (BRA), los inhibidores de la renina y los antialdosterónicos han demostrado en múltiples estudios clínicos, a lo largo de diferentes estadios o etapas de enfermedad renal crónica, atenuar la progresión de la enfermedad renal crónica y de insuficiencia cardíaca junto con la disminución de la tasa de mortalidad total, particularmente en los pacientes con enfermedad renal crónica antes de ladiálisis (etapas 1-4).

Chronic kidney disease represents a major cause of morbidity and mortality and the nature of this phenomenon reflects the fact that chronic kidney disease does not exist in isolation. Moreover, the multiple comorbidities and concurrent risk factors commonly associated make optimal management difficult, and the intricate bidireccionally relationship between cardiac and renal physiology demand that both organ systems be addressed. Prospective and epidemiologic studies have shown that microalbuminuria is predictive, independently of traditional risk factors, of all-cause and cardiovascular mortality and CVD events within groups of patients with diabetes or hypertension, and in the general population. Inhibition of the renin angiotensin system has demonstrated consistently to reduce or halt the progressive deterioration of renal function through reduction of blood pressure and proteinuria, the two main determinants of renal function decline. The benefits of angiotensin-convertin genzyme inhibitors or angiotensin AT1 receptor blockers (ARBs), renin inhibitors and anti-aldosteronics have demonstrated in multiple clinical trials across varying degrees of chronic kidney disease an attenuation of progression of chronic kidney disease, reducing new cases heart failure, and lowering rates of all-cause mortality, particularly in pre-dialysis chronic kidney disease patients (stages 1-4).

El eje cardiorrenal: una nueva estrategía con trascendencia clínica / Cardiorenal axis: a new strategy with transcendence clinic

La encrucijada entre corazón y riñón ha llevado a los investigadores a considerar nuevos abordajes en ambas patologías. La microalbuminuria es reflejo del daño endotelial y de la agresión vascular a nivel del glomérulo y está asociada con todos los factores vasculares de riesgo que se relacionan con el daño vascular y la tasa de filtración glomerular, la cual hoy día ha demostrado una estrecha relación con la evolución de los pacientes con enfermedad cardíaca o hipertensión arterial (HTA). Estas dos mediciones reflejan diferentes aspectos del riesgo cardiorrenal. Los principales factores de riesgo cardiovascular, tales como la HTA, tabaquismo, diabetes mellitus y dislipidemia, comúnmente se encuentran asociados con la enfermedad renal crónica (ERC), pero confrecuencia son ignorados o no bien tratados. La enfermedad renal es un problema de salud pública en crecimiento en la mayoría de los países y el número de personas portadoras de ERC se ha incrementado sustancialmente en los últimos 20 años. Este incremento ha ocurrido, principalmente, en las personas mayores de 65 años de edad, en los hipertensos y en los diabéticos. Proponemos el eje cardiorrenal como un concepto integrado con visión novedosa enfocada en el control de los factores mayores de riesgo cardiovascular y en la vigilancia de la función renal.

The relationships between cardiac and renal diseases have led investigators to consider new approaches to both pathologies. Microalbuminuria is a reflection of endothelial and vascular injury at the level of the glomeruli and is associated with all the vascular risk factors that relate to vessel damage and the glomerular filtration rate, which has been demonstrated to bear a close relationship with progression of cardiac disease or arterial hypertension in patients. Thus these two assessments reflect different aspects of cardiorenal risk. Major cardiovascular risk factors such as hypertension, smoking, diabetes mellitus and dyslipidemia are commonly associated with chronic renal disease but frequently ignored or not well treated. Kidney disease is a growing public health problemin most countries and the number of persons with treated end-stagerenal disease (ESRD) has increased substantially during the past 20 years. This increase has occurred primarily in individuals older than 65 year of age, in hypertensive and indiabetic patients. We propose a cardiorenal axis as an integrated concept with a novel vision focused on the control of major cardiovascular risk factors and monitoring of renal function.

Compromiso renal en pacientes HIV+ / Renal abnormalities in HIV infected patients

Varias complicaciones nefrológicas pueden ocurrir durante la infección por el virus de la inmunodeficiencia humana (HIV) especialmente en estadios avanzados de la enfermedad o relacionadas con otras infecciones o drogas. Poco conocida es la prevalencia de alteraciones renales subclínicas de pacientes HIV+ surgidas como complicación o relacionadas a la infección y/o tratamiento. Realizamos un corte transversal de pacientes asintomáticos HIV+ referidos en forma consecutiva al consultorio de nefrología para la detección de alteraciones nefrológicas. Se estudiaron 52 pacientes adultos mediante exámenes de sangre y orina, ultrasonido y biopsia renal. Edad media 39.9 ± 10.6 años, 88% varones, tiempo de diagnóstico de la infección: 53.2 ± 41.2 (2-127) meses. El 71% tenían síndrome de inmunodeficiencia adquirida (HIV-sida) y el 77% recibían con antirretrovirales. La carga viral al momento del estudio fue 7043 ± 3322 copias y el recuento de CD4+ 484 ± 39 cel/mm³. El 30.7% presentó alteraciones del sedimento urinario: albuminuria: 16.6%, hematuria microscópica: 11.5%, hipercalciuria: 10.8% y cristaluria 6%. La media del filtrado glomerular fue 102.2 ± 22.9 ml/min (rango: 34-149). El 41% presentó anormalidades que corresponderían a enfermedad renal crónica (estadios 1 a 3). Los pacientes con alteraciones tenían mayor edad, con duración más prolongada de la infección. Las anomalías renales no se asociaron con mayor prevalencia de HIV-sida. Dos pacientes fueron biopsiados, con hallazgos de nefritis túbulo-intersticial crónica con cristales y glomerulonefritis por IgA. No hubo hallazgos de nefropatía por HIV. El amplio espectro y la alta prevalencia de anormalidades nefrológicas subclínicas encontradas sugieren que los pacientes asintomáticos HIV+ deberían realizar evaluaciones nefrológicas de rutina.

Several renal complications may occur during HIV infection, especially in advanced stages related to HIV, to other infectious agents and/or drugs. Little is known about the prevalence of renal diseases that may occur as a complication of or related to HIV infection in asymptomatic patients. This is a single center cross-sectional study of asymptomatic HIV+ patients referred to a nefrology care service at an Argentine hospital to look for the presence of renal abnormalities. Fifty two consecutive patients were studied between April and November 2008. Patients underwent plasma and urine analysis, ultrasound, and kidney biopsy as needed. Mean age was 39.9 ± 10.6 years, 88% were male, time from HIV diagnosis 53.2 ± 41.2 months (2-127); 71% had HIV-disease and 77% were on antiretroviral therapy. Mean plasma HIV-RNA copies number was 7.043 ± 3.322 and CD4+ cell count: 484 ± 39. Pathologic findings in urine analysis were present in 30.7% of patients: albuminuria 16.6%, microscopic hematuria 11.5%, hypercalciuria 10.8% and crystalluria 6%. Mean glomerular filtration rate was 102.2 ± 22.95 ml/min (34-149) and 41% of patients could be classified in stages 1 to 3 of chronic kidney disease. Renal abnormalities prevaled in older patients without relationship with presence of HIV-disease. Two patients were biopsied and the findings included: tubulointerstitial nephritis with presence of crystal deposition in one and IgA nephropathy in the other. No HIV-associated nephropathy was detected. The broad spectrum and the high prevalence of lesions found in this series suggest that asymptomatic HIV-infected patients should routinely undergo renal evaluation.

Frecuencia de microalbuminuría en pacientes diabéticos tipo 2 de la consulta de medicina interna: ambulatorio urbano tipo III Dr. Daniel Camejo Acosta: Barquisimeto-Estado Lara mayo-septiembre 2000 / Frequency of microalbuminuria in diabetic patients type 2 of the consultation of medicine hospitalized ambulatory urban type III Dr. Daniel Camejo Acosta Barquisimeto State Lara: may-september 2000

Determinar la frecuencia de microalbuminuria en pacientes con Diabetes Mellitus tipo 2 que acudieron a la consulta de Medicina Interna del ambulatorio tipo III "Dr. Daniel Camejo Acosta". Se realizó un estudio descriptivo de corte transversal, durante mayo a septiermbre de 2000. La población estuvo constituida por 88 pacientes. La muestra fue de tipo no probabilística constituida por 35 pacientes, los cuales cumplieron con los críterios de inclusión. Para determinar la microalbuminuría se utilizó la técnica del Micral-test II. De 35 pacientes el 28,57 por ciento (n=10) presentó microalbuminuria patológica. De estos pacientes con microalbuminuría patológica: el 40 por ciento (n=4) presentaron 60-69 años. El 60 por ciento (n=6) fueron mujeres. El 50 por ciento (n=5) correspondió a la clase socieconómica III. El 70 por ciento (n=7) cumplían el tratamiento regularmente. El 80 por ciento (n=8) tenían 6-10 años de evolución de la diabetes y 2 (20 por ciento) pacientes tuvieron menos de 5 años de evolución. Estos resultados similares a los de otras investigaciones resaltan en la importancia de la realización de la microalbuminuría, en el control del paciente con diabetes, para la detección precoz de la nefropatía diabética.

Microalbuminuria, uric acid, uric acid clearance, gamma glutamyl transferase and cholesterol level in patients with chronic obstructive airway disease

This study was performed on thirty-two patients with chronic obstructive airway disease [COPD] subdivided into sixteen patients not receiving theophylline [group A] and sixteen patients taking regular theophylline [group B] and a control group of ten healthy individuals. Microalbuminuria was increased significantly in the patients compared with the controls, with the use of theophylline no significant difference was noted between group A and B. Serum gamma glutamyl transferase [GGT] was increased significantly in the patients compared with the controls and no difference was noted with the use of theophylline between groups A and B. Serum uric acid was increased significantly in the patients group compared with the controls. In the patients using aminophylline, it was significantly increased than patients not using theophylline. Serum uric acid clearance was increased significantly in the patients group as a whole compared with the controls. This increase was significantly higher in patients not using theophylline [group A] than patients using theophylline [group B]. Serum cholesterol was significantly increased in the patients group than the controls, this increase was more significant in the patients not using theophylline [group A] than patients using theophylline [group B]. Serum triglycerides, fasting blood sugar, serum creatinine and urea all showed no significant difference in the patients compared with the controls or with the use of theophylline. As regards the respiratory function, all patients with COPD showed a statistically significant decrease in all the studied parameters compared with the control and no significant difference was noted between the patients using theophylline [group B] and those not using theophylline [group A]. No correlation was found between microalbuminuria, uric acid clearance, cholesterol or respiratory functions in the study, while serum GGT was found to be correlated to cholesterol, but not by any other parameter

Values of certain clinical and biochemical tests for prediction of pre-eclampsia

To evaluate different predictive tests for pre-eclampsia, either individually or in combination, we prospectively studied 100 primigravid females. Eighty-eight of the subjects continued the follow-up until delivery and 17 developed pre-eclampsia. Venous blood samples were taken for determination of plasma fibronectin, and urine samples were taken for determination of microalbuminuria and calcium-creatinine ratio. Isometric handgrip exercise tests were also performed. Evaluation of predictive tests, as well as t and chi-squared statistical tests, were used for analysis of data. Pre-eclampsia developed in 19.3% of the patients studied. Pre-eclamptic and normotensive females showed significant differences in calcium-creatinine ratio and plasma fibronectin levels in both [14-24 weeks and 28-32 weeks] gestation periods [P<.0001]. Plasma fibronectin had the best sensitivity, positive, and negative values in gestation period 14-24 weeks, whereas isometric handgrip exercise tests had the best specificity. These values improved for all the tests in the 28-32-week gestation period; even so, plasma fibronectin proved best of all. A combination of tests failed to improve the predictive ability of fibronectin alone. We conclude that plasma fibronectin is the best predictive test for pre-eclampsia

Assessment of the value of the corrected Q-T interval in the diagnosis of cardiac autonomic neuropathy and its relation to microalbuminuria in diabetic patients [type I diabetes mellitus]

The validity of Q-T interval prolongation as a marker of cardiac automatic neuropathy [CAN] as well as its relation to the development of microalbuminuria [early marker of diabetic microangiopathy] are the objectives of this study. The study included 30 patients with insulin dependent diabetes mellitus [17 males and 13 females], and 10 healthy subjects as a control group. Definite CAN [score=5] was found in 13.33% of diabetics, borderline CAN [score > 2] was found in 76.66% of diabetics and normal cardiovascular reflexes was found in 10%. A prolonged corrected Q-T interval [Q-T > 433 ms] was present in 76.7% of diabetics with CAN, and a non prolonged corrected Q-T interval in 6.66% of diabetics with CAN. On the other hand, a prolonged corrected Q-T interval was found in 6.66% of diabetics without CAN and a non prolonged corrected Q-T interval was found in 10% of diabetics without CAN. Corrected Q-T interval prolongation was 92% sensitive and 60% specific in diagnosis of CAN. Microalbuminuria was present in 78.26% of diabetic patients with prolonged corrected Q-T interval and in 50% of diabetic patients without prolonged corrected Q-T interval. In conclusion, corrected Q-T interval prolongation in diabetic patients can be considered as a sensitive marker of cardiac autonomic neuropathy, its presence correlate with microalbuminuria, and hence microangiopathy. The reversibility of Q-T interval prolongation with tight diabetic control may be an objective for further study, if Q-T interval prolongation proves to be reversible with tight control it may then prove to be not only a simple bed side test which indicates microangiopathy but also may guide therapy and monitor diabetic control

Microalbuminuria as an early marker of autonomic neuropathy and retinopathy in type II diabetic patients

In this study 40 normotensive, non-insulin dependent diabetic patients, having no gross proteinuria, were subjected to clinical examination, body mass index [MBI] electro-cardiography, fundus examination, standard autonomic tests, blood urea, serum and creatinine, fasting and two hours post prandial blood glucose as well as urinary micro albumin estimation. Patients were classified into 3 groups according to uniray albumin excretion: Group A including 9 patients with urinary albumin less than 30 mg/gm creatinine, group B incliuding 15 patients with urinary albumin ranging between 30-100 mg/gm creatinine and group C with urinary albumin ranging between 100-300 mg/gm creatinine, this latter group included 16 patients. Patients were also classified according to the results of autonomic function tests into : Group I including 9 patients without autonomic neuropathy, Group II including 13 patients with mild degree of automic neuropathy and Group III including 18 patients with severe of degree of autnonmic neuropathy. It was found that the degree of autonomic neuropathy and urinary microalbumin excreation were positively correlated with the age of patients [p< 0.01 and < 0.05 respectively] and the duration of their diabetes [p< 0.001 for both variable] the BMI, the systolic and to a lesser extent the diastolic blood pressure were also positively correlated with the urinary mirobumin excertion [p< 0.001, < 0.001 and < 0.02 respectively]. It was also found that diabetic patients with highest urinary microalbuminuria [Group C] were having the severest form of retinopathy [Table 2]. Positive correlations was also found between urinary microalbumin excretion and autonomic dysfunction, patients without autonomic neuropathy [Group I] had urinary albumin excretion significantly than those having severe degree of autonomic neuropathy [Group III] with p value < 0.001. We can thus suggest that every patient recently diagnosed as diabetic must be followed for the presence of microabluminuria, autonomic dysfunction and retinopathy. The degree of autonomic neuropathy and retinopathy is directly related to the amount of microalbuminuria being an early index of microagiopathy. Deficient autonomic innervation can perpetuate and increase the albuminuria, thus early management meant of both disorders is very important for the diabetic patients

Clinical significance of microalbuminuria in diabetes mellitus

The objective of this work was to study some of the clinical and laboratory features associated with abnormal albumin excretion [micro- and macroalbuminuria] in Egyptian patients with insulin dependent diabetes [IDDM] and noninsulin dependent diabetes [NIDDM]. The study included 30 IDDM patients, 44 NIDDM patients and 20 normal controls. Excluded criteria included associated nondiabetic renal disease, urinary tract infection, prediabetic hypertension, heart failure, newly diagnosed diabetes and diabetic keto-acidosis. All cases were subjected to complete clinical history and examination, electrocardiogram, urine analysis including bacterial count, fasting blood sugar, glycated hemoglobin level, blood urea, serum creatinine, serum cholesterol, HDL cholesterol and 24 hours urine proteins by Albustix. Albustix negative patients were subjected to urinary microalbumin assay 3 times within 6 months period. The results revealed that in the IDDM group, 26.7% had normoalbuminuria, 40% had microalbuminuria and 33.3% had macroalbuminuria and that urinary albumin excretion rate [AER] correlated significantly with the duration of diabetes, glycated hemoglobin level, the presence of neuropathy and retinopathy as well as high serum cholesterol/HDL cholesterol ratio. Also, in IDDM abnormal AER was associated with higher incidence of hypertension, peripheral vascular disease and ischemic heart disease. In the NIDDM, AER was significantly correlated to the duration of diabetes, the presence of retinopathy as well as to high serum cholesterol/ HDL cholesterol level. Also, the abnormal AER was associated with high glycated hemoglobin level, the presence of neuropathy, hypertension, peripheral vascular disease and ischemic heart disease. It was concluded that early detection of microalbuminuria in IDDM and NIDDM will help to predict those susceptible not only to overt nephropathy but also to the various diabetic complications as retinopathy, neuropathy, hypertension, ischemic heart disease, peripheral vascular disease and lipid abnormalities

Left ventricular hypertrophy and its relation to microalbuminuria in essential hypertension

Left ventricular hypertrophy [LVH] increases the risk of cardiac failure, angina, myocardial infarction and sudden death. Recent studies proved that microalbuminuria is a strong predictor of cardiovascular events. In this study the relation between LVH and microalbuminuria was elevated among 95 patients [71 males, 24 females] with uncomplicated essential hypertension. A positive correlation was found between the degree of microalbuminuria and left ventricular mass index [LVMI] in total group studied [r = 0.76] and in both recently diagnosed hypertensive [r = 0.81] and long standing cases [r = 0.73] and in males [r = 0.79] and in females as well [r = 0.81]. There is no close correlation between the degree of both LVH and microalbuminuria and the height of blood pressure or the age of the patient. Microalbuminuria was moderately significantly increased, while LVH was highly significantly increased in long standing hypertensives than in recently diagnosed patients