hypertension is the growing issues of public health problem of adult population in both developed as well as developing world , affecting single person in every four people . the exact cause for hypertension is difficult to predict because hypertension results from a complex interaction of genes and environmental factors . furthermore , mau has been described as an early sign of kidney damage and a redactor for end stage renal disease ( esrd ) and cardiovascular disease . mau is defined as the increased urinary excretion of albuminuria ( 30 - 300 mg/24 h ) which can not be detected by routine protein dipstick method . measurement of mau can be done by using random spot urine sample . due to the variation in urinary flow rate and concentration thus , obtaining urinary albumin creatinine ratio ( acr ) of 30 - 300 mg albumin / g creatinine , corresponding to 3.4 - 33.9 mg albumin/ mmol creatine can be considered positive acr or microalbuminuria . thus , it is of great importance to study urinary acr and progression of kidney disease in hypertensive patients . thus , the objective of our study was to find out the prevalence and association of urinary microalbuminuria in newly diagnosed essential hypertensive patients in nepalese population . this hospital based cross - sectional study was conducted in the department of biochemistry in collaboration with department of internal medicine ( nephrology unit ) , tribhuvan university teaching hospital ( tuth ) , nepal from 2008 february to 2010 august . we enrolled 106 essential hypertensive cases of age between 25 years and 65 years and similar numbers as well as age of normotensive healthy controls were also enrolled . we measured biochemical profile including total cholesterol ( tc ) , high density lipoprotein cholesterol ( hdl - c ) , low density lipoprotein cholesterol ( ldl - c ) , triglyceride ( tg ) , creatinine , and uric acid from all participants . the urine sample was also processed on the same day and estimated for urinary microalbuminuria and creatinine . internal quality control sera , both normal , and pathological , were also run for each lot of the test , for the validation of the results . subjects having age of more than 25 years and less than 65 years with essential hypertension were enrolled as cases . similarly , the age of more than 25 years and less than 65 years without hypertension were enrolled as a healthy control group . subjects having age less than 25 years and more than 65 years , diabetes mellitus , chronic kidney disease , end stage renal failure , nephrotic syndrome , pregnancy , and under steroid therapy were excluded from study . hypertension was categorized according to blood pressure readings by jnc - vii definitions : normal ( systolic < 120 mm hg and diastolic < 80 mm hg ) , prehypertension ( systolic 120 to 139 mm hg or diastolic 80 to 89 mm hg ) , hypertension stage i ( systolic 140 to 159 mm hg or diastolic 90 to 99 mm hg ) , and hypertension stage ii ( systolic 160 or diastolic 100 mm hg ) . in spot urine sample albumin was measured quantitatively and adjusted to creatininuria then interpreted as albumin creatinine ratio ( acr ) < 3.4 mg albumin / mmol creatinine as normal albuminuria , 3.4 - 33.9 mg albumin/ mmol creatinine as microalbuminuria , and > 33.9 mg albumin/ mmol creatinine as macroalbuminuria . the formula of cockcroft and gault equation was used to calculate egfr . calculation of egfr in males : egfr = 140-age ( in years )  weight ( in kg )  88.4/[72  serum creatinine ( mol / l ) ] . a companion equation for women , based on their 15% lower muscle mass ( on average ) : egfr = 140-age ( in years )  weight ( in kg )  88.4 0.85/[72  serum creatinine ( mol / l ) ] . the data were analyzed using excel 2003 , r 2.8.0 statistical package for the social sciences ( spss ) for windows version 16.0 ( spss inc ; chicago , il , usa ) . comparison of mean of continuous data between stages different group of urinary acr level was tested by anova test . a p - value of < 0.05 ( two - tailed ) was used to establish statistical significance . we measured biochemical profile including total cholesterol ( tc ) , high density lipoprotein cholesterol ( hdl - c ) , low density lipoprotein cholesterol ( ldl - c ) , triglyceride ( tg ) , creatinine , and uric acid from all participants . the urine sample was also processed on the same day and estimated for urinary microalbuminuria and creatinine . internal quality control sera , both normal , and pathological , were also run for each lot of the test , for the validation of the results . subjects having age of more than 25 years and less than 65 years with essential hypertension were enrolled as cases . similarly , the age of more than 25 years and less than 65 years without hypertension were enrolled as a healthy control group . subjects having age less than 25 years and more than 65 years , diabetes mellitus , chronic kidney disease , end stage renal failure , nephrotic syndrome , pregnancy , and under steroid therapy were excluded from study . subjects having age of more than 25 years and less than 65 years with essential hypertension were enrolled as cases . similarly , the age of more than 25 years and less than 65 years without hypertension were enrolled as a healthy control group . subjects having age less than 25 years and more than 65 years , diabetes mellitus , chronic kidney disease , end stage renal failure , nephrotic syndrome , pregnancy , and under steroid therapy were excluded from study . hypertension was categorized according to blood pressure readings by jnc - vii definitions : normal ( systolic < 120 mm hg and diastolic < 80 mm hg ) , prehypertension ( systolic 120 to 139 mm hg or diastolic 80 to 89 mm hg ) , hypertension stage i ( systolic 140 to 159 mm hg or diastolic 90 to 99 mm hg ) , and hypertension stage ii ( systolic 160 or diastolic 100 mm hg ) . in spot urine sample albumin was measured quantitatively and adjusted to creatininuria then interpreted as albumin creatinine ratio ( acr ) < 3.4 mg albumin / mmol creatinine as normal albuminuria , 3.4 - 33.9 mg albumin/ mmol creatinine as microalbuminuria , and > 33.9 mg albumin/ mmol creatinine as macroalbuminuria . calculation of egfr in males : egfr = 140-age ( in years )  weight ( in kg )  88.4/[72  serum creatinine ( mol / l ) ] . a companion equation for women , based on their 15% lower muscle mass ( on average ) : egfr = 140-age ( in years )  weight ( in kg )  88.4 0.85/[72  serum creatinine ( mol / l ) ] . the data were analyzed using excel 2003 , r 2.8.0 statistical package for the social sciences ( spss ) for windows version 16.0 ( spss inc ; chicago , il , usa ) . comparison of mean of continuous data between stages different group of urinary acr level was tested by anova test . a p - value of < 0.05 ( two - tailed ) was used to establish statistical significance . microalbuminuria in male hypertensive cases , female hypertensive cases , and total hypertensive cases were found to be 46.67 , 58.7 , and 51.88% , respectively . similarly , microalbuminuria in male normotensive healthy controls , female normotensive healthy controls , and total normotensive healthy controls were found to be 12.08 , 14.58 , and 13.2% , respectively . the association between hypertension and microalbuminuria was very strong ( p - value < 0.001 ) . distribution of study population according to microalbuminuria in male and female ( categorized by taking cut off point 3.4 mg albumin / mmol creatinine for microalbuminuria ) table 2 shows the prevalence of microalbuminuria according to sex and age in different stages of blood pressure . microalbuminuria was found in higher number with the advances of ages and it was again worse in female . prevalence ( in percentage ) of microalbuminuria in persons with hypertension table 3 shows the comparison of mean value of demographic , clinical , and biochemical characteristics to different level of acr group . serum level of total cholesterol ( p - value 0.178 ) , tg ( p - value 0.519 ) , and ldl - c ( p - value 0.077 ) were found to be insignificantly increased with the increased level of urinary acr . however , serum level of hdl - c ( p - value 0.013 ) was found to be significantly decreased with the increased level of urinary acr . similarly , serum level of uric acid ( p - value 0.07 ) and creatinine ( p - value < 0.001 ) were found to be significantly increased with the increased level of urinary acr . with the increases of age ( p - value < 0.001 ) , the level of urinary acr was also increased . systolic blood pressure ( p - value < 0.001 ) and diastolic blood pressure ( p - value < 0.001 ) were significantly increased with the level of urinary acr whereas egfr ( p - value < 0.001 ) level was significantly decreased with increased level of urinary acr . among the 106 hypertensive patients , 51 patients with non ckd had normoalbuminuria , 42 patients had microalbuminuria , and 13 patients had macroalbuminuria . we found 51.88% of overall hypertensive patients had microalbuminuira positive and 13.2% of general population had microalbuminuria positive by taking the cut off point of acr 3.4 mg albumin / mmol creatinine to define microalbuminuria . some of the study showed approximately 30% of hypertensive patients had microalbuminuria positive and some other studies reported even higher prevalence of microalbuminuria in hypertensive patients . the newly diagnosed essential hypertension ( with bp>140/90 mmhg ) of age 25 - 65 years visiting tuth were enrolled in this study and the presence of obesity was not considered in both normal healthy controls who were enrolled after normal blood pressure ( < 120/80 mmhg ) as well as hypertensive cases . excess body weight has been reported to be associated with mau and albuminuria independently of other risk factors such as hypertension and diabetes . we reported high prevalence of microalbuminuira ( 13.2% ) in normotensive healthy controls and our report suggests that the presence of microalbuminuria may be due to different causes other than hypertension and diabetes . the prevalence of microalbuminuria in female hypertensive population and male hypertensive population were 58.7 and 46.67% , respectively . however , the prevalence of microalbuminuria between genders in normotensive population was hardly different which accounts for 14.58 and 12.08% of microalbuminuria in normotensive female population and normotensive male population , respectively . the prevalence of mau in female hypertensive population was higher than in male hypertensive population of our study whereas the reverse was found in some other populations . increased prevalence of mau in female than in male might be related to lower muscle mass ( approximately 15% less ) hence low creatinuria in women . therefore , some authors have suggested the use of sex - related cut - off points to define mau ( 2.5 - 30 mg albumin/ mmol creatinine for male and 3.5 - 30 mg albumin / mmol creatinine for female ) . however , we have not used the sex - specific cut - off point of acr . moderately higher prevalence of microalbuminuria in male and lower microalbuminuria in female would results in case of using a sex - specific cut off point for urinary acr . however , the overall prevalence of microalbuminuria might not be altered to a large extent . such sex - specific criteria might have a particular impact on the prevalence of microalbuminuria in the youngest age group in which muscle mass is high which may trigger somewhat increased urinary creatinine excretion . besides chosen cut off points for urinary acr , this difference may also be consistent with a increased prevalence of obesity in female hypertensive population than in male hypertensive population , but it was not considered in our study population . the mean value of body mass index ( bmi ) was found to be increased insignificantly ( p - value 0.09 ) with the increased level of acr . we found that serum level of uric acid ( p - value 0.047 ) and creatinine ( p - value < 0.001 ) were increased with the increased level of urinary acr , although , both the parameters fell well within the normal reference range . . the higher level of uric acid and creatinine with the increased level of urinary acr may be due to subclinical ultra structural changes in the glomeruli of hypertensive patients . higher level of urinary acr was noted with the advances of age ( p - value < 0.001 ) . some studies reported that the presence of microalbuminuria in early stage of hypertension can be taken as an important independent predictor for progression of renal disease . hypertension is the established risk factor for cardiovascular disease and renal disease . by showing strong association between mau and hypertension , our findings suggest that mau could be a useful marker to assess risk management of cardiovascular disease and renal disease . further studies in large scale population are required to further verification of mau as a screening tool to predict cardiovascular and renal disease .
background : microalbuminuria in hypertension has been described as an early sign of kidney damage and a predictor for end stage renal disease and cardiovascular disease . 
 thus , it is of great importance to study urinary albumin creatinine ratio and progression of kidney disease in hypertensive patients.aims:the present study was undertaken to find out the prevalence and association of microalbuminuria in newly diagnosed essential hypertension.materials and methods : newly diagnosed essential hypertensive cases ( n = 106 ) and normotensive controls ( n = 106 ) were enrolled . 
 hypertension was defined according to joint national committee - vii definitions . 
 microalbuminuria was measured using an u - albumin ( nycocard , norway ) and adjusted for urine creatinine . 
 descriptive statistics and testing of hypothesis were used for the analysis using spss 16 software.results:51.88% of hypertension cases and 13.2% of normotensive controls had microalbuminuria in total population ( odds ratio 7.086 , p - value < 0.001 ) . 
 46.67% of cases and 12.08% of controls had microalbuminuria in male population ( odds ratio 6.375 , p - value < 0.001 ) . 
 similarly , 58.7% of cases and 14.58% of controls had microalbuminuria in female population ( odds ratio 8.32 , p - value < 0.001).conclusions : by showing strong association between microalbuminuria and hypertension , our findings suggest that microalbuminuria could be a useful marker to assess risk management of cardiovascular disease and renal disease .