Racial differences in microalbumin excretion in healthy adolescents

It has been suggested that "normal" levels of urine albumin excretion rate (AER) may be predictive of an increased risk for progression of hypertension, cardiovascular morbidity, and mortality. No data are available on the effect of race and gender on AER in normal youth. We evaluated AER in timed urine samples in subjects participating in a study of stress-induced pressure natriuresis. A total of 317 healthy, normotensive adolescents aged 15 to 18 years (155 males and 162 females; 216 blacks and 101 whites) participated in a 5-hour testing protocol, which included a 1-hour period of mental stress preceded and followed by a 2-hour rest period. AER (micrograms per minute) was determined after 60 minutes of rest, and log transformation was used to normalize the data. AER was significantly higher in blacks as compared with whites (P=0.006). We also found a race-by-sex interaction, which was driven by the low albumin excretion in white females (P=0.036). Indexing urine albumin to creatinine excretion revealed the same pattern. Among blacks, AER was also higher in subjects who demonstrated impaired stress-induced pressure natriuresis versus those with normal sodium excretion (P=0.024). AER was related to blood pressure only in African-American males. The relative elevation of AER in normotensive black adolescents and the association with impaired pressure natriuresis and blood pressure is noteworthy. These findings suggest that albumin excretion may be a marker for a population at increased risk for the development of vascular and renal injury even before the manifestation of hypertension.