Microalbuminuria

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Microalbuminuria
SpecialtyNephrology

Microalbuminuria is a term to describe a moderate increase in the level of urine albumin. It occurs when the kidney leaks small amounts of albumin into the urine, in other words, when an abnormally high permeability for albumin in the glomerulus of the kidney occurs. Normally, the kidneys filter albumin, so if albumin is found in the urine, then it is a marker of kidney disease. The term microalbuminuria is now discouraged by Kidney Disease Improving Global Outcomes[1] and has been replaced by moderately increased albuminuria.

Causes

Higher dietary intake of animal protein, animal fat, and cholesterol may increase risk for microalbuminuria,[2] and generally, diets higher in fruits, vegetables, and whole grains but lower in meat and sweets may be protective against kidney function decline.[3][4][5]

Associations

  • Marker of vascular endothelial dysfunction
  • An important prognostic marker for kidney disease
    • in
      diabetes mellitus
    • in hypertension
    • in
      post-streptococcal glomerulonephritis
  • Increasing microalbuminuria during the first 48 hours after admission to an
    multiple organ failure
    , and overall mortality
  • A risk factor for venous thromboembolism[6]

Microalbuminuria is an important adverse predictor of glycemic outcomes in prediabetes. Prediabetes individuals with increased microalbuminuria even in the so-called normal range is associated with increased progression to diabetes and decreased reversal to normoglycemia. Hence, prediabetes individuals with microalbuminuria warrant more aggressive intervention to prevent diabetes in them.[7]

Diagnosis and treatment

The level of albumin

microalbumin urine test
determines the presence of the albumin in urine. In a properly functioning body, albumin is not normally present in urine because it is retained in the bloodstream by the kidneys.

Microalbuminuria can be diagnosed from a 24-hour urine collection (between 30 and 300 mg/24 hours) or, more commonly, from elevated concentration in a spot sample (30 to 300 mg/L). Both must be measured on at least two of three measurements over a two- to three-month period.[8]

An albumin level above the upper limit values is called "macroalbuminuria", or sometimes just albuminuria. Sometimes, the upper limit value is given as one less (such as 300 being given as 299) to mark that the higher value (here 300) is defined as macroalbuminuria.[9]

N-acetylcysteine
(Nefrosave Tablet) was useful in attenuating UACR in microalbuminuric type 2 diabetic patient as per Indian Journal of Nephrology 2008

To compensate for variations in urine concentration in spot-check samples, comparing the amount of albumin in the sample against its concentration of creatinine is helpful. This is termed the albumin/creatinine ratio (ACR)[10] and microalbuminuria is defined as ACR ≥3.5 mg/mmol (female) or ≥2.5 mg/mmol (male),[11] or with both substances measured by mass, as an ACR between 30 and 300 µg albumin/mg creatinine.[12] For the diagnosis of microalbuminuria, care must be taken when collecting sample for the urine ACR. An early-morning sample is preferred. The patient should refrain from heavy exercises 24 hours before the test. A repeat test should be done 3 to 6 months after the first positive test for microalbuminuria. Lastly, the test is inaccurate in a person with very high or very low muscle mass. This is due to the variation in creatinine level which is produced by the muscle.[13]

Definitions of microalbuminuria
Individual Lower limit Upper limit Unit
24h urine collection 30[9] 300[9] mg/24h (
milligram
albumin per 24 hours)
Short-time urine collection 20[9] 200[9] µg/min (microgram albumin per minute)
Spot urine albumin sample 30[14] 300[14] mg/L (milligram albumin per
liter
of urine)
Spot urine albumin/creatinine ratio Women 3.5[15] 25[15] or 35[15] mg/mmol (milligram albumin per
millimole
creatinine)
30[15] 400[15] μg/mg (microgram albumin per milligram creatinine)
Men 2.5[15] or 3.5[15] 25[15] or 35[15] mg/mmol
30[15] 300[15] μg/mg


References

Footnotes

  1. ^ "KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease" (PDF).
  2. PMID 20299364
    .
  3. PMID 21251540
    .
  4. PMID 3600911
    .
  5. PMID 8893161
    .
  6. PMID 19417196
    .
  7. S2CID 206117
    .
  8. ^ "Person—microalbumin level (measured), total micrograms per minute N[NNN].N". Retrieved 2007-07-05.
  9. ^
    ISBN 978-1-58528-274-6
    .
  10. PMID 10333950
    .
  11. ^ "Proteinuria". UK Renal Association. December 15, 2005. Archived from the original on August 14, 2007.
  12. ^ clinlabnavigator.com > Test Interpretations Last Updated on Saturday, 19 June 2010
  13. ^ Microalbuminura in diabetes
  14. ^ a b Person—microalbumin level (measured) at Australian Institute of Health and Welfare. 01/03/2005
  15. ^
    PMID 16567839
    .

External links
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