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Microalbumin, Urine

Microalbumin, Urine

Test Summary

Microalbumin, Urine

  

Clinical Use

  • Detect and monitor early renal disease in patients with diabetes mellitus

  • Detect and monitor albuminuria in patients with cardiovascular disease

  • Detect kidney damage in individuals at risk for renal disease

Clinical Background

Albuminuria is frequently one of the first signs of renal disease and may indicate renal damage which, left untreated, may progress to overt renal failure.1,2 In patients with diabetes, early detection of albuminuria, followed by improvement of glucose control and treatment with angiotensin converting enzyme inhibitors or angiotensin receptor blockers, may slow or prevent progression to end stage renal disease.2 Without specific intervention, 80% of patients with type 1 and 20% to 40% of those with type 2 diabetes who have persistent albuminuria will progress to overt nephropathy.2 Additionally, albuminuria is independently associated with an increased risk of cardiovascular events and heart failure and an increased incidence of all-cause mortality in the general population.3

The 2012 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guidelines recommend use of urinary albumin when diagnosing, staging, or assessing prognosis of chronic kidney disease (CKD).1

Individuals Suitable for Testing

  • Individuals with diabetes mellitus without overt albuminuria

  • Individuals with cardiovascular disease

  • Individuals at risk for renal diseas

Method

  • Albumin: Immunoturbidimetric assay

   Analytical specificity: immunoreactive albumin

   Analytical sensitivity: 2 mg/L.

  • Creatinine: Colorimetric, kinetic assay

Interpretive Information

The KDIGO guidelines state that an abnormal albumin level (≥30 mg/24 h or mg/g creatinine) for more than 3 months is diagnostic of CKD.1 Table 1 provides interpretation of specific urinary albumin values.
Table 1. Interpretation of Albumin Values1

Random Collection

(mg/g creatinine)

24-Hour Collection

(mg/24 h)

Interpretation
<30 <30 Normal to mild increase
30-300 30-300 Moderate increase
>300 >300 Severe increase

Exercise within 24 hours of collection, infection, fever, congestive heart failure, marked hyperglycemia, marked hypertension, pyuria, and hematuria may cause elevated urinary albumin levels. Results should be interpreted in conjunction with other laboratory and clinical findings.

References

  1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Inter Suppl. 2013;3:1-150. http://www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO_2012_CKD_GL.pdf. Accessed March 25, 2013.

  2. American Diabetes Association position statement: nephropathy in diabetes. Diabetes Care. 2004;27:S79-S83.

  3. Hillege HL, Fidler V, Diercks G, et al. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation. 2002;106:1777-1782.
     

Content reviewed 04/2013
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