Microalbuminuria

Microalbuminuria
Classification and external resources
Specialty	Nephrology
ICD-9-CM	791.0
MedlinePlus	003591
Patient UK	Microalbuminuria

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 there is an abnormally high permeability for albumin in the glomerulus of the kidney. The term 'microalbuminuria' is now discouraged by KDIGO (Kidney Disease Improving Global Outcomes) and has been replaced by 'moderately increased albuminuria'.

Associations/Indications

• 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 intensive care unit predicts elevated risk for acute respiratory failure, multiple organ failure, and overall mortality
• a risk factor for venous thromboembolism

Microalbuminuria is an important adverse predictor of glycemic outcomes in pre-diabetes. Pre-diabetes 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.

Diagnosis

The level of albumin protein produced by microalbuminuria can be detected by special albumin-specific urine dipsticks. A 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 30–300 mg/24 hours) or, more commonly, from elevated concentrations 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.

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.

To compensate for variations in urine concentration in spot-check samples, it is helpful to compare the amount of albumin in the sample against its concentration of creatinine. This is termed the albumin/creatinine ratio (ACR) and microalbuminuria is defined as ACR ≥3.5 mg/mmol (female) or ≥2.5 mg/mmol (male), or, with both substances measured by mass, as an ACR between 30 and 300 µg albumin/mg creatinine. 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 too much or too little muscle mass. This is due to the variation in creatinine level which is produced by the muscle.

Definitions of microalbuminuria

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

See also

• Albuminuria

References

• 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.

External links

• Microalbumin and Urine Albumin/Creatinine Ratio – Lab Tests Online
• Online Microalbumin Urine Calculator