The albumin / creatinine ratio , is a recommended annual screening test . This easy urine test helps find people who are at greater risk of developing diabetic kidney disease. The leakage of albumin from blood into the urine is caused by damage to small blood vessels in kidneys.
normal < 30 ug/mg creatinine
microalbuminuria 30 to 299 ugm/mg creatinine
macroalbuminuria > or = 300 ug/mg creatinine
Microalbuminuria ( 30 to 299 mg/24 hours ), is a early marker of kidney damage and is also associated with increased risk of cardiovascular disease. The leakage of small amounts of albumin in the urine does not alway mean that a person will progress on to more severe kidney damage.
Those who progress on to Macroalbuminuria ( > 300 mg / 24 hours) are at increased risk of developing kidney failure.
Early detection and treatment can reduce the risk
#1 Blood Pressure Control as demonstrated in the in the UKPDS demonstrated that a small reduction in BP 154/87 to 144/82 resulted in a 34% relative reduction in small vessel disease (eye and kidney damage) . Other studies have also demonstrated the effectiveness of Blood pressure control in preserving kidney function.
Kidney Int. 1995 ; 47:1703-1720 ( DCCT study in Type 1 Diabetes )
New ENG. J. of Medicine 1993; 329: 1456-1462
Am. J.Med 1995; 99: 497-504
Am J kidney disease 2000; 36: 646-661
#2 Glucose control with a target goal of A1c of 7 .
A 1% point ( 8 .4 to 7.4 ) provided a 24 to 30 % relative risk reduction in 2 classic studies.
Type 2 Diabetes UKPDS
Type 1 Diabetes DCCT
ACE Inhibitors are usually the first choice for people with Diabetes . They are excellent for controlling blood pressure , reducing the risk of heart attacks and strokes, and reducing the risk of developing microalbuminuria. They also slow the progression of microalbuminuria and macroalbuminuria to more severe kidney dysfunction.
There are over 10 different brands of ACE Inhibitors on the market. I have listed a few of the
common brands. If your BP medication ends in "pril " it is probable a ACE inhibitor. check with
lisinopril ( zestril , prinivil )
ramipril ( Altase )
quinipril ( Accupril )
enalapril ( Vasotec, enalaprilat )
Tomorrow we will review ARBS , Calcium channel blocker and others
Have fun , Be smart check your BP pills and see if you are on a ACE inhibitor
I was scanning one of the ADA websites and noticed the abstract of an article discussing a new technique for identifying people at risk for developing kidney disease .This reminded me of a sometimes overlooked test, albumin/creatinine ratio
Albumin/creatinine ratio is one of the recommended routine test for people with Type 1 and type 2 Diabetes test . This test is an early indicator of increased risk for developing kidney disease . Confirmed levels over 30 microgram/ mg creatinine will trigger the efforts for improved glucose management , aggressive blood pressure control and the use of medications called ACE inhibitors
Definitions to know
Albumin/ creatinine ratio - spot urine test - goal <30
confirmed test > 30 suggest microalbuminuria
Microalbuminuria- 24 hour urine collection- 30 to 300 mg albumin/24hours
increases the risk of progressing to macroalbuminuria
Macroalbuminuria = 24 hour urine collection > 300 mg/24 hour
increases the risk of progressing to more severe kidney damage
Tomorrow I will review a few of the studies discussing the treatment of a "confirmed " test result over 30 microgram/ mg of creatinine.
Have fun , Be smart and review your albumin/creatinine ratio