Friday, August 31, 2012

Albumin/creatinine ratio is a recommended annual screening

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.

Definations
  albumin/creatinine ratio
         normal                           < 30        ug/mg creatinine
         microalbuminuria         30 to 299 ugm/mg creatinine
         macroalbuminuria        >  or = 300  ug/mg creatinine

The Risk
  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

#3  Medications
         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
       your pharmacist.
                  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
David Calder,MD
        

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Your comments and questions are appreciated. David Calder,MD