Tuesday, August 28, 2012

What is your albumin/creatinine ratio ?

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
David Calder,MD

Urinary Proteomics for Early Diagnosis in Diabetic Nephropathy

  1. Peter Rossing3
+Author Affiliations
  1. 1mosaiques diagnostics GmbH, Hannover, Germany
  2. 2Austin Health, Heidelberg, Australia
  3. 3Steno Diabetes Center, Gentofte, Denmark
  4. 4Department of Endocrinology & Diabetes, St Vincent's Hospital & University of Melbourne, Fitzroy, Australia
  5. 5BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, U.K.
  1. Corresponding author: Petra Zürbig, zuerbig@mosaiques-diagnostics.com.


Diabetic nephropathy (DN) is a progressive kidney disease, a well-known complication of long-standing diabetes. DN is the most frequent reason for dialysis in many Western countries. Early detection may enable development of specific drugs and early initiation of therapy, thereby postponing/preventing the need for renal replacement therapy. We evaluated urinary proteome analysis as a tool for prediction of DN. Capillary electrophoresis–coupled mass spectrometry was used to profile the low–molecular weight proteome in urine. We examined urine samples from a longitudinal cohort of type 1 and 2 diabetic patients (n = 35) using a previously generated chronic kidney disease (CKD) biomarker classifier to assess peptides of collected urines for signs of DN. The application of this classifier to samples of normoalbuminuric subjects up to 5 years prior to development of macroalbuminuria enabled early detection of subsequent progression to macroalbuminuria (area under the curve [AUC] 0.93) compared with urinary albumin routinely used to determine the diagnosis (AUC 0.67). Statistical analysis of each urinary CKD biomarker depicted its regulation with respect to diagnosis of DN over time. Collagen fragments were prominent biomarkers 3–5 years before onset of macroalbuminuria. Before albumin excretion starts to increase, there is a decrease in collagen fragments. Urinary proteomics enables noninvasive assessment of DN risk at an early stage via determination of specific collagen fragments.
  • Received March 20, 2012.
  • Accepted May 30, 2012.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. Seehttp://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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Your comments and questions are appreciated. David Calder,MD