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
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.