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Microalbuminuria

Diabetic nephropathy (DN) is glomerular sclerosis and fibrosis caused by the metabolic and hemodynamic changes of diabetes mellitus. It manifests as slowly progressive albuminuria with worsening hypertension and renal insufficiency. Diabetic nephropathyis the most common cause of Nephrotic Syndrome and of end-stage renal disease (ESRD). The renal failure is particularly common in blacks, Asians, and Hispanics with type 2 diabetes and usually takes ≥ 10 yr to develop. However DN is asymptomatic in early stages, therefore early diagnose and treatment become extreme improtant.

Diagnosis

Diagnosis is suggested by proteinuria, diabetic retinopathy and/or hypertension, and a history of diabetes. Other renal diseases should be considered if there is heavy proteinuria with a short diabetic history, absence of diabetic retinopathy, rapid onset of heavy proteinuria, gross hematuria, Red Blood Cell casts, or a rapid decline in Glomerular Filtration Rate (GFR). Renal biopsy can confirm the diagnosis but is rarely necessary.

If proteinuria is evident on urinalysis, testing for microalbuminuria is unnecessary because the patient already has macroalbuminuria suggestiveof diabetic renal disease. Patients with type 1 diabetes without known renal disease should be screened for microalbuminuria and proteinuria beginning 5 year after diagnosis and at least annually thereafter. Patients with type 2 diabetes should be screened at the time of diagnosis and annually thereafter.

In patients without proteinuria on urinalysis, a microalbumin-to-creatinine ratio (ACR) should be measured on a 1st morning void urine specimen. A ratio ≥ 0.03 (≥ 30 mg/g) indicates microalbuminuria if it is present on at least 2 of 3 measures within 3 to 6 months and if it cannot be explained by infection or exercise.

 

Who gets microalbuminuria likely?

  1. Familial hostory of hypertension, diabetes.
  2. Hypertension
  3. Diabetes mellitus Type I
  4. Diabetes mellitus Type II