Moderately increased albuminuria (microalbuminuria) in type 1 diabetes mellitus
- David K McCulloch, MD
David K McCulloch, MD
- Clinical Professor of Medicine
- University of Washington
- George L Bakris, MD
George L Bakris, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Professor of Medicine
- The University of Chicago
- Section Editors
- Richard J Glassock, MD, MACP
Richard J Glassock, MD, MACP
- Editor-in-Chief — Nephrology
- Section Editor — Glomerular Diseases
- Emeritus Professor
- The David Geffen School of Medicine at UCLA
- David M Nathan, MD
David M Nathan, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Diabetes Mellitus
- Professor of Medicine
- Harvard Medical School
INTRODUCTION AND DEFINITIONS
Increased urinary protein excretion is the earliest clinical manifestation of diabetic nephropathy [1-5]. However, when assessing protein excretion, the urine dipstick is an insensitive marker for initial increases in protein excretion, not becoming positive until protein excretion exceeds 300 to 500 mg/day (upper limit of normal less than 150 mg/day, with most individuals excreting less than 100 mg/day) .
Using a specific assay for albumin is a more sensitive technique. The normal rate of albumin excretion is less than 30 mg/day (20 mcg/min); persistent albumin excretion between 30 and 300 mg/day (20 to 200 mcg/min) is called moderately increased albuminuria (the new terminology for what was formerly called "microalbuminuria")  and, in patients with diabetes (particularly type 1 diabetes), may be indicative of early diabetic nephropathy unless there is some coexistent renal disease. Albumin excretion above 300 mg/day (200 mcg/min) is considered to represent severely increased albuminuria (the new terminology for what was formerly called "macroalbuminuria" , and which is also called overt proteinuria, clinical renal disease, or dipstick positive proteinuria) .
The clinical significance, screening, and management of moderately increased albuminuria in patients with type 1 diabetes will be reviewed here.
The significance of moderately increased albuminuria in patients with type 2 diabetes, the association of moderately increased albuminuria with cardiovascular risk, and the treatment of overt diabetic nephropathy are discussed separately. (See "Moderately increased albuminuria (microalbuminuria) in type 2 diabetes mellitus" and "Moderately increased albuminuria (microalbuminuria) and cardiovascular disease" and "Treatment of diabetic nephropathy".)
Establishing the diagnosis of moderately increased albuminuria (formerly, microalbuminuria) requires the demonstration of an elevation in albumin excretion that persists over a three- to six-month period. Fever, exercise, heart failure, and poor glycemic control are among the factors that can cause transient increases in albuminuria . (See "Assessment of urinary protein excretion and evaluation of isolated non-nephrotic proteinuria in adults".)
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- INTRODUCTION AND DEFINITIONS
- Urine albumin concentration
- Urine albumin-to-creatinine ratio
- - Limitations
- Detection recommendation
- NATURAL HISTORY
- Risk factors
- Regression to normoalbuminuria
- Progression to severely increased albuminuria (macroalbuminuria)
- Moderately increased albuminuria (microalbuminuria) and GFR
- Other microvascular complications
- Glucose control
- Angiotensin inhibition
- Other antihypertensive drugs
- PRIMARY PREVENTION
- Glycemic control
- ACE inhibitors or ARBs
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS