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Moderately increased albuminuria (microalbuminuria) in type 1 diabetes mellitus

Authors
David K McCulloch, MD
George L Bakris, MD
Section Editors
Richard J Glassock, MD, MACP
David M Nathan, MD
Deputy Editor
John P Forman, MD, MSc

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) [6].

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") [7] 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" [7], and which is also called overt proteinuria, clinical renal disease, or dipstick positive proteinuria) [8].

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".)

DETECTION

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 [9]. (See "Assessment of urinary protein excretion and evaluation of isolated non-nephrotic proteinuria in adults".)

                       

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Literature review current through: Nov 2016. | This topic last updated: Tue Jan 12 00:00:00 GMT+00:00 2016.
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