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Moderately increased albuminuria (microalbuminuria) in type 1 diabetes mellitus

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


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]. In patients with diabetes, moderately increased albuminuria is a risk marker for cardiovascular disease and mortality [8], and (particularly in patients with type 1 diabetes) it may sometimes but not always be indicative of early diabetic nephropathy.

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) [9].

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".)

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Literature review current through: Nov 2017. | This topic last updated: Nov 30, 2017.
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