Management of Moderately Increased Albuminuria

Understanding the Significance

An albumin/creatinine ratio (ACR) of 98 mg/g indicates moderately increased albuminuria, a marker of kidney damage, and is associated with increased risk for progression of kidney disease, cardiovascular disease, and mortality, according to the American College of Physicians 1, 2
This level of albuminuria is associated with increased risk for end-stage renal disease, as stated by the American Diabetes Association 3
The term "microalbuminuria" is no longer recommended; instead, use "moderately increased albuminuria" or "category A2" (30-299 mg/g), as suggested by the National Kidney Foundation 1, 4

Initiate ACE inhibitor or ARB therapy, strongly recommended for patients with moderately increased albuminuria (30-299 mg/g), to reduce the risk of chronic kidney disease progression and cardiovascular events, as recommended by the American Heart Association 3, 5
Optimize blood pressure control to target levels (typically <130/80 mmHg) and glucose control to reduce risk of progression, as recommended by the American Diabetes Association 3, 5
Dietary protein intake should be approximately 0.8 g/kg body weight per day (recommended daily allowance), as suggested by the National Kidney Foundation 3

Monitor serum creatinine and potassium levels after starting ACE inhibitors, ARBs, or diuretics, and continue monitoring ACR to assess response to therapy and disease progression, as recommended by the American College of Physicians 3, 5
Assess estimated glomerular filtration rate (eGFR) to determine kidney function, and refer to nephrology if eGFR <60 mL/min/1.73 m² or if difficulties occur in management of hypertension or hyperkalemia, as recommended by the National Kidney Foundation 5, 7
Refer to nephrology if there is rapid progression of kidney disease or uncertainty about the etiology of kidney disease, as recommended by the American Society of Nephrology 8, 9

At any level of GFR, increased ACR is associated with higher risk for adverse outcomes, and the risk increases as a continuum as ACR rises, as stated by the American College of Cardiology 1, 2
A 30% reduction in albuminuria is considered a surrogate marker for slowed progression of kidney disease, as suggested by the American Diabetes Association 6