Microalbuminuria Testing in Diabetic Patients

Screening Recommendations

The American Diabetes Association recommends performing annual urine albumin excretion testing in type 1 diabetic patients with diabetes duration of 5 years and in all type 2 diabetic patients starting at diagnosis 1, 2
The American Diabetes Association recommends measuring serum creatinine at least annually in all adults with diabetes regardless of the degree of urine albumin excretion to estimate GFR and stage chronic kidney disease (CKD) if present 1

The American Diabetes Association recommends measurement of the albumin-to-creatinine ratio in a random spot urine collection as the preferred screening method 1, 3
The American Diabetes Association recommends using first morning void samples to minimize effects of orthostatic proteinuria 3, 4

The American Diabetes Association defines microalbuminuria as urinary albumin excretion of 30-299 mg/24h or 30-299 mg/g creatinine on a random spot urine sample 3, 4
The American Diabetes Association defines normal albumin excretion as <30 mg/g creatinine 1
The American Diabetes Association defines macroalbuminuria (clinical albuminuria) as ≥300 mg/g creatinine 1

Microalbuminuria is an early marker of diabetic nephropathy and predicts progression to overt nephropathy 5

The American Diabetes Association recommends initiating treatment with ACE inhibitors or ARBs for patients with confirmed microalbuminuria, even if blood pressure is normal 4
The American Diabetes Association recommends optimizing glycemic control to reduce risk or slow progression of diabetic kidney disease 1, 4
The American Diabetes Association recommends optimizing blood pressure control to reduce risk or slow progression of nephropathy 1, 4
The American Diabetes Association recommends considering moderate protein intake restriction (0.8–1.0 g/kg body weight/day) in individuals with diabetes and early stages of CKD 1