Kennebec Region Health Alliance

Author: Elias Lemoine, DO MaineGeneral Kidney Care
Date: 5.11.2016.

Who to screen, How often do you screen, What test to order, Result interpretation, How often is the test repeated.

1. Who to screen:
   1. Patients with type 1 diabetes starting five years after onset
   2. Patients with type 2 diabetes starting at time of diagnosis
2. How often do you screen:
   Both type 1 and type 2 diabetic patients should be screened yearly
3. What test to order:
   Untimed urinary sample looking at urine albumin-to-creatinine ratio
4. Result interpretation:
   1. The normal amount of albumin excretion is less than 30 mg /day
   2. Repeated results between 30 and 300 mg / day is called persistent or microalbuminuria
   3. Repeated results above 300 mg / day is called severely increased albuminuria or macroalbuminuria
5. How often is the test repeated:
   Abnormal results should be repeated at least two times over 6 months to rule out false positives or transient microalbuminuria (causes include Fever, exercise, heart failure, and poor glycemic control)
   Two abnormal test results during the 6 month time frame establish the diagnosis of increased urinary albumin

References:

1. Standards of medical care in diabetes – 2015: summary of revisions. Diabetes Care 2015; 38 Suppl: S4.
2. Qaseem A, Hopkins RH Jr, Sweet DE, et al. Screening, Monitoring, and treatment of stage 1to 3 chronic kidney disease: A clinical practice guideline from the American College of Physicians. Ann Intern Med 2013; 159: 835.
3. Mogensen CE. Prediction of clinical diabetic nephropathy in IDDM patients. Alternatives to microalbuminuria? Diabetes 1990; 39;761.
4. Mogensen CE, Vestbo E, Poulsen PL, et al. Microalbuminuria and potential confounders. A review and some observations on variability of urinary albumin excretion. Diabetes Care 1995; 18: 572.

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