Microalbuminuria may be a signal of the earliest abnormalities in kidney function. To do this, a UIA analysis is performed to identify processes of pathological vascular damage (atherosclerosis) in the body and, accordingly, an increased likelihood of heart disease. Given the relative ease of detecting excess albumin in urine, it is easy to understand the relevance and value of this analysis in medical practice.

Microalbuminuria - what is it?

Albumin is a type of protein that circulates in human plasma. It performs a transport function in the body, responsible for stabilizing fluid pressure in the bloodstream. Normally, it can enter the urine in symbolic quantities, in contrast to protein fractions that are heavier in molecular weight (they should not be present in urine at all).

This is due to the fact that the size of albumin molecules is smaller and closer to the diameter of the pores of the kidney membrane.

In other words, even when the blood-filtering “sieve” (the glomerular membrane) is not yet damaged, but there is an increase in pressure in the glomerular capillaries or the control of the “throughput” of the kidneys changes, the concentration of albumin increases sharply and significantly. At the same time, no other proteins are observed in the urine even in trace concentrations.

This phenomenon is called microalbuminuria - the appearance of albumin in the urine in a concentration exceeding the norm in the absence of other types of protein.

This is an intermediate state between normoalbuminuria and minimal (when albumin is combined with other proteins and is determined using tests for total protein).

The result of the MAU analysis is an early marker of changes in the renal tissue and allows making predictions about the condition of patients with arterial hypertension.

Microalbumin norm indicators

To determine albumin in urine at home, allowing for a semi-quantitative assessment of the protein concentration in urine. The main indication for their use is that the patient belongs to risk groups: the presence of diabetes mellitus or arterial hypertension.

The strip test scale has six gradations:

• “not determined”;
• “trace concentration” – up to 150 mg/l;
• “microalbuminuria” – up to 300 mg/l;
• “macroalbuminuria” – 1000 mg/l;
• “proteinuria” – 2000 mg/l;
• “proteinuria” – more than 2000 mg/l;

If the screening result is negative or “traces”, then in the future it is recommended to periodically conduct research using test strips.

If the urine screening result is positive (value 300 mg/l), confirmation of the pathological concentration using laboratory tests will be required.

The materials for the latter can be:

• a single (morning) portion of urine is not the most accurate option, due to the presence of variations in protein excretion in the urine at different times of the day, it is convenient for screening studies;
• – appropriate when monitoring therapy or in-depth diagnostics is necessary.

The result of the study in the first case will be only the albumin concentration, in the second the daily protein excretion will be added.

In some cases, the albumin/creatinine indicator is determined, which allows for greater accuracy when taking a single (random) portion of urine. The correction for eliminates the distortion of the result due to an uneven drinking regime.

The UIA analysis standards are given in the table:

In children, there should be practically no albumin in the urine; it is also physiologically justified to lower its level in pregnant women compared to previous results (without any signs of malaise).

Decoding analysis data

Depending on the quantitative content of albumin, three types of possible patient’s condition can be distinguished, which can be conveniently summarized in a table:

An analysis indicator called the rate of albumin excretion in urine is also sometimes used, which is determined over a certain time interval or per day. Its meanings are deciphered as follows:

• 20 mcg/min – normoalbuminuria;
• 20-199 mcg/min – microalbuminuria;
• 200 or more – macroalbuminuria.

These numbers can be interpreted as follows:

• the current normal threshold may be lowered in the future. The basis for this is research concerning an increased risk of cardiovascular and vascular pathologies already at an excretion rate of 4.8 mcg/min (or from 5 to 20 mcg/min). From this we can conclude that screening and quantitative tests should not be neglected, even if a one-time test did not show microalbuminuria. This is especially important for people with non-pathological high blood pressure;
• If a microconcentration of albumin is detected in the blood, but there is no diagnosis that would classify the patient as a risk group, it is advisable to provide a diagnosis. Its goal is to exclude the presence of diabetes mellitus or hypertension;
• if microalbuminuria occurs against the background of diabetes or hypertension, it is necessary to bring the recommended values ​​​​of cholesterol, blood pressure, triglycerides and glycated hemoglobin using therapy. A set of such measures can reduce the risk of death by 50%;
• if macroalbuminuria is diagnosed, it is advisable to analyze the content of heavy proteins and determine the type of proteinuria, which indicates severe kidney damage.

Diagnosis of microalbuminuria has great clinical value if there is not one test result, but several, done at intervals of 3-6 months. They allow the doctor to determine the dynamics of changes occurring in the kidneys and cardiovascular system (as well as the effectiveness of the prescribed therapy).

Causes of high albumin levels

In some cases, a single study can reveal an increase in albumin due to physiological reasons:

• predominantly protein diet;
• physical and emotional overload;
• pregnancy;
• violation of the drinking regime, dehydration;
• taking non-steroidal anti-inflammatory drugs;
• elderly age;
• overheating or vice versa, hypothermia of the body;
• excess nicotine entering the body when smoking;
• critical days for women;
• racial characteristics.

If changes in concentration are associated with the listed conditions, then the test result may be considered false positive and uninformative for diagnosis. In such cases, it is necessary to ensure correct preparation and submit the biomaterial again after three days.

Microalbuminuria may indicate an increased risk of heart and vascular diseases and an indicator of kidney damage in the earliest stages. In this capacity, it can accompany the following diseases:

• diabetes mellitus types 1 and 2 - albumin penetrates into the urine due to damage to the kidney vessels against the background of increased blood sugar levels. In the absence of diagnosis and therapy, it progresses rapidly;
• hypertension - analysis of the UIA suggests that this systemic disease has already begun to cause complications on the kidneys;
• metabolic syndrome with accompanying obesity and a tendency to thrombosis;
• general atherosclerosis, which cannot but affect the vessels that provide blood flow to the kidneys;
• inflammatory diseases of the kidney tissue. In the chronic form, the analysis is especially relevant, since the pathological changes are not acute in nature and can occur without pronounced symptoms;
• chronic alcohol and nicotine poisoning;
• (primary and secondary, in children);
• heart failure;
• congenital fructose intolerance, including in children;
• systemic lupus erythematosus - the disease is accompanied by or;
• complications of pregnancy;
• pancreatitis;
• infectious inflammation of the genitourinary organs;
• problems with the kidneys after .

The risk group, whose representatives are indicated for a routine test for albumin in urine, includes patients with diabetes mellitus, hypertension, chronic glomerulonephritis and patients after a donor organ transplant.

How to prepare for a daily UIA

This type of examination provides the greatest accuracy, but will require the implementation of simple recommendations:

• the day before the collection and during it, avoid taking antihypertensive drugs from the ACE inhibitor group (in general, taking any medications should be discussed with your doctor in advance);
• the day before urine collection, you should avoid stressful and emotionally difficult situations, intense physical training;
• at least two days in advance, stop drinking alcohol, energy drinks, and, if possible, smoking;
• maintain a drinking regime and do not overload the body with protein foods;
• The test should not be performed during non-infectious inflammation or infection, as well as critical days (in women);
• the day before collection, avoid sexual contact (for men).

How to take the test correctly

Collecting daily biomaterial is a little more difficult than a single portion, which is why it is preferable to do everything carefully, minimizing the possibility of distorting the result. The sequence of actions should be as follows:

If a single portion is taken (screening test), then the rules are similar to taking a general urine test.

Testing for microalbuminuria is a painless method for early diagnosis of heart disease and related renal disorders. It will help to recognize a dangerous trend even when there are no diagnoses of “hypertension” or “diabetes mellitus” or their slightest symptoms.

Timely therapy will help prevent the development of future pathology or alleviate the course of an existing one and reduce the risk of complications.

A study to determine the presence of the main blood plasma proteins - albumins - in the urine. Proteins of this particular group first begin to enter the urine in case of kidney disease. Their appearance in urine is one of the earliest laboratory indicators of nephropathy.

Synonyms Russian

Microalbumin in urine, microalbuminuria (MAU).

English synonyms

Research method

Immunoturbidimetry.

Units

mg/day (milligrams per day).

What biomaterial can be used for research?

Daily urine.

How to properly prepare for research?

• Eliminate alcohol from your diet 24 hours before the test.
• Avoid taking diuretics 48 hours before donating urine (in consultation with your doctor).

General information about the study

Albumins are water-soluble proteins. They are synthesized in the liver and make up the majority of serum proteins. In the body of a healthy person, only a small amount of the smallest albumin, microalbumin, is normally excreted in the urine, since the glomeruli of an unaffected kidney are impermeable to larger albumin molecules. During the initial stages of damage to the cell membranes of the renal glomerulus, more and more microalbumin are excreted in the urine; as the damage progresses, larger albumins begin to be released. This process is divided into stages according to the amount of excreted proteins (from 30 to 300 mg/day, or from 20 to 200 mg/ml in the morning urine, is considered to be microalbuminuria (MAU), and more than 300 mg/day is proteinuria). MAU always precedes proteinuria. However, as a rule, once proteinuria is detected in a patient, changes in the kidneys are already irreversible and treatment can only be aimed at stabilizing the process. At the MAU stage, changes in the renal glomeruli can still be stopped with the help of properly selected therapy. Thus, microalbuminuria is understood as the release of albumin in the urine in an amount that exceeds the physiological level of its excretion, but precedes proteinuria.

There are two periods in the development of nephropathy (both diabetic and those caused by hypertension, glomerulonephritis). The first is preclinical, during which it is almost impossible to detect any changes in the kidneys using traditional clinical and laboratory research methods. The second - clinically pronounced nephropathy - advanced nephropathy with proteinuria and chronic renal failure. During this period, renal dysfunction can already be diagnosed. It turns out that only by determining microalbumin in urine can the initial stage of nephropathy be detected. In some kidney diseases, MAU very quickly turns into protenuria, but this does not apply to dysmetabolic nephropathies (DN). MAU may precede the onset of DN for several years.

Since DN and the resulting chronic renal failure (CRF) occupy the first place in prevalence among kidney diseases (in Russia, Europe, USA), the determination of MAU in patients with diabetes mellitus (DM) type I and II is most significant.

Early detection of DN is extremely important as it has been shown to slow the progression of DN and renal failure. The only laboratory criterion that allows one to identify the preclinical stage of DN with a high degree of reliability is MAU.

It is advisable to prescribe a urine microalbumin test for initial signs of nephropathy in pregnant women, but in the absence of proteinuria (for differential diagnosis).

What is the research used for?

• For early diagnosis of diabetic nephropathy.
• For the diagnosis of nephropathy in systemic diseases (secondary nephropathy) that occurs with prolonged hypertension, congestive heart failure.
• For monitoring renal function in the treatment of various types of secondary nephropathy (primarily DN).
• For the diagnosis of nephropathy during pregnancy.
• To identify the early stages of nephropathy resulting from glomerulonephritis, inflammatory and cystic kidney diseases (primary nephropathy).
• To identify renal dysfunction in autoimmune diseases such as systemic lupus erythematosus, amyloidosis.

When is the study scheduled?

• For newly diagnosed type II diabetes mellitus (and then every 6 months).
• For type I diabetes mellitus lasting more than 5 years (once every 6 months is mandatory).
• For diabetes mellitus in children at an early age, with a labile course of diabetes mellitus (frequent decompensations: ketosis, diabetic ketoacidosis, hypoglycemia), after 1 year from the onset of the disease.
• For long-term, especially uncompensated arterial hypertension, congestive heart failure, accompanied by specific edema.
• During pregnancy with symptoms of nephropathy (if a general urine test showed the absence of proteinuria).
• In the differential diagnosis of early stages of glomerulonephritis.
• For systemic lupus erythematosus, amyloidosis for early diagnosis of specific kidney damage accompanying these diseases.

What do the results mean?

Reference values: 0 - 30 mg/day.

Reasons for increased microalbumin levels:

• dysmetabolic nephropathy,
• nephropathy caused by hypertension, heart failure,
• reflux nephropathy,
• radiation nephropathy,
• early stage of glomerulonephritis,
• pyelonephritis,
• hypothermia,
• renal vein thrombosis,
• polycystic kidney disease,
• nephropathy of pregnancy,
• systemic lupus erythematosus (lupus nephritis),
• kidney amyloidosis,
• multiple myeloma.

Decreased microalbumin levels not diagnostically significant.

What can influence the result?

Albumin excretion in urine increases:

• dehydration,
• high protein diet,
• diseases that occur with an increase in body temperature,
• inflammatory diseases of the urinary tract (cystitis, urethritis).

Albumin excretion in urine is reduced by:

• excess hydration,
• low protein diet,
• taking angiotensin-converting enzyme inhibitors (captopril, enalapril, etc.),
• taking non-steroidal anti-inflammatory drugs.

• Total protein in urine
• Creatinine in daily urine
• Urea in daily urine
• Rehberg test (endogenous creatinine clearance)

Who orders the study?

Nephrologist, therapist, endocrinologist, urologist, general practitioner, gynecologist.

Literature

• Keane W. F. Proteinuria, albuminuria, risk, assessment, detection, elimination (PARADE): a position paper of the National Kidney Foundation / W. F. Keane, G. Eknoyan // Amer. J. Kidney Dis. – 2000. – Vol. 33. – P. 1004-1010.
• Mogensen C. E. Prevention of diabetic renal disease with special reference to microalbuminuria / C. E. Mogensen, W. F. Keane, P. H. Bennett // Lancet. – 2005. – Vol. 346. – R. 1080-1084.
• Saudi J Kidney Dis Transpl. 2012 Mar;23(2):311-5. Ambulatory blood pressure monitoring in children and adolescents with type-1 diabetes mellitus and its relation to diabetic control and microalbuminuria. Basiratnia M, Abadi SF, Amirhakimi GH, Karamizadeh Z, Karamifar H.

Urine testing to detect microalbuminuria (MAU) is widely used in the diagnosis of the initial stages of renal tissue damage.

What is important is the quantitative determination of the level of urinary albumin, which is directly proportional to the degree of damage to the renal glomerulus (the main structural element of the kidney).

Microalbuminuria is the excretion of albumin protein in the urine in quantities exceeding physiological values.

Table 1 - Definition of microalbuminuria. Source - RMJ. 2010. No. 22. S. 1327

• Show all

  1. Physiological and pathological albuminuria

  A healthy person excretes a small amount of protein molecules in the urine (up to 150 mg/dl), while the albumin content in it is less than 30 mg/dl.

  The amount of protein excreted in urine can vary widely at different times of the day. Thus, at night, the excretion of albumin in urine is approximately 30-40% less, which is associated with a low level of vascular pressure and a horizontal body position. This leads to a decrease in renal blood flow and the rate of urine filtration in the glomerulus.

  In an upright position, the level of albumin excretion in urine increases, and after physical activity it can briefly be in the range of 30-300 mg/l.

  The amount of albumin excreted in urine may be influenced by the following factors:

  1. 1 Food high in protein;
  2. 2 Hard physical labor;
  3. 3 Urinary infection;
  4. 4 Circulatory failure;
  5. 5 Taking NSAIDs (non-steroidal anti-inflammatory drugs);
  6. 6 Severe bacterial infection, sepsis;
  7. 7 Pregnancy.

  Taking antihypertensive drugs from the group of ACE inhibitors, on the contrary, reduces albumin secretion.

  The rate of urinary excretion of albumin may also depend on age and race. Abnormal excretion of albumin in the absence of evidence of concomitant pathology of internal organs occurs in the elderly and Africans, and is often combined with excess weight.

  2. Urine analysis for UIA - indications for use

  Microalbuminuria (abbreviated MAU) is the earliest and most reliable sign of kidney tissue damage.

  Since it is impossible to determine it using routine methods, testing urine for microalbuminuria is included in the standards for examining patients at risk, primarily in patients with established diabetes mellitus and arterial hypertension.

  List of patients to be screened for microalbuminuria:

  1. 1 Patients with any type of diabetes mellitus and a history of the disease of more than 5 years (once every 6 months);
  2. 2 Patients with hypertension (once every 12 months);
  3. 3 Patients after kidney transplantation to monitor the development of rejection reactions;
  4. 4 Patients with chronic glomerulonephritis.

  3. Causes of damage to the glomerulus

  Among the main causes of damage to the renal glomeruli, and therefore microalbuminuria, are:

  1. 1 High glycemic level. MAU is the very first sign of diabetic nephropathy. The main mechanism for the occurrence of microalbuminuria in diabetes mellitus is hyperfiltration in the renal glomerulus and damage to the kidney vessels as a result of hyperglycemia. If left untreated, diabetic nephropathy rapidly progresses, leading to kidney failure and the need for hemodialysis. That is why every patient with diabetes mellitus should undergo a urine test for UIA at least once every six months, for early detection of nephropathy and its timely treatment.
  2. 2 High level of systolic pressure. Hypertension is a systemic disease that affects a large number of organs and systems, including the kidneys. In this case, MAU is a sign of the development of kidney complications - hypertensive nephrosclerosis, which is based on increased filtration pressure, tubulointerstitial fibrosis and increased permeability of the vascular wall to protein. MAU is a self-sufficient risk factor for the development of complications of hypertension.
  3. 3 Overweight, obesity, metabolic syndrome. Since 1999, WHO has defined microalbuminuria as one of the components of metabolic syndrome.
  4. 4 Hypercholesterolemia and hypertriglyceridemia, which lead to the development of generalized atherosclerosis. MAU in this case reflects the phenomena of endothelial dysfunction and is directly related to increased cardiovascular risk.
  5. 5 Chronic inflammation of the kidney tissue. The appearance of MAU (and proteinuria in general) is a prognostically unfavorable sign of the progression of glomerulonephritis.
  6. 6 Smoking. In smokers, the excretion of albumin in urine is approximately 20-30% higher (Nelson, 1991, Mogestein, 1995), which is associated with nicotine damage to the vascular endothelium.

  4. Method of determination

  Pathological albuminuria is not detected by routine methods of urine examination, for example, by acid precipitation.

  Given the significant daily variability in urinary albumin excretion, only the detection of MAU in two or three consecutive urine tests is diagnostically significant.

  For a urine screening test for UIA, it is permissible to use specially designed test strips, but in case of a positive test using rapid tests, it is necessary to confirm pathological albuminuria using methods that allow determining the albumin concentration.

  Semi-quantitative assessment is carried out using special strips - strip tests, where there are 6 gradations of albumin concentration in urine ("not detected", "traces" - up to 150 mg/l, more than 300 mg/l, 1000 mg/l, 2000 mg/l). l, and more than 2 thousand mg/l). The sensitivity of this method is about 90%.

  Quantitative determination is carried out using:

  1. 1 Determination of the ratio of creatinine and albumin (C/A) in urine;
  2. 2 Direct immunoturbidimetric method. The method allows you to estimate the albumin concentration by the turbidity of the solution obtained after the interaction of the protein with specific antibodies and the precipitation of immune complexes.
  3. 3 Immunochemical method using the “HemoCue” system (immunochemical reactions using anti-human antibodies). Albumin-antibody complexes lead to the formation of a precipitate, which is subsequently captured by a photometer.

  5. How to collect material for research?

  Collecting urine for research does not require prior preparation.

  Rules for collecting material:

  1. 1 Urine collection occurs over a full day (from 08.00 on the first day to 08.00 on the second day), the very first portion of urine must be poured into the toilet.
  2. 2 All urine excreted over 24 hours is collected in a single container (sterile). During the day, the container should be kept in a cool place in the absence of sunlight.
  3. 3 The daily amount of urine must be measured and the result recorded on the issued research referral form.
  4. 4 After this, the urine is mixed (this is necessary, since the protein can settle at the bottom of the jar!) and poured into a sterile container in a volume of about 100 ml.
  5. 5 The container is delivered to the laboratory as soon as possible.
  6. 6 All urine collected per day does not need to be sent to the laboratory.
  7. 7 Since the release of albumin depends on height and weight, these parameters MUST be recorded on the issued direction. Without them, urine will not be accepted for examination.

  6. What to do if microalbuminuria is detected?

  If, apart from microalbuminuria, no other pathology of internal organs has been identified, then it is advisable to conduct additional diagnostics to exclude diabetes mellitus and hypertension.

  For this, 24-hour blood pressure monitoring and a glucose tolerance test are required.

  In patients with MAU and previously diagnosed diabetes mellitus and/or hypertension, the following laboratory criteria must be achieved:

  1. 1 Cholesterol<4,5 ммоль/л;
  2. 2 Triglycerides (TG) up to 1.7 mmol/l;
  3. 3 Glycated hemoglobin up to 6.5%;
  4. 4 Systolic pressure<130 мм.рт.ст.

  This helps reduce mortality from cardiovascular complications by 50%. In patients with type 1 diabetes, the indicators are slightly different and are:

  1. 1 Glycated hemoglobin< 8,0%;
  2. 2 Blood pressure<115/75 мм.рт.ст;
  3. 3 Cholesterol up to 5.1 mmol/l;
  4. 4 Triglycerides up to 1.6 mmol/l.

  7. Prevention of UIA

  In order to prevent damage to kidney tissue, several rules must be followed:

  1. 1 Systematic monitoring of fasting glucose - normal levels are 3.5 - 6.0 mmol/l.
  2. 2 Daily blood pressure monitoring, which should not exceed 130/80 mmHg.
  3. 3 Quarterly monitoring of lipid profile indicators - with high levels of cholesterol and triglycerides, not only the formation of atherosclerotic plaques occurs, but also damage to kidney tissue;
  4. 4 Completely quit smoking and nicotine analogue cigarettes. Nicotine is dangerous for all blood vessels in the human body, including the kidney vessels. The risk of developing proteinuria in smokers is approximately 21 times higher than in non-smokers.

The doctor prescribes it not only to determine the amount of glucose in it, but also to monitor kidney function.

Data decoding contains information about the main indicators of urine: color, smell, transparency and concentration of various substances.

If there are deviations in the data, the doctor prescribes additional examination and treatment appropriate to the disease. The sugar content in urine according to the results of a daily test or express method should be minimal, and normally absent altogether.

Indications for urine testing

Most often, a doctor prescribes a sugar test if there is a suspicion of disturbances in the functioning of the endocrine system. The examination is recommended for potentially healthy patients every three years. Changes in glucose levels can warn of the development of a serious disease at an early stage.

Regular analysis is prescribed for the purpose of:

• diagnosing;
• assessing the effectiveness of treatment;
• correction of hormonal therapy;
• determining the amount of glucose lost in the urine.

Preparing for the study

In order for the results of the study to be reliable, certain rules for preparing for it should be followed:

1. On the eve of the analysis, spicy and salty foods are excluded from the diet. The amount consumed should be kept to a minimum. It is advisable to adhere to such a menu two days before the analysis;
2. the patient should not overload himself with physical labor and... Should also be avoided;
3. the day before, it is undesirable to undergo medical tests that cause psychological and physiological discomfort;
4. Urine collection for daily analysis is carried out within 24 hours. This is necessary to assess the changes occurring in urine during this period. In this case, the morning portion is not taken, since it contains the largest amount of glucose.

Collection begins with the second portion of urine. All liquid collected during the day is poured into a common container placed in the refrigerator.

For convenience, you can use a glass jar. After 24 hours, the contents of the container are mixed, 100 ml of urine is poured into a clean container and taken for analysis.

Interpretation of urine test indicators for sugar

Any deviations from the indicators indicate the development of one or another pathology.

If too much urine is produced, the patient experiences symptoms characteristic of diabetes mellitus. The color of normal urine ranges from straw to yellow. Too bright a color indicates insufficient water consumption and fluid retention in the tissues.

A cloudy sediment is a sign of developing urolithiasis, the presence of phosphates, and purulent discharge. The smell of urine from a healthy person is not pungent, without specific impurities. Protein should not be more than 0.002 g/l. The normal hydrogen index is (pH) -5-7.

If glucose is detected in the urine, the patient is prescribed.

Normal for diabetes mellitus

There should be no sugar in human urine. The maximum permissible concentration of the substance is 0.02%.

Reasons for deviation of results from the standard

Glucose is contained in urine in patients with:

• diabetes;
• problems with the pancreas;
• Cushing's syndrome.

Sugar is detected in many pregnant women when taking a urine test, as well as in those who abuse foods containing it.

Determining glucose levels in urine using test strips

Their action is based on the enzymatic reaction of glucose oxidase and peroxidase.

As a result of the process, the color of the indicator zone changes. They can be used at home and in hospital settings.

Test strips are used by patients with disorders of fatty acid metabolism and patients with diabetes for the convenience of monitoring glucose levels.

Video on the topic

What is a UIA urine test? What is the norm for diabetes? Answers in the video:

To determine the amount of glucose in the body, the doctor prescribes a urine test: general or daily. The second allows you to assess the condition of the kidneys in more detail and identify the reasons for exceeding normal values.

A person should not have glucose in their urine. To ensure the reliability of the test results, you should avoid eating tomatoes, citrus fruits on the eve of the study, and also do not overdo physical activity.

Before handing over the material, it is necessary to carry out hygienic procedures to prevent bacteria from entering it. The main indications for the study are endocrine diseases and diabetes.

Microalbuminuria (MAU) may be the first sign of kidney dysfunction and is characterized by abnormally high amounts of protein in the urine. Proteins such as albumin and immunoglobulins help blood clot, balance fluid in the body and fight infection.

The kidneys remove waste substances from the blood through millions of filtering glomeruli. Most proteins are too large to pass through this barrier. But when the glomeruli are damaged, proteins pass through them and enter the urine, which is what the microalbumin test reveals. People with diabetes or hypertension are more at risk.

What is microalbumin?

Microalbumin is a protein that belongs to the albumin group. It is produced in the liver and then circulates in the blood. The kidneys are a filter for the circulatory system, removing harmful substances (nitrogenous bases), which are sent to the bladder in the form of urine.

Typically, a healthy person loses a very small amount of protein in the urine; in tests this is displayed as a number (0.033 g) or the phrase “traces of protein detected” is written.

If the blood vessels of the kidneys are damaged, then more protein is lost. This leads to the accumulation of fluid in the intercellular space - edema. Microalbuminuria is a marker of the early stage of this process before the development of clinical manifestations.

Research indicators - norm and pathology

In people with diabetes, UIA is usually detected during a routine medical examination. The essence of the study is to compare the ratio of albumin and creatinine in urine.

Table of normal and pathological analysis parameters:

The normal level of albumin in urine should not be higher than 30 mg.

To differentiate between kidney disease and diabetic nephropathy, two tests are performed. For the first, a urine sample is used and protein levels are examined. For the second, blood is taken and the glomerular filtration rate of the kidneys is checked.

Diabetic nephropathy is one of the most common complications of diabetes, so it is important to get tested at least once a year. The earlier it is detected, the easier it is to treat in the future.

Causes of the disease

Microalbuminuria is a possible complication of type 1 or 2 diabetes mellitus, even if it is well controlled. About one in five people diagnosed with diabetes will develop MAU within 15 years.

But there are other risk factors that can cause microalbuminuria:

Symptoms of microalbuminuria

In the early stages there are no symptoms. In later stages, when the kidneys do not cope well with their functions, you may notice changes in the urine and notice the appearance of edema.

In general, several main symptoms can be noted:

1. Changes in urine: as a result of increased protein excretion, creatinine may take on a foamy appearance.
2. Edema syndrome - a decrease in albumin levels in the blood causes fluid retention and swelling, which is primarily noticeable in the arms and legs. In more severe cases, ascites and facial swelling may occur.
3. Increased blood pressure - there is a loss of fluid from the bloodstream and, as a result, thickening of the blood occurs.

Physiological manifestations

Physiological symptoms depend on the cause of microalbuminuria.

These include:

How to collect analysis?

How to give urine for analysis is one of the frequently asked questions to a doctor.

An albumin test can be done on a urine sample collected:

• at random times, usually in the morning;
• within a 24 hour period;
• for a certain period of time, for example at 16.00 pm.

An average portion of urine is required for analysis. A morning sample provides the best information about albumin levels.

The UIA test is a simple urine test. It does not require special preparation. You can eat and drink as usual, you should not limit yourself.

Technique for collecting morning urine:

1. Wash your hands.
2. Remove the lid from the test container and place it with the inside surface facing up. Do not touch the inside with your fingers.
3. Start urinating into the toilet, then continue into the test jar. Collect about 60 ml of midstream urine.
4. Within an hour or two, the analysis should be delivered to the laboratory for testing.

To collect urine over a 24-hour period, do not save the first urine sample in the morning. Over the next 24 hours, collect all urine in a special large container, which should be stored in the refrigerator overnight.

Decoding the results:

1. Less than 30 mg is normal.
2. From 30 to 300 mg – microalbuminuria.
3. More than 300 mg – macroalbuminuria.

There are several temporary factors that influence the test result (they should be taken into account):

• hematuria (blood in the urine);
• fever;
• recent vigorous exercise;
• dehydration;
• urinary tract infections.

Some medications may also affect urinary albumin levels:

• antibiotics, including aminoglycosides, cephalosporins, penicillins;
• antifungal drugs (Amphotericin B, Griseofulvin);
• Penicillamine;
• Phenazopyridine;
• salicylates;
• Tolbutamide.

Video from Dr. Malysheva about urinalysis indicators, their standards and reasons for changes:

Treatment of pathology

Microalbuminuria is a sign that you are at risk of developing serious and potentially life-threatening conditions such as chronic kidney disease and coronary heart disease. This is why it is so important to diagnose this pathology at an early stage.

Microalbuminuria is sometimes called "incipient nephropathy" because it can be the onset of nephrotic syndrome.

If you have diabetes mellitus in combination with UIA, you need to get tested once a year to monitor your condition.

Treatment with medications and lifestyle changes can help prevent further kidney damage. It can also reduce the risk of cardiovascular diseases.

• exercise regularly (150 minutes per week of moderate intensity);
• stick to a diet;
• stop smoking (including electronic cigarettes);
• reduce your consumption of alcoholic beverages;
• Monitor your blood sugar levels and if they are significantly elevated, consult a doctor immediately.

For high blood pressure, various groups of medications for hypertension are prescribed, most often these are angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). Their use is important because high blood pressure accelerates the development of kidney disease.

The presence of microalbuminuria may be a sign of damage to the cardiovascular system, so the attending physician may prescribe statins (Rosuvastatin, Atorvastatin). These medications lower cholesterol levels, thereby reducing the likelihood of a heart attack or stroke.

If edema is present, diuretics may be prescribed, for example, Veroshpiron.

In severe situations with the development of chronic kidney disease, hemodialysis or kidney transplantation will be required. In any case, it is necessary to treat the underlying disease that is causing the proteinuria.

A healthy diet will help slow the progression of microalbuminuria and kidney problems, especially if it also lowers blood pressure, cholesterol and prevents obesity.

In particular, it is important to reduce the number of:

• saturated fat;
• table salt;
• foods high in protein, sodium, potassium and phosphorus.

You can get more detailed advice on nutrition from an endocrinologist or nutritionist. Your treatment is a comprehensive approach and it is very important to rely on more than just medications.