Understanding What You Need To Know About Albuminuria And Diabetic Kidney Disease

Underatnding What You Need To Know About Albuminuria And Diabetic Kidney Disease

There are several disorders that are associated with diabetes: high blood pressure, high cholesterol, obesity, heart disease and kidney disease. According to the American Diabetes Association (ADA) Guidelines, kidney disease occurs in 20-40% of patients with diabetes and is the leading cause of end-stage renal disease meaning.  When you have end-stage renal disease that means that the kidneys are functioning less than 10%. .1 Uncontrolled diabetes, can damage the kidneys over time. This kidney damage is called diabetic kidney disease (DKD) or diabetic nephropathy.  Uncontrolled blood pressure (hypertension) can also cause kidney disease.

 

What is albuminuria or proteinuria?

Normal functioning kidneys remove waste (broken down proteins, minerals, etc) from the blood into the urine and keeps important substances like albumin in the blood. Albumin is a protein that is made by the liver that carries important nutrients and hormones through the blood. The function of albumin is to help maintain normal fluid volume. Damaged kidneys may leak albumin into the urine along with waste products. When albumin is found in the urine it is referred to as albuminuria or proteinuria, it is often a sign of diabetic kidney disease. Albuminuria shows that there is a risk for progressive renal disease and cardiovascular disease.

How is albuminuria diagnosed and screened?

Positive screening for albuminuria requires two of three samples within three to six months with abnormal levels of albumin. According to the ADA Guidelines, urine albumin should be assessed at least once a year.1 It is reported as a ratio called urine albumin creatinine ratio (UACR). Anything greater than 30mg/g Cr is a positive result and means you have protein in your urine.

Signs and Symptoms of albuminuria

There are no early signs or symptoms of albuminuria. If your urine looks foamy, it may be a sign that albumin is being removed from your body. In advanced kidney disease there may be some edema (swelling in the hands, feet, stomach area or face). Testing the urine helps determine the severity of kidney damage.2

Prevention/Treatment

In patients with diabetes, it is critical to control both blood sugars and blood pressure to prevent or slow kidney damage. Increased blood pressure can damage the blood vessels in the kidneys which reduce their ability to work. Keeping your blood pressure less than 140/90 mmHg will reduce the risk or slow the progression of diabetic kidney disease. In some people your goal blood pressure may be less than 130/80. Another way to combat this issue is by keeping fasting blood sugars between 80-130mg/dL, your 2 hour after meal blood sugar less than 180 and an A1C less than 7%.1 These targets may be lower or higher for some patients; your health care provider will help you determine a goal. Young and healthier patients may have lower targets.

The most common medications that patients with diabetes and high blood pressure take for albuminuria are angiotensin-converting-enzyme inhibitors (ACE inhibitors) or angiotensin II receptor blockers (ARBs). Even in a patient with diabetes who do not have high blood pressure, if they have albuminuria these drugs are indicated.  These agents have been shown to slow the progression of kidney disease in people with diabetes with or without hypertension.3

All patients with diabetes  should get their urine tested yearly for albuminuria. aIn patients with diabetes it is possible to prevent albuminuria by achieving and maintaining a healthy body weight, eating a balanced diet,participating in moderate level physical activity and controlling your blood sugar and blood pressure. If you have albuminuria discuss with your health care provider to make sure you are taking either an ACE inhibitor or an ARB.1

This Article is Brought to you By Our Guest Staff Writers:
Stephanie Lin, PharmD Candidate 2017, MCPHS University, Boston, MA
David Sze, PharmD, MCPHS University Fellow, Boston, MA
Jennifer Goldman, PharmD, CDE, BC-ADM, FCCP, Professor of Pharmacy Practice, MCPHS University, Boston, MA, Clinical Pharmacist, Well Life, Peabody, MA

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