Module 1: Understanding Chronic Kidney Disease (ckd)

Urine albumin results are used for screening, diagnosing, and treating CKD

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• Standard of diabetes care (annual screen)
• Diagnosis
• Forty percent of people are identified with CKD on the basis of urine albumin alone.
• Prognosis
• Important prognostic marker, especially in diabetes mellitus (DM)
• Tool for patient education and self-management (such as A1C or eGFR)

Damaged kidneys allow albumin to cross the filtration barrier into the urine

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• Increased glomerular permeability allows albumin and other proteins to cross the glomerulus into the urine.
• Higher levels of protein within the tubule may exacerbate kidney damage.
• Level of protein may exceed the tubules’ ability to reabsorb the proteins.

Risk Factors for Albuminuria

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Known risks	Possible risks	Transient increases may be due to:
Diabetes Hypertension Smoking Obesity	High sodium intake High protein intake Inflammation	Episodic hyperglycemia Exercise Fever Urinary tract infection

• References: De Jong et al. Kidney International. 2004;66:2109–2118;
• Tuttle et al. Diabetes Care; 2014: 37:2864–2883

Use urine albumin-to-creatinine ratio (UACR) for urine albumin assessment

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• UACR uses a spot urine sample.
• In adults, ratio of urine albumin to creatinine in a spot specimen correlates closely to albumin excretion in 24 hours.
• UACR < 30 mg/g is generally the cutoff for normal.

• Reference: http://nkdep.nih.gov/resources/quick-reference-uacr-gfr.shtml