In insulin-dependent diabetes, detection of early proteinuria usually indicates diabetic nephropathy which frequently progresses to end-stage renal failure.
As many as 45% of insulin-dependent diabetics will develop diabetic nephropathy. Patients with microalbuminuria and an increased GFR (>150 mL/min) have a 20 fold chance of developing clinical albuminuria and nephropathy.
Microalbuminuria (30-300mg albumin/day) occurs long before clinical proteinuria becomes evident and has been shown to indicate a highly increased risk of renal failure. These smaller increases in urinary albumin are treatable by improving glycaemic control and arterial blood pressure.
Urine samples may be timed collections thus allowing albumin excretion rate to be calculated. The National Kidney Foundation recommends microalbuminuria to be measured on random urine specimens in which the albumin:creatinine ratio (ACR) is calculated.
Urine samples may be timed collections thus allowing albumin excretion rate to be calculated or they may be random specimens in which the albumin:creatinine ratio is calculated.
Albumin:creatinine ratio: <3.0 mg/mmol creatinine
24h Albumin excretion: <0.003 g/24h (<30 mg/24h)