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Screen for and monitor diabetic kidney disease and CKD
Risk of CKD progression combines eGFR + UACR
| A1 | A2 | A3 | |
|---|---|---|---|
| G1-G2 | Low | Mod | High |
| G3a | Mod | High | V.High |
| G3b-G4 | High | V.High | V.High |
Predicts CKD progression. Higher albuminuria = faster decline. Each doubling of UACR increases ESRD risk ~2.5x.
Strong predictor of CV events, independent of eGFR. Even A2 albuminuria increases heart disease and stroke risk.
Reducing albuminuria slows CKD progression. ACEi/ARBs, SGLT2i, and blood pressure control reduce UACR.
First-line for diabetic kidney disease. Reduce UACR 30-50%. Examples: lisinopril, losartan.
Proven kidney and CV benefits independent of diabetes control. Examples: empagliflozin, dapagliflozin.
Target <130/80 mmHg in patients with albuminuria. Lower BP reduces proteinuria.
Non-steroidal MRA. Additional UACR reduction on top of ACEi/ARB in diabetic CKD.
UACR measures albumin specifically. UPCR measures total protein. UACR is more sensitive for early diabetic kidney disease. UPCR is better for monitoring nephrotic syndrome.
Yes, especially if caught early. Tight glucose control, ACEi/ARB therapy, SGLT2 inhibitors, and blood pressure control can significantly reduce or normalize albuminuria.
Exercise within 24h, UTI, fever, heart failure exacerbation, menstruation, and contamination. Confirm with repeat testing on a different day.
Annually in diabetics without albuminuria. Every 3-6 months if A2 category. Monthly to quarterly if A3 or monitoring treatment response.
First morning void is preferred as it minimizes variation from posture and hydration. If not possible, any random spot urine is acceptable for screening.
Yes, it is significant. A2 indicates early kidney damage and predicts both CKD progression and cardiovascular events. Early intervention can prevent or slow progression.
Per KDIGO 2024: Screen all diabetics annually for albuminuria. Treat A2+ with ACEi/ARB. Add SGLT2i if eGFR ≥20 and UACR ≥200 mg/g (or ≥20 with UACR ≥300).