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Microalbuminuria


Expert reviewer, Professor Raj Persad, Consultant Urological Surgeon
Next review due October 2022

Microalbuminuria means that there’s a small increase in the level of a protein called albumin in your urine compared to normal. It can be an early sign of kidney disease, which often occurs as a complication of diabetes and other conditions.

These days, many people use the terms ‘albuminuria’ or ‘proteinuria’ instead of microalbuminuria. These terms refer more generally to an increased level of albumin or protein in your urine.


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About microalbuminuria

Albumin is a protein in your blood. Your kidneys filter your blood to remove waste products, which are lost from your body in your urine when you pee. Normally, with healthy kidneys, very little protein (including albumin) is passed into your urine during this process. But if blood vessels in your kidneys are damaged, more protein leaks from your kidneys into your urine (albuminuria or proteinuria).

Microalbuminuria simply means the increase in albumin is relatively small or moderate. But even this low level of albumin in your urine can suggest you may have an early phase of chronic kidney disease. Doctors use your albumin level, along with results of other tests to diagnose chronic kidney disease and estimate how quickly your condition is likely to progress.

Causes of microalbuminuria

Microalbuminuria can be a sign of kidney damage. You might have damage to your kidneys if you have:


There are also things that can temporarily make the level of protein in your urine higher, such as vigorous exercise, having a fever, dehydration and in men, recently having sex. For more information on this, see our FAQ below: Why do I need a repeat test for microalbuminuria?

Symptoms of microalbuminuria

If you have microalbuminuria, then your albumin levels aren’t usually high enough for you to have any noticeable symptoms. The symptoms only become noticeable when your kidneys have become very damaged, and the levels of albumin in your urine get much higher. At this stage, your urine may become foamy and your skin may get puffy.

Because it doesn’t cause any symptoms, it’s important for people at risk of microalbuminuria – such as those with diabetes – to have regular tests for it.

Diagnosis of microalbuminuria

The only way to confirm whether or not you have microalbuminuria is by having a urine test for albumin. Your doctor will ask you to have a test every year if you’ve been diagnosed with diabetes or high blood pressure.

You may also be offered a test if you:

  • have a disease affecting your heart or blood vessels
  • have an injury to your kidney
  • have a condition that affects your kidney
  • are taking drugs that affect your kidney
  • have a family history of kidney disease
  • have had another urine test that’s shown up blood in your urine

The microalbuminuria test

Screening for microalbuminuria is by a test called the albumin to creatinine ratio (ACR). This can spot microalbuminuria early on.

The ACR test measures how well your kidneys are working. It compares the amount of albumin in your urine with the amount of creatinine. Creatinine is a waste product produced by your muscles, and a measure of how dilute your urine is. You’ll be asked to collect a urine sample, either first thing in the morning or sometimes just at any random time. This will be sent to a laboratory for testing.

If your ACR is found to be moderately increased, you’ll be asked to come back and repeat the test three months later. This is to confirm whether your ACR is persistently high or it was just temporarily higher at your first test. Your ACR can fluctuate (rise and fall) daily, and test results can be affected by a variety of things. For more information, see our FAQ below: Why do I need a repeat test for microalbuminuria?

Your GP will use the results of your ACR test alongside other assessments of your kidney function to assess whether or not you have chronic kidney disease.

Self-help for microalbuminuria

If you’re found to have microalbuminuria, taking measures to control your blood pressure, glucose and cholesterol levels can help to stop it getting worse, and prevent further damage to your kidneys.

Your GP may advise you to:

  • exercise regularly, aiming for 150 minutes of moderate intensity activity each week if you’re able to (but any amount of exercise can have benefits)
  • maintain a healthy weight
  • eat healthily – in particular, try to cut down on saturated fat, salt and high-protein foods
  • stop smoking

Treatment of microalbuminuria

If it’s been confirmed that your microalbuminuria is due to chronic kidney disease, your GP will arrange for you to be regularly monitored. This is to check for progression of chronic kidney disease, as well as for any complications. You’ll usually be offered a urine test alongside other assessments once a year to check if the damage to your kidneys has got any worse.

The aim of treatment for microalbuminuria is to prevent further damage to your kidneys and reduce the risk of other complications. This is done through medicines and the lifestyle measures outlined above.

Medicines

Your doctor may prescribe you a type of medicine for high blood pressure, called an angiotensin converting enzyme (ACE) inhibitor or an angiotensin II receptor blockers (ARBs). If your microalbuminuria is caused by diabetes, your doctor will prescribe one of these medicines regardless of whether or not you have high blood pressure. This is because these medicines can help prevent any further damage to your kidneys.

Having microalbuminuria also means that you’re at risk of problems with your heart and blood vessels (cardiovascular disease). Because of this, your GP may prescribe you a medicine called a statin. Statins lower your cholesterol, which can reduce the chance of having a heart attack or stroke. Your GP may also advise you to take blood-thinning medication such as aspirin every day if you're at particular risk of a heart attack or stroke.

Treatment for microalbuminuria is through a combination of medicines and the lifestyle changes outlined in the section on Self-help above. So, it’s important not to rely solely on your medicine.

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Complications of microalbuminuria

Microalbuminuria is an early marker of chronic kidney disease and coronary heart disease. You can have microalbuminuria for many years without it getting any worse. In some cases, it even gets better; (for more information on this, see our FAQ: Can you reverse microalbuminuria? below) Without treatment though, it’s more likely to progress to advanced kidney disease.

Long-term complications of chronic kidney disease can include problems affecting your heart and blood vessels, as well as your bones, nerves and muscles.

At the final stage of kidney disease, you may need a transplant or dialysis treatment to replace the role of your kidneys. It can take years for microalbuminuria to get to this stage, and it only happens in a small number of people with kidney problems. Treatment and lifestyle changes can help slow down and reduce this risk.

Frequently asked questions

  • Testing your albumin level is one of the assessments used to check your kidney function. But one test showing a moderate increase in albumin in your urine isn't enough to say for certain that you’ve got chronic kidney disease. There are other things that can cause a temporary increase in albumin in your urine when you give a sample. These include:

    • vigorous exercise
    • illness (such as a fever)
    • a urine infection
    • blood in your urine (including periods in women)
    • being dehydrated
    • in men, recently having had sex

    These may lead to ‘false positive’ test results that show microalbuminuria even though it’s only temporary.

    If you have one test showing a moderate increase in your albumin level, you’ll be asked to come for a repeat test three months later. Don't ignore a positive result – make sure you get tested again. If further tests show that you do have chronic kidney disease, you can start making changes and getting treatment to help stop it getting any worse.

  • Yes, some people who have microalbuminuria find that their level of albumin returns to normal after they start treatment. It may go up again, but it can stay at a normal level for years.

    Microalbuminuria is often one of the first signs of damage to your kidneys. If you start taking treatment and making lifestyle changes straight away, you’ll have a better chance of reversing any damage already done. At the very least, you’ll be able to slow down progression of the disease.

    Once the amount of albumin in your urine gets to a certain level, this indicates more serious damage to your kidney. It’s unlikely you’ll be able to do anything to reverse the damage at this stage.


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Related information

    • Microalbuminuria. Patient. patient.info, last reviewed 6 December 2016
    • Urine albumin to creatinine ratio or ACR. Lab Tests Online UK. labtestsonline.org.uk, last reviewed 27 November 2018
    • Chronic kidney disease in adults: assessment and management. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, last updated January 2015
    • KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013; 3:1–150. kdigo.org
    • Renal system. Encyclopaedia Britannica. www.britannica.com, accessed 9 September 2019
    • Chronic kidney disease. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised March 2019
    • Proteinuria. Kidney Research UK. kidneyresearchuk.org, accessed 23 September 2019
    • Assessment of proteinuria. BMJ BestPractice. bestpractice.bmj.com, last reviewed August 2019
    • Domachevsky L, Grupper M, Shochat T, et al. Proteinuria on dipstick urine analysis after sexual intercourse. BJUI 2006; 97:146–48
    • Proteinuria (albuminuria). Diabetes UK. www.diabetes.co.uk, accessed 23 September 2019
    • Diabetic renal disease. Oxford handbook of endocrinology and diabetes. Oxford Medicine Online. oxfordmedicine.com, published online March 2014
    • Diabetic complications. NICE British National Formulary. bnf.nice.org.uk, last updated 30 August 2019
    • Diabetic kidney disease. BMJ Best Practice. bestpractice.bmj.com, last reviewed August 2019

  • Reviewed by Pippa Coulter, Freelance Health Editor, October 2019
    Expert reviewer, Professor Raj Persad, Consultant Urological Surgeon
    Next review due October 2022



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