Microalbuminuria

Your health experts: Dr Richard Hull, Consultant in Renal Medicine and Dr Ade Adeniyi, Bupa Clinics GP
Content editor review by Rachael Mayfield-Blake, April 2022
Next review due April 2025

Microalbuminuria is when the level of a protein called albumin in your pee (urine), is slightly higher than normal. It can be an early sign of kidney disease, which often happens as a complication of diabetes and other health conditions.

About microalbuminuria

Albumin is a protein in your blood. Your kidneys filter your blood to remove waste products. The waste products are then removed from your body in your pee (urine). Normally, with healthy kidneys, very little protein (including albumin) passes into your pee during this process. But if filters in your kidneys are damaged, more protein can pass from your kidneys into your pee.

You might also hear the terms albuminuria or proteinuria. These terms refer more generally to an increased level of albumin or protein in your pee. Microalbuminuria means the increase in albumin is relatively small or moderate.

Even this small amount of albumin in your pee may indicate early long-lasting (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 may progress.

An increased level of protein in your pee may also indicate an increased risk of cardiovascular conditions such as heart attacks and stroke. This can help doctors to find and treat these conditions.

Causes of microalbuminuria

Microalbuminuria can be caused by kidney damage, which might happen if you have:

a health condition such as glomerulonephritis that affects the parts of your kidney called the glomeruli (these are the filters in your kidneys)
diabetes (type 1 or type 2)
high blood pressure
pre-eclampsia in pregnancy
obesity

There are also things that can temporarily raise the level of protein in your pee and cause microalbuminuria, such as if you:

exercise vigorously
have a fever
are dehydrated

Symptoms of microalbuminuria

If you have microalbuminuria, you usually won’t notice any symptoms because the albumin levels in your pee (urine) aren’t usually high enough to cause any symptoms. You may notice microalbuminuria symptoms when the levels of albumin in your pee get higher. At this stage, your pee may become foamy. When your kidneys are very damaged, your skin may get puffy. Sometimes, you may have swollen ankles, hands, tummy or face.

Because microalbuminuria doesn’t cause any symptoms, it’s important to have regular tests if you’re at risk of it. If you have diabetes, for example, you should have a test for microalbuminuria once a year.

Diagnosis of microalbuminuria

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

Your doctor may also offer you a test if you:

have a health condition that affects your heart or blood vessels
have a health condition that affects your kidney
have an injury to your kidney
are taking medicines that affect your kidney
have a family history of kidney disease
have had another urine test that’s found blood in your urine

The microalbuminuria test

A test called albumin to creatinine ratio (ACR) can screen for microalbuminuria and spot it early.

The ACR test measures how well your kidneys are working. It compares the amount of albumin in your pee with the amount of creatinine. Creatinine is a waste product produced by your muscles. You’ll need to collect a sample of your pee (urine sample), usually first thing in the morning. This will be sent to a laboratory for testing.

If your ACR is found to be moderately increased, your doctor will ask you to come back and repeat the test within three months. This will confirm whether your ACR is persistently high or it was just temporarily higher at your first test. Your ACR can rise and fall daily, and test results can be affected by a variety of things. For more information on this, see our section on causes of microalbuminuria above.

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

Self-help for microalbuminuria

If you have microalbuminuria, you can take measures to control your blood pressure and glucose levels. This will help to stop the microalbuminuria getting worse and prevent further damage to your kidneys. You can also take some steps to control your cholesterol to help reduce your risk of cardiovascular disease, which may be higher if you have microalbuminuria.

Your GP may advise you to:

exercise regularly, if you can
maintain a healthy weight
eat healthily – in particular, try to cut down on saturated fat, salt and high-protein foods
stop smoking

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Treatment of microalbuminuria

If your microalbuminuria is due to chronic kidney disease, your GP will regularly monitor you to see if your chronic kidney disease gets any worse. They’ll also check to see if you have any complications. They will usually offer a urine test alongside other assessments once a year.

The aim of microalbuminuria treatment is to prevent further damage to your kidneys and reduce the risk of other complications. It also aims to reduce your risk of cardiovascular disease such as heart attacks and stroke. Microalbuminuria treatment is with medicines plus the lifestyle measures outlined in our self-help section above.

Medicines

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

If you have diabetes or high levels of albumin in your pee, your doctor may also prescribe a type of medicine called an SGLT2 inhibitor. This will help to protect your kidneys and reduce your risk of cardiovascular disease.

If you have microalbuminuria, you’re also at risk of problems with your heart and blood vessels (cardiovascular disease). Because of this, your GP may prescribe a medicine called a statin. Statins lower your cholesterol, which can reduce the chance of having a heart attack or stroke.

Treatment for microalbuminuria is through a combination of medicines and the lifestyle changes outlined in our section on self-help above. Medicines and lifestyle changes are equally important. So, it’s important to make changes to your lifestyle and take your medicines as instructed by your doctor.

Complications of microalbuminuria

Microalbuminuria is an early sign of long-lasting (chronic) kidney disease and risk of coronary heart disease. You can have microalbuminuria for many years without it getting any worse. It can even get better in some people. But without treatment, it’s more likely to progress to advanced kidney disease.

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

At the final stage of kidney disease, you may need a kidney transplant or dialysis treatment to replace the role of your kidneys. It can take years for kidney disease to progress to this stage, and it only happens in a small number of people with kidney problems. Microalbuminuria is the first sign that your kidneys are being damaged so having treatment and making changes to your lifestyle can help slow down and reduce this risk.

Microalbuminuria can be a sign of kidney damage. There are things that can temporarily raise the level of protein in your pee and cause microalbuminuria. These include exercise, a fever and dehydration.

For more information, see our section on causes of microalbuminuria above.

Microalbuminuria means there’s a small increase in the level of a protein called albumin in your pee (urine), compared to normal. It can be an early sign of kidney disease. Microalbuminuria can be measured with an albumin to creatinine ratio (ACR) test. You may have microalbuminuria if your ACR is 3 mg/mmol or more.

For more information, see our section: About microalbuminuria above.

The best treatment for microalbuminuria is a combination of medicines and lifestyle measures to prevent further damage to your kidneys and reduce the risk of other complications.

For more information, see our sections on self-help for microalbuminuria and treatment for microalbuminuria above.

You can do things to control your blood pressure, glucose and cholesterol levels to help to stop microalbuminuria getting worse and prevent further damage to your kidneys. These include exercising regularly, maintaining a healthy weight and stopping smoking.

For more information, see our section on self-help for microalbuminuria above.

Yes, your level of albumin may return to normal after you get treatment and may stay at a normal level for years. If you start treatment and make lifestyle changes straight away, you’ll have a better chance of reversing any damage to your kidneys from microalbuminuria, or at least slow down its progression.

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