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Author Topic: Fluctuating Microalbumin levels
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Post Fluctuating Microalbumin levels
on: July 12, 2013, 13:05
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I wanted to curbside on a patient. She is a type 1 diabetes with generally suboptimal control. Her urine micr/albumin to creatinine ratio over the past 2 years have fluctuated wildly as noted below:

Albumin / Creatinine, urine

571 (H)
426 (H)
2244
56
135

MicroAlbumin, urine

187.4
102.7
298.1
1.7
25.7

Would you suggest an ACE-I be added even with the downward overall trend?

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Post Re: Fluctuating Microalbumin levels
on: July 12, 2013, 13:11
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Thanks for your question. There are some inconsistencies in the values above that I would like to discuss.

1) I noticed that the UACR rose to a peak of 2.2 g/g (3rd value) and then precipitously dropped. I am wondering if the 2.2 g/g value is incorrect? I believe it is incorrect.

2) the drop in UACR is a good sign *if* there is a concomitant rise in creatinine clearance (or eGFR). In patients whose clearance/eGFR *decrease*, there will be less urinary albumin. This makes the UACR decrease and can give the impression that the patient is improving (when in reality, they are actually worsening).

Can you send me a similar trend for the eGFRs?

If the eGFRs (or clearances) are improving, I would *still* attempt to place the patient on an ACE-inhibitor or ARB. Some form of RAAS blockade would be of great benefit to this patient over the long term. Drugs like dihydropyridines can lower urinary albumin but do not have as long an antiproteinuric effect as RAAS-blocking agents.

If the eGFRs/clearances are decreasing, then additional RAAS blockade may be warranted in a "last ditch" attempt to halt progression of CKD (delay the onset of dialysis).

So I guess in both scenarios an ACE-inhibitor would have a role, but the underlying reasons would be important to know.

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Post Re: Fluctuating Microalbumin levels
on: July 12, 2013, 13:50
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BUN: 14
Creatinine: 0.63

BUN: 13
Creatinine: 0.53 (L)

BUN: 10
Creatinine: 0.51 (L)

BUN: 16
Creatinine: 0.74

Glucose (POC): 75

BUN: 12
Creatinine: 0.59 (L)

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Post Re: Fluctuating Microalbumin levels
on: July 12, 2013, 13:52
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GFR were not concommittantly with all of the urine micro/cr ratio so I sent BUN/CR and whatever GFR readings are avaialable. My own inclination is put the patient on an ACE-I. The only issue is compliance in young female who is sexually active and has not always been compliant with her diabetic recommendations.

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