I am 30 years old, have had type 1 diabetes for 23 years, and my recent urine microalbumin was 857 (normal: 0-19). What is microalbumin? What does this test mean? I can’t find any answers.

Albumin is a protein that is screened for in the urine. It is used as a marker for diabetes-related kidney disease. Microalbumin refers to the test which measures small amounts of albumin. This originally meant that albumin levels could be measured at amounts less than could be tested for by standard dipstick urine tests for protein. In addition, albumin is more specific for kidney abnormalities than total protein.

Normally, albumin is not in the urine because its size and charge do not allow for it to be filtered into the urinary space by the kidney. However, with diabetes, there is a change in the charge and the size selectivity within the kidney which allows albumin to show up. False positives can occur with high protein diet, high glucose levels, and exercise. However, the result you have is not borderline.

Previous reports indicated that with the onset of microalbuminuria, there was an 80% chance of having kidney progression to overt nephropathy. However, these results are too generous. Current estimates indicate that once microalbuminuria occurs, there is a 40-45% risk of progression to overt kidney disease.

The thing to do is see your doctor and make sure you have a strategy for addressing this. First, make sure a second urine test is performed to verify the persistent elevation of protein in the urine. Second, intensify blood sugar control and blood pressure control. You should probably be on an ACE inhibitor as these medications have been shown to provide kidney protection in individuals at risk of developing progressive kidney dysfunction with diabetes. ACE inhibitors are blood pressure-lowering medications. They also decrease the amount of albumin in the urine. Finally, you should make sure your cholesterol levels are aggressively managed.

JTL