I am on an ACE inhibitor for kidney protection. Recently, I had a 24 hour urine done and my microalbumin (protein, urine 24 hour) with a result of 74.0 mg/24 hour with limits of 30.0 to 150.0. I was told by my endocrinologist that it was elevated, but for having diabetes for 38 years, it is expected. I am confused. What are the normal results for this test? She stated that 74.0 was elevated. What does the limits of 30.0 to 150.0 mean? Should I be concerned with these results? Are there other preventative actions I should be taking? All other blood work for kidney function were normal.

It should be pointed out that laboratory tests that measure total protein in the urine are different from those that measure just microalbumin. Albumin is only one type of protein measured in the total protein assay. It is more specific to measure just albumin or microalbumin as this is more tightly associated with the pathophysiology of diabetes involvement of the kidneys. My suggestion to you is to speak with your physician about doing a test for microalbumin. It can now be accurately measured with a random collection when the laboratory measures both albumin and creatinine in the specimen. Microalbuminuria in a patient with diabetes greater than 30 years suggest you are at low risk for progression to chronic renal failure. However, I agree that ACE inhibitor therapy is good treatment for kidney protection. The ACE inhibitor should be titrated up to the maximum dose to normalize the albumin excretion or until you cannot go any farther because of maximum dose or side effects. Blood pressure and serum potassium levels should be monitored. Blood pressure goals should be for levels less than 130/80 mm Hg. It is also important to know there is a degree of interindividual variability in measuring albumin excretion. False positive levels can occur with vigorous exercise, a high protein diet, or high blood sugars.

JTL