The initial signs of kidney damage include microalbuminuria in diabetes, identifying which is important to determine treatment tactics.
As a rule, due attention is not paid to the condition of the kidneys. This is explained by the long, long-term development of nephropathy with scanty symptoms.
But it ultimately leads to kidney failure. The ability to prevent the formidable complication of hypoinsulinism – glomerulosclerosis – depends on how quickly the diagnosis is made.
What is albuminuria?
Albumins are one of the types of proteins produced in the liver and present in the blood plasma. Their volume makes up about 60% of all proteins.
The functions that albumins perform are important for:
- stable osmotic pressure in body systems;
- transportation of products produced both by internal organs (bilirubin, fatty acids, urobilin, thyroxine) and coming from outside;
- creating a protein reserve.
Albumin molecules are small in volume, have the greatest mobility and are the majority.
Therefore, when the filtration function in the kidneys is impaired, they are the first to be lost. The appearance of a small amount of proteins in the urine - microalbuminuria - is characteristic of the initial level of diabetic kidney damage.
The insidiousness of this stage is the absence of external manifestations of the lesion, but the pathological process continues to develop. After a few years (12-15) from the manifestation of diabetes, the stage of proteinuria begins - a clear loss of protein by the body.
Here the symptoms of the disease are already obvious: swelling, increased blood pressure, weakness. The progression of the pathology leads to the uremic stage - renal failure develops.
Thus, kidney damage in diabetes goes through the following stages:
- microalbuminuria;
- proteinuria;
- uremia.
The loss of even a small amount of proteins already indicates significant kidney damage. But at the first stage, with timely treatment, it is possible to stop the process.
Expert opinion
Guseva Yulia Alexandrova
Specialized endocrinologist
It is important to identify the pathology at an early stage, even before clinical signs, when therapy is effective.
The role of albumin in the human body
Proteins, in particular albumins, are the main material for all cells of the body. They maintain the balance of fluid and microelements between cellular and extracellular structures. Albumin is necessary for the functioning of all organs and systems.
Most proteins are synthesized from amino acids in liver cells. After this, they enter the systemic bloodstream and are distributed throughout the body. The synthesis of some proteins requires essential amino acids from food. The loss of such proteins in the urine is observed in serious pathologies and threatens the body with serious consequences.
How to properly take a urine test for microalbuminuria in diabetes mellitus?
When diabetes is diagnosed, the patient must periodically take a test for microalbumin in the urine for early recognition of changes in the renal structures.
The usual method for such diagnosis is not effective. For a more accurate determination, radioimmune, immunoenzyme, and immunoturbidimetric methods are used in the laboratory.
It is better to collect the analysis within 24 hours in a clean 3-liter jar. Then sequentially:
- the liquid is stirred;
- 150 ml is poured into a sterile container;
- The laboratory assistant is given information about the total amount of urine.
The level of albumin loss varies depending on time and body position.
Thus, their excretion increases in an upright position, with exercise, protein nutrition, urological infection, heart disease, and smoking. Old age, obesity, and race also affect the results.
Before collecting the analysis, you must:
- reduce the preliminary intake of proteins, salt, products that color urine, and water with food;
- maintain physical peace and avoid agitation;
- do not expose the body to temperature changes;
- no smoking;
- Carry out a hygienic procedure before collecting urine.
There is a quick method for determining microproteins (sensitive strips).
With their help, you can conduct an analysis at home in a few minutes. The results are clearly visible when comparing the colored area of the strip with the scale marked on the packaging. The sensitivity of the test is high, but if the result is negative, it is better to repeat the analysis in the laboratory.
Expert opinion
Guseva Yulia Alexandrova
Specialized endocrinologist
It is important to regularly use all available methods to monitor kidney function. Correct collection of analysis will help avoid diagnostic errors.
Preparing for analysis
To maximize the information content of a urine test for UIA, proper preparation for the analysis is necessary.
Before the planned collection of biomaterial it is necessary:
- exclude fruits and vegetables from the diet that change the color of urine per day;
- carry out hygiene of the external genitalia immediately before collecting urine;
- Biomaterial should be collected in the morning on an empty stomach.
If the patient takes medications on an ongoing basis, before taking the test, a consultation with a doctor is necessary, who will determine the advisability of stopping taking medications for a day.
Norms for healthy people and diabetics
Healthy people also excrete small amounts of proteins. The normal amount of protein is about 150 mg/dl, and albumin is less than 30 mg/dl in a single serving.
Daily losses are up to 30-300 mg/day. An increase in indicators may indicate pathology.
When it is difficult to determine the time at which urine was collected, the ratio of albumin to creatinine is determined. In men, this figure is slightly lower - 2.5 mg/µmol is normal. For women – 3.5 mg/µmol. The increased numbers indicate the painfulness of the process.
Considering that the excretion of albumin in urine depends on many factors and can be detected sporadically in a healthy body, it is recommended to do three consecutive tests over 3-6 months.
Expert opinion
Guseva Yulia Alexandrova
Specialized endocrinologist
If you have diabetes, it is important to regularly monitor urine tests for microalbumin.
Stages of nephropathy
Impaired kidney function occurs in stages that are characterized by certain features.
Initial manifestations
Analysis for MAU shows the presence of microalbumin. There are no external symptoms.
Prenephrotic changes
The patient experiences fluctuations in blood pressure, the kidneys filter fluid slowly, and in urine the protein concentration level is 30 - 300 MHz/day.
Nephrotic changes
The patient’s kidneys reduce their filtration capacity, resulting in edema, increased blood pressure, proteinuria, and microhematuria. Sometimes urea and creatinine levels increase.
Uremia
Blood pressure reaches high levels that cannot be treated. Edema, hematuria and proteinuria appear. In the analysis, the number of red blood cells, creatinine, and urea increases. With heart pathology, the patient experiences chest pain, sometimes on the left side.
If, when analyzing for UIA, the norm is too high, you should adhere to proper nutrition and undergo regular examinations by specialists who will prescribe restorative and corrective medications. The earlier the disease is diagnosed, the more effective therapeutic measures are.
A urine test for microalbumin content (MAU) is one of the most informative tests that allows you to assess the patient’s health status.
This type of examination is important if there is suspicion of damage to the kidney tissue.
In this case, the concentration of microalbumin reflects the degree of damage to the excretory organ.
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Reasons for rejecting study results
Kidney damage in both type 1 and type 2 diabetes is associated with specific damage:
- metabolic systems;
- vessels (arterioles).
Insulin deficiency leads to thickening of the main membrane of glomerular capillaries and an increase in the intervascular lumen due to increased attachment of sugar to molecules.
The vascular factor in the initial diabetic disorder affects the increase in glomerular filtration rate, which causes an increase in pressure within the capillaries. The glomeruli hypertrophy and vascular permeability increases. This promotes the penetration of albumin into urine.
Treatment and normalization of microalbuminuria in diabetes mellitus
Diabetology has achieved significant results in the development of diabetes treatment methods. New drugs are constantly being created to replace endogenous insulin.
This section of medicine also deals with the selection of individual diets and primary prevention, which aims not only to treat diabetes, but also to reduce its occurrence.
At the stage of microalbuminuria, which is already a complication of the disease, it is necessary:
- closely adjust the carbohydrate metabolism of drugs (mainly by switching to insulin options);
- even with a slight increase in blood pressure, use ACE inhibitors or an analogue group (if they are intolerant), as they have nephroprotective properties;
- use statins in therapy;
- undergo a course of treatment with angioprotectors and antioxidants.
In addition, it is necessary to follow a certain regime in:
- nutrition (limiting simple carbohydrates, fried, spicy, salty);
- work and rest (do not overexert);
- physical activity (regular physical exercise with dosed exercise);
- healthy functioning (without harmful addictions).
Expert opinion
Guseva Yulia Alexandrova
Specialized endocrinologist
Following all recommendations for treatment and prevention at the stage of microalbuminuria will significantly improve the condition and prolong life.
Features of urine collection
Urinalysis for diabetes mellitus and its indicators are the basis for monitoring and correcting the patient’s pathological condition. There are a number of rules for quality collection of material.
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This approach will avoid false indicators and show accurate results:
- The urine collection container must be sterile to avoid the possibility of inaccuracies.
- Before the procedure, perform personal hygiene of the external genitalia.
- The qualitative composition of urine is maintained for 2 hours, so it is important to quickly deliver the material to the laboratory.
- Avoid taking any medications, especially potent ones.
- Stop intense physical and psychological stress.
- Carefully monitor your diet, exclude fried and sweet foods on the eve of the test.
By following all the recommendations you can get an effective result. During the study, attention is also paid to the color of urine; impurities indicate concomitant diseases of the excretory system.
In order for laboratory test data to be reliable, it is necessary to adhere to the basic rules for collecting urine for UIA analysis. So, first of all, you need to prepare. A day before the tests, vegetables and fruits that change the color of urine are completely excluded from food - these are carrots, strawberries, mulberries, currants and others.
You also need to take care of the urine jars. The ideal option is a special plastic container, which is sold in a pharmacy. But if you don’t have one, you can take any plastic or glass container with a lid, wash it well, dry it and treat it with alcohol before use. About one hundred milliliters of material is enough to carry out an analysis on Mau. After collection, the material must be sent to the laboratory within one or two hours.
