Some patients progress to end stage renal disease (ESRD) more rapidly than others. Some patients never progress to ESRD. It is important to monitor all patients with CKD.
Those at highest risk for rapid progression must be identified and treated aggressively.
Risks for progression include:
- diabetes, especially when associated with high levels of albuminuria
- high blood pressure
- increasing albuminuria
- decreasing estimated glomerular filtration rate (eGFR)
Monitoring urine albumin can assess response to therapy and progression of disease. Reducing urine albumin excretion to the normal or near-normal range may improve renal and cardiovascular prognoses.
Urine albumin is a continuous risk factor. UACR greater than 30 mg/g is considered abnormal. Traditionally, 30-300 mg/g has been called microalbuminuria and greater than 300 mg/g has been called macroalbuminuria. However, the 300 mg/g cut-off merely represents a rough correlation with the lower limit of sensitivity of the traditional urine dipstick and does not reflect physiologic threshold.
More frequent monitoring may be indicated in patients with changing clinical status or after therapeutic interventions.