Check for microalbuminuria

Your pee can give you clues about your risk for heart or kidney disease.


Breakthroughs in the technology of medical testing offer a new and incredibly effective new way of catching heart disease in the bud. Testing for microalbuminurea in your urine can now predict how prone you are to heart disease!

When an individual’s urine has small but abnormal amounts of protein, this is referred to as microalbuminurea. This is measured at a time when the amounts are so small that they do not show up in the conventional dipstick method. (30-300mg of albumin excretion by the kidneys over a period of 24 hours.)

The dipstick method of measuring albumin in the urine, only detects protein excretion that exceeds 300 mg per 24 hours. This is the standard range that is currently denoted as macroalbuminuria, or gross proteinuria(high levels of protein in the urine). With new testing, even smaller levels of protein in urine can be spotted, which means that conditions like kidney and cardiac disease can be spotted at a very early stage and steps can be taken that may even be able to reverse the condition!

‘Albumin’ is the most common protein found in blood. In people with normal blood levels, the kidneys will not allow albumin to be excreted. So when there is albumin in the urine, it’s a sign that something may be wrong. Microalbumin in the urine is an early indicator of kidney disease. Microalbuminuria is almost unheard of in childhood and before adolescence. Factors that contribute to the incidence of microalbuminuria are: duration of diabetes, high blood pressure, genetic susceptibility.

Microalbuminuria is most commonly associated with diabetic nephropathy (kidney disease setting in as a result of diabetes), but there are other causes, which include glomerulonephritis, amyloidosis and other forms of kidney disease. Detecting microalbuminuria early is important because it is often a sign that the patient may be at risk of developing overt proteinuria (macroalbuminuria) and renal failure. It is also a risk factor for cardiovascular disease.

Nephrologists and diabetologists have been measuring microalbuminuria in their patients to check for the development and progression of kidney disease. But urine is also being increasingly recognized as a sensitive predictor for cardiovascular risk. Studies show a clear relationship between microalbuminuria and cardiovascular events. If this is identified early, medication can be used to work against the condition and have a beneficial effect on the cardiovascular system.

At present the incidence of type 2 diabetes is increasing world-wide, with half the population unaware that they are diabetic. The result is an increase in deaths that are caused by end-stage renal disease and cardiovascular disease. Type 2 diabetes mellitus is a silent killer, bringing with it many life-threatening complications on different organs like the kidney and heart. So there is a need for early identification of patients who are at greatest risk. By spotting the risk early, patients can start on renal and cardiovascular protective treatments early and have better quality of life.

As with every test, microalbuminuria too has the drawback of having false positive results. False positive reports happen when the patient has done strenuous exercise or has urinary tract infection, or severe hypertension, or some prolonged illness. But the chances of false positive in microalbuminuria are minimal. The best part of this new finding is that now, we can spot the onset of two potentially lethal conditions right when they start, and that too with something as simple as a urine test!

Facing Diabetes

Article by Dr. Sreejith N. Kumar, Chairman of the Indian Diabetes Association and President of the Indian Medical Association, Thiruvananthapuram. Dr. Sreejith took his MBBS from Thiruvananthapuram Medical College and Masters in Medicine from Armed Forces Medical College, Pune. He also has a Diploma in Diabetology from Vuk Vrhovac Institute, Zagreb, World Health Organisation Collaborating center. He is the Editor of the Kerala Medical Journal and the Secretary of the Thiruvananthapuram Diabetes Club.

When your body is not making any insulin or isn’t making enough, your body can’t convert blood sugar- glucose- into fuel for your body’s cells. This condition is diabetes, an illness that is growing on a global scale. Find out the causes, symptoms and diagnosis of diabetes.

what is diabetes?

     Diabetes simply means an increased amount of glucose in blood. However the condition is not as simple as one might think, in terms of the disease per se and its causes.Most of the food we eat is turned into glucose, a form of sugar. We use glucose as a source of energy to provide power for our muscles and other tissues. Our bodies transport glucose in our blood. In order for our muscles and other tissues to absorb glucose from our blood, we need a hormone called insulin. Without insulin, our bodies cannot obtain the necessary energy from our food.

     Insulin is made in a large gland behind the stomach called the pancreas. It is released by cells called beta cells. When a person has diabetes, either their pancreas does not produce the insulin they need, or their body cannot use its own insulin effectively. Many new mechanisms leading to high blood glucose have recently been described. We will see some of the details later.

            People with diabetes cannot use enough of the glucose in the food they eat. This leads to the amount of glucose in the blood increasing. This high level of glucose or “high blood sugar” is called hyperglycaemia.All of us have glucose in our blood. Normally, it is <100 mg/dl before food and <140mg/dl after meal. In a diabetic patient this level increases to >126 mg/dl before and >200 mg/dl after food. The values in between Diabetes and normal ranges include impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). These conditions are otherwise called pre-diabetes. Thus we have three sets of values as shown in the table below.

To see the full online flipper version of this article, click this link and search archives for the August 2011 issue. On clicking the thumb image of the cover you can read the whole magazine online.

There are many ways to check the blood glucose values. Usually we check the glucose level in the blood, drawn from a vein using a syringe or from the capillaries obtained by a finger prick. A fasting sample has to be taken after eight hours of overnight fasting. After meal blood is drawn two hours after breakfast. Ideally the post meal value should be obtained from a blood sample drawn two hours after consuming 75gm glucose dissolved in a glass of water.

                Diabetes is usually associated with some symptoms like Increased thirst, urination and unexplained weight loss.  If someone has these symptoms even one value of blood glucose more than 200 mg/dl will define diabetes. However, if someone does not have the classical symptoms of Diabetes, then a repeat check up done on a different day also has to be abnormal before the person can be labeled as Diabetic. Another method to diagnose Diabetes is by doing a test called HbA1C. Hb (Hemoglobin) is the pigment which gives red colour to blood. Some of the  Hemoglobin in the blood would combine with glucose. This is known as glycated Hemoglobin (Hb A1C). The glycated hemoglobin level can be estimated by some special techniques. The normal level is <5.4 %. If it’s more than 6.5%, the person is diabetic. Estimation of HbA1C has an advantage over blood glucose. The lifespan of the red blood cells is three months. Hence glycated hemoglobin gives an estimate of the blood glucose over the past three months. Blood glucose estimation can tell us the value only at that particular point of time. However HbA1C estimation has some limitations as well. In our country the standardization is not proper and all the A1C results we get may not be accurate. HbA1C estimation is difficult and also is eight to ten times more costly than blood sugar estimation and is therefore not yet very popular in India for diagnosis of Diabetes.
                If someone has  the symptoms of Diabetes he should check the blood glucose value to find out whether they are high. Even if there are no symptoms it is good to check blood glucose once in a while. We have some specific guidelines in this regard which will be detailed later. It is very important that Diabetes is detected and treated early. We have many new evidences coming up in this regard. So the message is clear – if in doubt check now, the earlier the better.


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