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Family Health Magazine
DIABETES

Microalbuminuria
A signal that you could develop health problems

The kidneys, which make urine, work by filtering blood through very small blood vessels. When someone has diabetes, these small vessels can become damaged. The vessels may begin to leak and not be able to filter blood properly. The pressure of the blood flowing through the kidneys may also increase. One of the first signs that the kidneys are not working properly is microalbuminuria.

Microalbuminuria - a signal

Microalbuminuria (MAU) is not an actual disease. Instead, it is a very early signal that some health problems could be developing. It means there are small amounts of albumin, a protein from the blood, in the urine. If the kidneys are filtering blood well, they do not allow albumin to go into the urine.

Why is it important to be tested?

If your doctor has decided to test you for microalbuminuria, it is probably because you have diabetes or high blood pressure. The kidneys are directly affected by these conditions. Proper treatment for diabetes and high blood pressure can help prevent further kidney damage and disease.

Many problems can develop if the kidneys do not work as they should. One of the problems is that the kidneys may become unable to excrete (remove from the body) drugs used to treat different conditions. This can result in a drug building up in the body, and changes to the dose may be needed. A change in dose will help to ensure that the levels of medication in the blood do not become too high and lead to medication side effects. It is better for your doctor to choose drugs that can lessen this build-up. Ask your doctor for more details.

As mentioned earlier, the kidneys work by filtering blood through very small arteries. So testing for albumin provides your doctor with information about the health of all the other arteries in your body. Microalbuminuria is an early indication that heart disease may lie ahead if you do not get proper treatment.

Inside Your Kidney
• Blood flows through the kidney at high pressre in cortex which helps to force small molecules through the wall into the tubules.
• Water, sodium and essential salts, glucose and amino acids are reabsorbed into the blood.
• The loop of Henle is concerned with the reabsorption of water and the maintenance of acid-alkaline balance.
• Unwanted salts, urea and water leave as urine.

Good news about microalbuminuria

Finding albumin in your urine has one significant advantage: it allows for early change in your treatment. When the problem is found at a very early stage, while the damage to your kidneys or heart is still minor, the damage can be reversed.

Can microalbuminuria be treated?

Yes, with both lifestyle changes and medication.

Lifestyle changes
The first way to correct microalbuminuria is to remove any factors that might make it worse.

• Smoking: if you smoke, it is vital that you stop without delay.
• Obesity: if you are overweight, controlling your weight is important. Your doctor may recommend changes to your diet.
• Cholesterol: if you have high cholesterol, follow your doctor’s instructions to correct this.
• Blood pressure: in addition to stopping smoking and watching your weight, eating a diet low in salt, fats and simple sugars can help control your blood pressure.

Medications
An essential aspect of treatment, especially if you have diabetes, is to control the level of sugar in your blood. This may help prevent the development of constant microalbuminuria.

Most drugs used to treat high blood pressure will reduce microalbuminuria by lowering your blood pressure. However, certain blood pressure drugs, called ACE inhibitors, have benefits beyond blood pressure control. These reduce microalbuminuria further through their helpful effects on the kidneys.

How do I know if my microalbuminuria is under control?

You can use a simple dipstick test to see if your medication and your own efforts are working. Small dipsticks are available which allow you to test your urine and read the results at home.

If you do the test yourself, you should be aware that small amounts of albumin in your urine are normal in certain situations. For instance:

• if you have a fever.
• after running or walking a long distance.
• if you have a urinary tract infection.

Do not do this test if you have a fever or an infection. As well, the urine should always be tested in the morning to avoid the effect of physical exercise on microalbuminuria.

This test should be done every three months. There is no point testing yourself more often, because microalbuminuria does not vary much from day to day. Discuss your test results at your next visit with your doctor.

Follow-up

The test results will help your doctor provide effective treatment. There are three reasons why the test might continue to show albumin in your urine even with treatment.

• You are not taking your medication every day as prescribed.
• You should have a higher dose of your medication.
• Your high blood pressure or diabetes is becoming more severe.

Your part in the treatment process

By testing for microalbuminuria, and treating diabetes or high blood pressure, your doctor is focusing on prevention rather than waiting for you to develop a possibly life-threatening illness. The only treatment options at the end-stage point of kidney disease are dialysis and organ transplantation.

It is up to you to follow your doctor’s advice and carefully follow the prescribed treatment. If you do this now, your future will be much healthier.