Albuminuria: how can it impact my body?

Albuminuria is a condition which can severely impact the kidneys, and may be an indicator of kidney disease. We speak to renowned consultant nephrologist  Dr Daniel Jones, who analyses the condition, including how it is detected, its impact on the body, and treatment options.  

What is albuminuria?

Albuminuria is the presence of excessive amounts of the protein albumin in the urine.

What does albuminuria mean for me?

Albumin should remain in our blood system, but it can appear in the urine when the filters of the kidney (glomeruli) are damaged. In some cases, blood can also be detected when this damage occurs.

There can be other reasons why albumin may be in the urine, and a single positive test does not necessarily mean that your kidney filters are damaged.

However, detecting persistent albuminuria provides an opportunity to intervene to prevent further damage and to protect your future kidney health.

How is the albuminuria detected?

For the majority of people/patients, this will be detected during a health assessment as part of diabetes and blood pressure care, through primary care or at a workplace private annual health check.

When albuminuria first develops, it is usually at low levels which tend to increase with time.  This can result in a decline in your kidney function.

Although rare, some people may develop sudden leg swelling (oedema) and find their urine to be frothy when high levels of albuminuria occur abruptly.

A simple test screens for albuminuria and is called, urine albumin creatinine ratio (uACR). It is able to detect a problem before urine dipsticks turn positive.

What causes albuminuria?

Albuminuria may be caused by common medical conditions such as diabetes and hypertension as well as many other conditions which may lead to kidney problems.

Does albuminuria need treatment?

When making a decision about treatment for albuminuria, it is important to consider the risk to your future kidney health and what you can do first yourself.

The risk can be assessed by a blood test to determine your kidney function and the urine albumin creatinine ratio. Once you know the level of your risk, the expected impact of evidence-based interventions for you can be determined.

If you have albuminuria, you should follow a low-salt diet and avoid non-steroidal anti-inflammatory medications such as ibuprofen. You should maintain a healthy diet, not restricting your dietary protein intake which is not the cause of the albuminuria.

It is important to ensure your blood pressure is well controlled, usually to a level less than 130/80. However, your target may not need to be as low as this if the level of albuminuria is low.  If you have diabetes, this also needs to be controlled, because without these simple measures, there is a greater risk to your kidney health.

What else can be done about albuminuria?

In some cases, albuminuria cannot be completely stopped. This will depend on what is causing it and how long it has been occurring.  However, treatments to reduce albuminuria will generally help maintain your kidney health.

A specialist will recommend a blood test to screen for a number of conditions and may recommend a kidney biopsy.  A biopsy is only recommended when there is a high risk to your future kidney health and there is concern blood tests have not excluded all potential causes.

There are a number of simple medicines that can be beneficial in treating albuminuria, such as angiotensin-converting enzyme inhibitors, angiotensin 2 receptor blockers and sodium-glucose co-transporter 2 inhibitors. These can reduce the workload on each damaged filter, allowing them to function longer.

If blood tests or a kidney biopsy identify a particular condition, more specific treatment of the condition can help to limit further damage to the kidney.

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