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Diabetic Microalbuminuria Guidelines

Annual screening test:

  • send urine sample (first pass) for ACR (and MSU) for culture, measure eGFR
  • If ACR  between 3.0 - 30.0 repeat x2 within next 3 months

What next:

If microalbuminuria confirmed (ACR 3 - 30 mg/mmol) in 2 samples and eGFR >60 (stage 1 or 2 CKD) then:

  • optimise glucose control - target HbA1c 48 - 59 mmol/L ( 6.5 - 7.5%) depending on individual patient circumstances and comorbidities
  • start statin (target cholesterol < 4.0mmol)
  • management as for stage 2 CKD
  • start ACEi / ARB and follow treatment plan if hypertensive
  • annual ACR, monitor eGFR, HbA1c, cholesterol, blood pressure

If ACR 30 - 60 mg/mmol and eGFR >60 then follow  plan above, consider referral

If eGFR 30 - 59 and stable then follow treatment plan above and consider routine referral - if indicated to Dr T Pickett at GRH, or Dr A Evans at CGH (joint renal diabetes clinics)