Diabetic Microalbuminuria Guidelines
Annual screening test:
- send urine sample (first pass) for ACR (and MSU) for culture, measure eGFR
- If ACR >2.5 (men) or >3.5 (women) 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)