Blood Glucose 155 mg/dL and eGFR 85 mL/min/1.73 m² with Urinalysis: Additional Concerns
Without seeing the actual urinalysis results, I cannot provide a complete assessment, but based on your blood glucose of 155 mg/dL and eGFR of 85 mL/min/1.73 m², you should immediately check the urinalysis for albuminuria (protein in urine), as this is the critical missing piece that determines your kidney disease risk and need for treatment.
What You Need to Look For
The most important finding on your urinalysis is the urine albumin-to-creatinine ratio (uACR):
- Normal (A1): <30 mg/g creatinine
- Moderately increased (A2): 30-300 mg/g creatinine
- Severely increased (A3): >300 mg/g creatinine
Your Current Status
Blood Glucose
Your glucose of 155 mg/dL suggests either:
- Pre-diabetes (if fasting)
- Diabetes that may not be optimally controlled
- Post-prandial elevation in someone with diabetes
This level warrants HbA1c testing if not recently done 1.
eGFR Assessment
Your eGFR of 85 mL/min/1.73 m² falls in the normal to mildly decreased range (Stage G1-G2). This is generally reassuring, but:
- Stage G1: eGFR ≥90 mL/min/1.73 m²
- Stage G2: eGFR 60-89 mL/min/1.73 m²
At this eGFR level, you do NOT have chronic kidney disease unless albuminuria is present 1, 3, 4.
Risk Stratification Based on Missing Urinalysis Data
If uACR is <30 mg/g (Normal):
- Low risk - No CKD present
- Annual screening recommended
- Focus on glucose control to prevent future kidney disease
- No specific kidney-protective medications needed beyond glucose management 1, 5
If uACR is 30-300 mg/g (Moderately Increased):
- Moderate risk - Stage A2 albuminuria present
- This defines early diabetic kidney disease even with normal eGFR
- Start ACE inhibitor or ARB for kidney protection 1, 5, 3
- Consider SGLT2 inhibitor (like empagliflozin or dapagliflozin) to reduce CKD progression and cardiovascular events 1, 4
- Recheck uACR every 6 months 5
- Optimize blood pressure control
- Target HbA1c <7% (individualized) 1
If uACR >300 mg/g (Severely Increased):
- High risk - Stage A3 albuminuria present
- This represents established diabetic kidney disease
- Strongly recommended: ACE inhibitor or ARB 1, 5, 3
- Strongly recommended: SGLT2 inhibitor if eGFR ≥20 mL/min/1.73 m² 1, 4
- Consider nonsteroidal mineralocorticoid receptor antagonist (finerenone) if eGFR ≥25 mL/min/1.73 m² and potassium normal 1, 4
- Goal: Reduce albuminuria by ≥30% to slow CKD progression 1, 3
- Recheck uACR every 3-6 months
- Screen for CKD complications (anemia, bone disease, electrolytes) 6
Additional Urinalysis Red Flags
Beyond albuminuria, check for these concerning findings that suggest non-diabetic kidney disease requiring nephrology referral 1, 3:
- Gross hematuria (blood in urine visible to eye)
- Active urinary sediment (red blood cells, white blood cells, or cellular casts on microscopy)
- Rapidly increasing proteinuria
- Nephrotic-range proteinuria (>3.5 g/day)
Common Pitfalls
Don't assume normal eGFR means no kidney disease - Albuminuria can occur with preserved eGFR and still indicates significant kidney damage and cardiovascular risk 1, 3
Don't delay treatment waiting for "worse" numbers - Early intervention with SGLT2 inhibitors and ACE/ARB prevents progression 1, 4
Don't use a single uACR measurement to diagnose CKD - Confirm with repeat testing, as biological variability is >20% 5, 3
Don't stop ACE/ARB for creatinine increases ≤30% unless volume depletion present 5, 7
Don't forget cardiovascular risk - Albuminuria predicts heart disease and stroke independent of kidney function 8, 7
Immediate Next Steps
- Obtain quantitative uACR if not already done (not just dipstick) 2, 3
- Check HbA1c to assess chronic glucose control 1
- Measure blood pressure - optimize to <130/80 mmHg if albuminuria present 1
- If albuminuria ≥30 mg/g: Start ACE inhibitor or ARB and SGLT2 inhibitor 1, 4
- Repeat uACR in 3 months to confirm persistence and assess treatment response 5, 3