From the Guidelines
For a patient with significant proteinuria (ACR of 93 mg/g), the initial management should focus on confirming the diagnosis and identifying the underlying cause, with referral to a nephrologist recommended for further evaluation and potential kidney biopsy. The workup should include:
- Repeating the ACR measurement to verify the result, as a single elevated value may not be diagnostic 1
- Ordering a 24-hour urine protein collection to quantify total protein excretion
- Comprehensive metabolic panel
- Complete blood count
- Urinalysis with microscopy
- Serum albumin level
- Renal function tests (BUN, creatinine) to assess kidney function
- Ultrasound of the kidneys to evaluate kidney size and structure
Treatment typically begins with an angiotensin-converting enzyme inhibitor (ACE inhibitor) such as lisinopril 10-40 mg daily or an angiotensin receptor blocker (ARB) like losartan 50-100 mg daily, which reduce proteinuria and slow kidney disease progression 1. Blood pressure should be controlled to a target of <130/80 mmHg. Lifestyle modifications including sodium restriction (<2g/day), moderate protein intake (0.8g/kg/day), and regular exercise are important. Patients with diabetes should maintain tight glycemic control with a target HbA1c <7%. These interventions are effective because they reduce intraglomerular pressure, decrease hyperfiltration, and minimize podocyte damage, thereby protecting kidney function and reducing protein leakage 1.
Given the patient's ACR of 93 mg/g, which is above the threshold for significant albuminuria, referral to a nephrologist is recommended for further evaluation and management, as outlined in the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Workup for Proteinuria with ACR 93
The workup for a patient with significant proteinuria, indicated by an Albumin to Creatinine Ratio (ACR) of 93, involves several steps:
- Assessment of proteinuria: Quantification of proteinuria is important in the assessment of chronic kidney disease (CKD) 2.
- Urinalysis: A urinalysis can help identify the presence of proteinuria, hematuria, or other abnormalities in the urine 3.
- Blood tests: Blood tests, such as complete blood count (CBC), blood urea nitrogen (BUN), and serum creatinine, can help assess kidney function and identify potential causes of proteinuria 4, 5.
- Imaging studies: Imaging studies, such as ultrasound or CT scans, may be ordered to evaluate the kidneys and urinary tract for any abnormalities 3.
Management of Proteinuria
The management of proteinuria depends on the underlying cause and severity of the condition:
- Lifestyle modifications: Lifestyle modifications, such as dietary changes and exercise, can help reduce proteinuria and slow the progression of CKD 3.
- Medications: Medications, such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), can help reduce proteinuria and slow the progression of CKD 2.
- Monitoring: Regular monitoring of proteinuria, kidney function, and other health parameters is essential to adjust treatment and prevent complications 3, 6.
Laboratory Parameters
Certain laboratory parameters, such as neutrophil-to-lymphocyte ratio (NLR), can be associated with proteinuria and its severity in patients with type 2 diabetes mellitus 6.