What measures can be taken to protect the kidneys with an elevated Microalbumin-to-Creatinine ratio and preserved eGFR?

From the Guidelines

To protect the kidneys with an elevated Microalbumin-to-Creatinine ratio and preserved eGFR, it is essential to implement interventions that slow the progression of kidney disease, focusing on optimizing blood pressure control, improving glycemic control, and adopting a kidney-friendly lifestyle. The most recent and highest quality study 1 suggests that lifestyle changes, including reasonable weight control, a healthy diet, smoking cessation, and proper exercise, are crucial in managing diabetic kidney disease. Key interventions include:

• Optimizing blood pressure control, aiming for targets below 130/80 mmHg, using ACE inhibitors or ARBs, which provide kidney protection beyond blood pressure reduction 1
• Improving glycemic control, targeting HbA1c below 7% if diabetic 1
• Adopting a kidney-friendly diet by reducing sodium intake to less than 2,300 mg daily, moderating protein consumption to 0.8 g/kg body weight, and limiting processed foods 1
• Regular exercise of at least 150 minutes weekly to improve metabolic parameters 1
• Avoiding nephrotoxic medications like NSAIDs and certain antibiotics when possible 1
• Scheduling follow-up testing every 3-6 months to monitor microalbuminuria and kidney function 1 These interventions are crucial because elevated microalbumin indicates early kidney damage and endothelial dysfunction, even when other kidney function markers remain normal, and early intervention can significantly slow progression to more severe kidney disease.

From the FDA Drug Label

The RENAAL study was a randomized, placebo-controlled, double-blind, multicenter study conducted worldwide in 1513 patients with type 2 diabetes with nephropathy (defined as serum creatinine 1.3 to 3.0 mg/dL in females or males ≤60 kg and 1.5 to 3. 0 mg/dL in males >60 kg and proteinuria [urinary albumin to creatinine ratio ≥300 mg/g])

Treatment with losartan resulted in a 16% risk reduction in this endpoint (see Figure 4 and Table 4)

Treatment with losartan also reduced the occurrence of sustained doubling of serum creatinine by 25% and ESRD by 29% as separate endpoints, but had no effect on overall mortality (see Table 4).

Compared with placebo, losartan significantly reduced proteinuria by an average of 34%, an effect that was evident within 3 months of starting therapy, and significantly reduced the rate of decline in glomerular filtration rate during the study by 13%, as measured by the reciprocal of the serum creatinine concentration

To protect the kidneys with an elevated Microalbumin-to-Creatinine ratio and preserved eGFR, measures that can be taken include:

• Using losartan as it has been shown to reduce the risk of progression of nephropathy by 16% in patients with type 2 diabetes and nephropathy 2
• Reducing proteinuria by an average of 34% with losartan therapy 2
• Slowing the decline in glomerular filtration rate by 13% with losartan therapy 2
• Controlling high blood pressure as part of comprehensive cardiovascular risk management 2
• Managing diabetes and reducing cardiovascular risk factors 2

From the Research

Measures to Protect the Kidneys

To protect the kidneys with an elevated Microalbumin-to-Creatinine ratio and preserved eGFR, several measures can be taken:

• Risk factor management: Managing risk factors such as hypertension, diabetes, and cardiovascular disease can help slow kidney function decline 3, 4, 5.
• Use of renin-angiotensin-aldosterone system (RAAS)-blocking agents: The use of RAAS-blocking agents, such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), has been shown to be effective in reducing albuminuria and slowing kidney function decline 3, 4, 5.
• Monitoring and screening: Regular monitoring and screening for kidney disease, including measurement of urine albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR), can help identify individuals at risk of kidney disease progression 3, 4, 5.
• Avoidance of potential nephrotoxins: Avoiding potential nephrotoxins, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can help prevent further kidney damage 5.
• Adjustments to drug dosing: Adjusting drug dosing to account for reduced kidney function can help prevent further kidney damage 5.

Additional Considerations

Additional considerations for individuals with an elevated Microalbumin-to-Creatinine ratio and preserved eGFR include:

• Lifestyle modifications: Making lifestyle modifications, such as maintaining a healthy diet and exercising regularly, can help manage risk factors and slow kidney function decline 5.
• Regular follow-up: Regular follow-up with a healthcare provider can help monitor kidney function and adjust treatment as needed 3, 4, 5.
• Referral to a nephrologist: Referral to a nephrologist may be necessary for individuals with advanced kidney disease or those who are at high risk of kidney disease progression 5.

Albuminuria Monitoring

Albuminuria monitoring is an important aspect of kidney disease management:

• Urine albumin-creatinine ratio (UACR) measurement: Measuring UACR can help identify individuals with albuminuria and monitor changes in albuminuria over time 3, 4, 6, 7.
• Variability in UACR measurements: UACR measurements can vary within an individual from day to day, and multiple collections may be necessary to accurately monitor changes in albuminuria 7.