From the Guidelines
Diabetics should undergo annual urine testing for albuminuria, specifically using the morning spot urine albumin-to-creatinine ratio (uACR), to monitor kidney function and detect early signs of diabetic nephropathy, as recommended by the most recent guidelines 1. The standard recommendation is to perform uACR testing at least once a year for type 2 diabetics and annually after five years of disease for type 1 diabetics.
- This testing is crucial for early detection of microalbuminuria, which allows for timely intervention with medications like ACE inhibitors or ARBs to slow kidney disease progression.
- The uACR should be measured using a morning spot urine sample, and if this is not possible, all urine collections should be at the same time of day, with the individual being well hydrated and not having ingested food within the preceding 2 hours or exercised 1.
- Semiquantitative uACR dipsticks can be used to detect early kidney disease and assess cardiovascular risk when quantitative tests are not available, with a moderate level of evidence 1.
- Regular urine testing is essential because kidney damage can occur silently for years before symptoms appear, and early intervention significantly improves outcomes, reducing morbidity, mortality, and improving quality of life.
- Patients with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² and/or albuminuria >30 mg/g creatinine should be monitored twice annually to guide therapy, as recommended by previous guidelines 1, but the most recent guidelines 1 suggest repeating the uACR every 6 months to assess change among people with diabetes and hypertension.
From the Research
Urine Test for Diabetics
- A urine test is often ordered for diabetics to check for kidney damage or disease, as diabetes can increase the risk of kidney problems 2, 3, 4.
- The urine albumin-to-creatinine ratio (UACR) is a sensitive and early indicator of kidney damage and should be used routinely to assess kidney health in diabetic patients 2.
- Microalbuminuria, which is the presence of small amounts of albumin in the urine, is an important diagnostic tool for detecting early kidney damage in diabetics 4.
- There are different types of urine tests that can be used to detect microalbuminuria, including timed urine samples and random spot samples, with the albumin to creatinine ratio (ACR) being a commonly used test 5.
- Urinary tract infections are more common in patients with type 2 diabetes mellitus, and diagnosis and management of these infections are important to prevent complications 6.
- Biomarkers such as transferrin, type IV collagen, and N-acetyl-beta-D-glucosaminidase may be useful in detecting incipient nephropathy and risk assessment of cardiovascular disease in diabetics 3.