Microalbumin and Microalbumin/Creatinine ratio

I guess the other thing I would add is when we did the infinity meta-analysis, which now includes Figaro and Fidelio, so people with diabetes, as well as people without diabetes, we see very similar results.

And in the highest-risk group by both UACR and EGFR, as you alluded to, the rates of hyperkalemia are higher, which is expected.

But again, the difference was about 15% to slightly less than 20%.

And even in that group of people, it was manageable, did not lead to drug discontinuations.

And actually, the estimated GFR goes into the base equation.

Those are things that go the A1C and the social deprivation index along with UACR go into the optional equation.

But it's a fancier equation.

It's a smarter equation that gives us more accurate risk estimates.

Yet your urine albumin creatinine ratio is your most important predictor of kidney disease and cardiovascular disease.

It should be a routine part of a well-person check, UACR, along with blood pressure and kidney function.

And then we would pick up a lot more kidney disease earlier and intervene much, much earlier and slow that progression down.

And that's really what we need to see, this increased awareness of that association.

Somebody with metabolic syndrome are going to have that.

So there's lots of potential ones that contribute to that, but that comes back to that assessment.

What is it doing? Where is it at? And any elevated UACR, yes, it needs to be repeated.

I wouldn't act on one single result, just like kidney function and blood pressure.

But we want to identify that in a timely fashion.

And people who are higher risk, we want to use both eGFR, estimated GFR, and UACR, urine albumin creatinine ratio.

But these are important metrics to be incorporating into practice.

And then additional things to look at are fatty liver disease or metabolic dysfunction associated steatotic liver disease is exceptionally common here.

Now, number two, and this is what I've been suggesting throughout this episode, is you want to check your urine albumin to creatinine ratio.

That's also known as the UACR.

And this is the one to fight for with your primary care physician.

It's basically seeing if there's any protein leaking into your urine, and it's creating a ratio with the amount of creatinine in your blood.

So how do you choose that? So either they had to have a GFR of twenty-five to sixty Uh, with a lower level of albuminuria.

Lower level still being, you know, some albuminuria, so, uh, UACR of 200 to 500 milligram per gram.

Uh, but this group with, you know, with less than 500 milligram per gram, they had to have a GFR of less than 60a, and the total population in the trial, this was capped at 10% because they did not-

10%

It's gonna be a little bit trickier.

Um, and do I wanna just give up and start 'em on amlodipine and call it a day? Because I know I'm not gonna have to call 'em back in.

And so I think that's where really looking at the, at these types of subgroup analyses really helps me kind of make decisions like, do I want to even bother starting this in someone whose GFR is less than forty-five? Do I wanna even bother pushing for this in someone whose, uh, UACR is really not that high? Maybe their U- UACR is only, you know, is, is less than a thousand.

So I think that knowing that that effect is consistent across lower, um, lower albuminuria or across SGLT2 inhibitors or in lower GFRs is really useful information for me, even though it's consistent, like, and that makes it almost sound like a nothing burger.

Urinalysis was normal.

UACR was normal.

Results showed aldosterone of 18.

Renin was suppressed below the assay's lower limit, which of course then gives the person an elevated aldosterone to renin ratio.

Is the proteinuria significantly albuminuria or not? That is the first question to answer.

So you, you have a very high UPCR, but you don't have that much high ACR.

We usually do both of them together.

If there's no correlation, it means that there's a lot of protein coming in the urine, but not a lot of albumin.

Protein can come from any level.

It could be tubular protein, it could be some abnormal protein like, uh, light chains.

Okay? So if you see a discrepancy in the PCR and the ACR, think on the lines of myeloma.

Okay? Uh, but obviously that has to be coupled with the fact that, you know, they have got, uh, they have got anemia, they've got, you know, kind of bone, uh, disorder, they've got hypercalcemia, they've got a suggestive history as well.