What Is Albuminuria in Diabetes?

Albuminuria, also called proteinuria, is a condition in which albumin—a type of protein found in blood plasma—leaches into the urine. Although very small amounts of protein in urine can be normal, a high level of albumin is one of several indicators of chronic kidney disease (CKD), a common complication of both type 1 and type 2 diabetes.

Because albuminuria doesn't cause noticeable symptoms, people at risk of kidney disease are typically advised to be tested regularly for protein in their urine in order to detect the condition. This is so measures can be taken right away to reduce the amount of protein in urine and protect the kidneys from further damage.

This article discusses the symptoms, causes, and diagnosis of albuminuria. It also discusses the treatment of the conditions that can cause albuminuria.

What Are the Symptoms of Albuminuria?

The only outward signs of excess protein in urine are those that develop in conjunction with chronic kidney disease. There are many symptoms of CKD that can be mistaken for other problems, which is why screening is vital.

Common symptoms of advanced CKD include:

• Intolerance to cold
• Fatigue
• Dizziness
• The scent of ammonia on the breath (uremia fetor)
• A metallic taste in the mouth (dysgeusia)
• Dyspnea (shortness of breath)
• Easy bruising
• Swelling (edema) of the face
• Trouble concentrating
• Itching (pruritus)
• Loss of appetite
• Foamy urine
• Difficult or frequent urination, including at night
• Pain in the kidneys, legs, or upper back

What Are the Causes of Albuminuria?

Albuminuria can be short term or long term. Some of the short-term problems that can cause albuminuria include:

• Dehydration
• Fever or infection
• Intense exercise

Long-term conditions that can cause albuminuria include:

• Kidney disease: Healthy kidneys will prevent the albumin in your blood from getting into your urine. Albumin in your urine can be a sign of early-stage kidney disease.
• Diabetes: Long-term hyperglycemia, higher-than-normal levels of glucose (sugar) in the blood, can damage capillaries in the kidneys called glomeruli. These tiny blood vessels are bundled together to form the glomerular membrane. This structure filters waste from the blood into the urine while preventing vital substances, such as albumin and blood cells, from leaking out.
• High blood pressure: About 40% of those with untreated high blood pressure and 25% of those taking medication for high blood pressure have albuminuria. Getting your blood pressure under control can help you manage the condition. High blood pressure is a common complication of diabetes.
• Heart disease: People who have heart failure often have albuminuria. However, the reasons why aren't very well understood. It could be the result of dysfunction of the layer of cells inside the blood vessels, or due to increased pressure inside the veins. Albuminuria in heart disease tends to be associated with a poorer prognosis. 

Complications of Albuminuria

Albuminuria is associated with a number of life-threatening health problems. In general, the higher your albumin levels, the greater your risk of developing these complications:

• Heart attack
• Stroke
• Heart failure
• Kidney failure
  

People with albuminuria also have a decreased life expectancy.

How Is Albuminuria Diagnosed?

Diagnosing albuminuria is a simple matter of a urine test (urinalysis). For this familiar test, a patient is asked to provide a small sample of urine by peeing in a clean specimen cup.

Only a couple of tablespoons of urine are necessary. Usually, it will be tested right away using a small plastic dipstick that will change colors in response to the presence of protein. (This initial test can also detect other suspicious substances in urine, such as bacteria, glucose, and blood cells—any of which can be a sign of a medical problem.)

A dipstick test isn't sensitive enough to detect very small amounts of protein in urine that could indicate the beginning stages of kidney disease—a condition known as microalbuminuria. Therefore, the urine sample will be sent to a lab for further analysis—an ACR (albumin-to-creatinine ratio) test.

Most healthcare providers do a urinalysis as part of regular checkups, but it's especially important that people with diabetes have their urine checked frequently—ideally at least once a year, according to the American Diabetes Association (ADA).

How Is Albuminuria Treated?

There is no treatment for albuminuria itself, as it is not a disease. Rather, it's a symptom of a condition such as diabetes, hypertension, or kidney disease. The way in which excess protein in urine is treated will depend on the cause.

In the case of diabetes, that means following a treatment protocol designed by a healthcare provider. For most people, managing diabetes involves a combination of adhering to a medically-approved diet, embarking on a regular exercise routine, taking medication to help control blood sugar, and self-testing glucose levels regularly.

Treatment for chronic kidney disease associated with diabetes also includes controlling blood glucose levels, as well as taking measures to lower blood pressure. This includes losing weight, eating less salt, cutting out alcohol, quitting smoking, and increasing activity levels.

Medication is sometimes necessary to treat hypertension; according to the ADA, ACE inhibitors are the safest choice for treating hypertension in people with diabetes.

The ADA also says that a low-protein diet is sometimes effective for treating kidney disease. If these measures do not head off kidney failure, dialysis or a kidney transplant will be necessary.

Summary

Albuminuria occurs when you have albumin in your urine. Your kidneys usually remove albumin before it can get into your urine, so the condition is a sign that your kidneys aren't functioning correctly.

Albuminuria can have short-term causes such as dehydration, but it can also be caused by chronic illnesses such as kidney disease, high blood pressure, or diabetes. Treatment involves treating the underlying cause.

A Word From Verywell

If you have diabetes and your urinalysis reveals you have protein in your urine, you have reason to be concerned. However, it's important to catch what may be the beginning of chronic kidney disease well before it has progressed to the point of causing symptoms of end-stage kidney disease.

With your healthcare provider's guidance, you can make lifestyle changes and take other measures to keep your kidneys healthy and functioning normally.