Urine is the end product of human activity, it is composed of the following components: uric acid, ammonia, urea, salt, creatinine, and others.
One of the main and essential functions of the kidneys is their unique ability to remove toxic metabolic products from the body in the urinary sediment. Glomerular and tubular apparatus body is in continuous operation, the “banishing” through the blood and cleaning it from all the harmful and unnecessary additives. All valuable components (proteins, glucose and others) are reverse flow into the bloodstream.
If for one reason or another is suffering the filtration ability of the tissues of the kidneys, and it increases the permeability of the glomerular membranes, urine begin to stand out useful substances for the body.
One of the first “alarm” bells indicating the beginning of the disease, is increasing the concentration of microalbumin in the urine. Normal synthesis of this protein occurs in the liver cells. The share of albumin in blood plasma accounts for approximately 50-60% of all protein components. Their main task – maintaining constant osmoticheskogo and oncotic pressure in the circulatory direction, which is achieved by their binding with water molecules.
Urine test for microalbuminuria (MAU) pursues the goal of early (preclinical) diagnosis, when the patient more completely missing the symptoms associated with kidney failure. This allows you to deal more effectively with the disease and timely correction of pathological processes.
Standards of laboratory performance
Detection of albumin in urine is not always indicative of a pathological process began. Microalbumin represents the smallest protein fraction, therefore, even in a healthy person a small amount of it can penetrate intact glomeruli. While larger molecules of albumin, can never be detected in normal urine. Children on the onset of pathology demonstrate even a minimal increase in protein in the urinary sediment.
Before proceeding to decrypt the received data, it is necessary to clarify what the numbers do not go beyond the physiological values:
- the rate of albumin, which the expert can detect in the study of urinary sediment should not exceed 30 mg per day (if values exceed these values, it is referred to as microalbuminuria, while a daily selection of more than 300 mg of protein evidence of proteinuria);
- the rate of microalbumin defined in a lump sum (one-time) portion of the urine does not exceed 20 mg/l
- the ratio of albumin/creatinine assessed in random urine samples, normal values should not exceed the following figures: women – 2.5, and men – up to 3.5. In case of increase of these indicators can be judged on the onset of nephropathy.
Causes of albumin in the urine
Microalbumin in the urine may exceed their concentration for quite natural reasons and to be fully reversible:
- Use before large amounts of fluid, resulting in increase in water load on the kidneys, increasing the filtering mechanism. The same thing can occur if people eat too much watermelon.
- Excessive exercise or increased exercise leads to increased blood flow, and thus to improve the kidney, which is not always cope with it.
- Nicotine and excessive consumption has a negative influence on the cellular structures of the entire body, and kidney tissue in particular.
- To temporarily increase the permeability of the glomerular membrane following factors: hypothermia or prolonged stay in hot conditions, swimming in the icy water, strong nervous stress or other mental disorders.
- Girls during menstruation can detect albumin in the urine, therefore, in this period the study was conducted is not recommended.
- After intercourse in women in the analyses, it is possible to detect substance – albumose, the source of which is the partner’s sperm. Less frequently it appears when a massive collapse of the cells in the body (for example, with gangrene or lung cancer).
Congestion of the kidneys “volume” – cause temporary microalbuminuria
In all the above situations, the urine MAU will be considered false positive, because after the exclusion of root causes, laboratory values completely normalized.
Most often, the level of protein in the urine is increased because of a number of diseases with infectious or non-infectious origin, the cause of which lies not only in diseases of the kidneys:
- Acute and chronic forms of glomerulonephritis or pyelonephritis (urinary sediment in the emergence of the protein components carry different degrees of expression).
- Nephrosis or nephrotic syndrome (especially in a lipid form).
- Hypertension and different degrees of heart failure.
- Atherosclerotic processes affecting the glomerular apparatus of the kidneys and the blood vessels of the body.
- Diabetes mellitus, which causes diabetic nephropathy.
- The chronic form of alcoholism or prolonged experience of nicotine addiction.
- Poisoning by nephrotoxic drugs or heavy metal salts.
- Preeclampsia during pregnancy, which threatens the life of the fetus and the mother.
Preeclampsia is a very dangerous disease in pregnant women, an early sign of which is the increase of albumin in the urinary sediment
Stage of the process
As mentioned above, the repeated appearance of albumin in urine in concentrations exceeding normal levels is a direct symptom of incipient nephropathy (normal kidney function).
In its development, the state goes through several stages:
- Stage asymptomatic manifestations – the patient are completely absent complaints “kidney” of nature, however, in the urinary sediment are already starting the change.
- Stage of initial manifestations of complaints are still missing, but in the urine there is microalbumin.
- Stage penetrationsex changes – the patient begins to note the instability of the numbers in blood pressure in the kidneys decreases the filtration rate, urinary sediment contains albumin in a concentration of from 30 to 300 mg/day.
- Stage nephritic changes – the patient have the pronounced swelling, instability of blood pressure and tendency to its increase, decreases the filtration ability of the kidneys, proteinuria, microhematuria.
- Stage of uremia – the patient’s edema, and significantly increased pressures that are difficult to treatment, sharply reduced glomerular filtration rate, the hematuria and massive proteinuria.
Who is screened for albuminuria with a prophylactic?
There is a category of patients who pass a urine test for microalbuminuria should be several times a year:
- diabetes (1 and 2);
- hypertension (especially in patients with long “experience” of hypertension);
- patients undergoing several courses of chemotherapy to treat the cancer process.
Pregnant women with increased risk of preeclampsia, urine test for MAU included in the standards of diagnosis.
How to collect urine for research?
You need to understand that a single detection of a high rate of albumin in urine is cause for the production of a diagnosis. Especially if you had to collect a random urine sample.
Of nephropathy can be judged multiple definition of microalbumin in analyses of patients who underwent preliminary training before the study
At the beginning of each urine collection is necessary to conduct a careful toilet of genitals. Women are advised to use a cotton swab to prevent falling of the substrate from the lumen of the vagina.
Before you pass a urine test, recommended at the time to abandon the use of drugs (unless absolutely necessary).
Urine is collected during the day in the same sterile container, from which then the specialist takes the necessary to study the volume.
Methods of correction of microalbuminuria
Problem microalbuminuria doctors of different specialties (internists, nephrologists, gynecologists, and others), and therefore the approach to the management of each category of patients has its own characteristics.
All patients are recommended to follow health food and to fight inflammatory component.
For the early detection of MAU attaches great importance to all preventive examinations and dispensary observation of patients
The basic principles of drug therapy include the following activities:
- The restoration of glucose level in the blood serum with the help of insulin or antidiabetic drugs.
- Stabilization of numbers of blood pressure (ACE inhibitors, diuretics and others).
- Correction of lipid profile with statins.
- In running situations resort to hemodialysis or preparing a patient for organ transplantation.
Early diagnosis of microalbuminuria is complicated due to the complete absence of clinical manifestations, which forced the patient to seek help to the doctor.