The Clinical and Diagnostic Value of Albuminuria in the Diagnosis of Chronic Kidney Disease

Chronic kidney disease (CKD) is one of the most widespread problem in the health care system with severe social and economic outcomes. The danger of CKD lies in complications arising from kidney failure, concomitant cardiovascular diseases, diabetes mellitus (DM), obesity. Despite the fact that the morbidity and mortality caused by CKD can be prevented by early diagnosis and treatment, unfortunately, today the diagnosis of this disease in the world is at a low level. The objective: to analyze the relationship between albuminuria and arterial hypertension (AH), heart failure, obesity, carbohydrate metabolism disorders. Materials and methods. 704 patients (400 men and 304 women) who visited the communal non-commercial enterprise “Vinnytsia Regional Clinical Specialized Endocrinology Center” were examined. Patients were divided into groups. The main group included patients with various disorders of carbohydrate metabolism (gestational diabetes, prediabetes, pancreatogenic diabetes). The second group included patients with hypertension, obesity, various pathologies of the thyroid gland, acromegaly, and osteoporosis. For all study participants the urine albumin-to-creatinine ratio (UACR) was determined using the test strip method in outpatient settings. In addition to UACR, to determine the stage of CKD, an estimated glomerular filtration rate (eGFR) based on blood creatinine was measured in all patients. Results. During the study it was established that type 1 and type 2 diabetes mellitus and pancreatogenic diabetes mellitus, obesity, prevailed among men who are in the risk group by gender for the development of complications. At the same time, prediabetes and thyroid pathology were more common among women. The eGFR index progressively decreased with increasing duration of type 1 and type 2 diabetes. The initial stages of nephropathy are characterized by an increase in eGFR, then its gradual decrease to a normal level, which can be mistakenly assessed as the absence of pathological changes in the kidneys. That is why the determination of only eGFR without UACR is not sufficient to establish a diagnosis of CKD. Routine determination of albuminuria is one of the ways to identify individuals at high risk of cardiovascular disease. Conclusions. It has been established that the prevalence of CKD depends on the timeliness of diagnosis, the duration and state of diabetes compensation, the use of hypoglycemic drugs with proven nephroprotective effect, especially in patients with type 1 diabetes. Early appointment of renal protective therapy to patients from risk groups according to international recommendations is effective in slowing the progression of CKD, delaying dialysis and reducing mortality from cardiovascular causes and overall mortality.