Albumin, Urine

Laboratory assay overview

Measurement of albumin levels in urine below the detection level of urine dipsticks. This test is useful in the management of patients with relatively early diabetes mellitus to assist in avoiding or delaying the onset of diabetic renal disease.

Laboratory assay overview

This test is used for measurement of albumin levels in urine below the detection level of urine dipsticks. This test is useful in the management of patients with relatively early diabetes mellitus to assist in avoiding or delaying the onset of diabetic renal disease.

Laboratory assay overview

This test measures the amount of albumin, a large protein, in urine. The presence of albumin in urine may be useful as an early marker of kidney damage. Because the kidneys usually excrete only small molecules into urine, even low levels of albumin in urine (microalbuminuria) may suggest kidney injury [1]. According to the Centers for Disease Control and Prevention (CDC), diabetes and high blood pressure are the major causes of chronic kidney disease (CKD). The CDC recommends regular testing for CKD in people who have diabetes, high blood pressure, and/or other risk factors, such as heart disease, family history of CKD, obesity, previous damage to the kidneys, and older age. The albumin/creatinine ratio is an important part of this assessment [2,3]. Microalbuminuria is a known risk factor for progressive kidney disease and cardiovascular death [4]. The National Kidney Foundation (NKF) recommends annual testing for microalbumin/albumin in all individuals with diabetes whose kidneys are functioning. According to the NKF, annual testing should start 5 years after diagnosis for individuals with type 1 diabetes and at diagnosis for individuals with type 2 diabetes [5]. The NKF recommends that at least 2 of 3 specimens, drawn within a 3- to 6-month period, be reported as abnormal before making a clinical diagnosis of either microalbuminuria or albuminuria [5]. Results are reported as a ratio of albumin (µg) to creatinine (mg). Test results should be interpreted in the context of pertinent clinical and family history and physical examination findings. References 1. Burtis C, et al. Amino acids and proteins. In: Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics. 7th ed. St Louis, MO: Elsevier; 2015:314-315. 2. Gaitonde DY, et al. Am Fam Physician. 2017;96:776-783. 3. Centers for Disease Control and Prevention. Chronic kidney disease in the United States, 2019. https://www.cdc.gov/kidneydisease/publications-resources/2019-national-facts.html. Last reviewed March 11, 2019. Accessed February 4, 2020. 4. Weir, MR. Clin J Am Soc Nephrol. 2007;2:581-590. 5. National Kidney Foundation. Am J Kidney Dis. 2007(Suppl 2);49:S1-S180.

Quest Diagnostics population reference ranges

Quest Diagnostics calculates these statistical intervals for this specific assay and demographic group, not as universal optimal targets.

Laboratory assay overview

According to the National Kidney Foundation, there are approximately 37 million adults in the U.S. who have chronic kidney disease (CKD), and about 90% are unaware of their condition. Diabetes is the leading cause of CKD in the United States. The significant impact of CKD on cardiovascular disease (CVD) risk has been increasingly recognized. Patients with CKD are far more likely to die, predominantly from CVD, than to progress to end-stage renal disease (ESRD). Currently, mainstays of treatment for diabetic kidney disease include control of hypertension, hyperglycemia and dyslipidemia. This panel has been established to aid in the identification and monitoring of hyperglycemia, dyslipidemia and CKD in patients with a history of diabetes and/or kidney disease. Guidelines and expert panels advocate renal function testing patients with diabetes and/or hypertension at least annually with urinary albumin to creatinine ratio (uACR) and estimated glomerular filtration rate (eGFR). CKD is characterized by gradual loss of kidney function over time, defined as presence of either kidney damage (as indicated by the presence of albuminuria) or declining kidney function (as indicated by the level of GFR) for more than three months.1 Non-HDL-C is a calculation (total cholesterol minus HDL-C), and includes the sum of the VLDL-C, LDL-C, and IDL-C. While LDL-C has long been the primary focus of cholesterol reduction efforts, there are several other lipoproteins that also affect cardiovascular health. The advantage of non-HDL-C measurement is that it accounts for cholesterol in the other potentially atherogenic lipoprotein particles, which include VLDL-C, IDL-C, LDL-C, and lipoprotein(a). Recent guidelines suggest that non-HDL levels above 190 mg/dL enhances the risk for CVD.2 Hemoglobin A1c values are used to assess glucose control in diabetes, and in 2010, the American Diabetes Associations affirmed the decision of an international expert committee recommendation to use the A1c test to diagnose diabetes with a threshold ≥6.5%. The Cardiorenal-glycemic Panel can be collected non-fasting.

Laboratory assay overview

This test is intended to help inform the clinician about the presence of hyperlipidemia as an index to cardiovascular disease and to identify patients with chronic kidney disease.

Laboratory assay overview

An estimated 37 million U.S. adults have chronic kidney disease (CKD). In addition to cardiovascular-associated events, they are at risk for kidney failure or end-stage kidney disease (ESKD) requiring dialysis or kidney transplant. In the 2015-2016 National Health and Nutrition Examination Survey, prevalence of CKD stages G1-4 was 14.2% among adult participants. One in three U.S. adults is at risk for CKD due to prevalent risk factors such as diabetes and/or high blood pressure. The incidence of CKD is projected to increase during the next 20 years because of increasing obesity rates and an aging U.S. population.1 Early-stage CKD is often asymptomatic, making laboratory testing imperative for at-risk patients.This typically includes two tests, a serum creatinine with estimated glomerular filtration rate (eGFR), a test of kidney function, and a urine albumin-to-creatinine ratio (uACR), a test of kidney damage. While eGFR results are commonly reported as part of metabolic panels, this test alone is insufficient for CKD detection: The presence of albuminuria reflects endothelial inflammation that may cause proximal tubular damage and progressive kidney function loss.1 Asymptomatic individuals with diabetes, hypertension, family history of kidney disease and cardiovascular disease are considered to be at high risk for CKD and should be tested at least annually for eGFR and albuminuria.2 Additionally, total urine protein measurements may be warranted in some individuals to detect other etiologies of CKD missed by urine albumin measurements.3 The Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guidelines suggest measurement of cystatin C, an alternative endogenous filtration marker, in specific circumstances when GFR estimates based on serum creatinine are thought to be less accurate and when decisions depend on more accurate knowledge of GFR, such as confirmation of CKD diagnosis, determining eligibility for transplant or adjusting dosage of drugs excreted by the kidney.4 A 2021 report from the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases recommended increased, routine and timely use of cystatin C combined with creatinine as a confirmatory assessment of kidney function, because combining filtration markers (creatinine and cystatin C) for eGFR calculation is more accurate and would support better clinical decisions than either marker alone. A new eGFR equation, the CKD-EPI 2021 eGFR creatinine-cystatin C equation without a race variable, was recommended for clinical use.5,6 More recently, the Chronic Kidney Disease Prognosis Consortium reported that the use of the new eGFR creatinine-cystatin C equation had significantly greater discrimination of risk of kidney failure with replacement therapy compared to creatinine only based eGFR equations, supporting the Task Force recommendations to increase cystatin testing.7

Laboratory assay overview

An estimated 37 million U.S. adults have chronic kidney disease (CKD). In addition to cardiovascular-associated events, they are at risk for kidney failure or end-stage kidney disease(ESKD) requiring dialysis or kidney transplant. In the 2015-2016 National Health and Nutrition Examination Survey, prevalence of CKD stages G1-4 was 14.2% among adult participants. One in three U.S. adults is at risk for CKD due to prevalent risk factors such as diabetes and/or high blood pressure. The incidence of CKD is projected to increase during the next 20 years because of increasing obesity rates and an aging U.S. population.1 Early-stage CKD is often asymptomatic, making laboratory testing imperative for at-risk patients.This typically includes two tests, a serum creatinine with estimated glomerular filtration rate(eGFR), a test of kidney function, and a urine albumin-to-creatinine ratio (uACR), a test of kidney damage. While eGFR results are commonly reported as part of metabolic panels, this test alone is insufficient for CKD detection: The presence of albuminuria reflects endothelial inflammation that may cause proximal tubular damage and progressive kidney function loss.1 Asymptomatic individuals with diabetes, hypertension, family history of kidney disease and cardiovascular disease are considered to be at high risk for CKD and should be tested at least annually for eGFR and albuminuria.2 Additionally, total urine protein measurements may be warranted in some individuals to detect other etiologies of CKD missed by urine albumin measurements.3 The Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guidelines suggest measurement of cystatin C, an alternative endogenous filtration marker, in specific circumstances when GFR estimates based on serum creatinine are thought to be less accurate and when decisions depend on more accurate knowledge of GFR, such as confirmation of CKD diagnosis, determining eligibility for transplant or adjusting dosage of drugs excreted by the kidney.4 A 2021 report from the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases recommended increased, routine and timely use of cystatin C combined with creatinine as a confirmatory assessment of kidney function, because combining filtration markers (creatinine and cystatin C) for eGFR calculation is more accurate and would support better clinical decisions than either marker alone. A new eGFR equation, the CKD-EPI 2021 eGFR creatinine-cystatin C equation without a race variable, was recommended for clinical use.5,6 More recently, the Chronic Kidney Disease Prognosis Consortium reported that the use of the new eGFR creatinine-cystatin C equation had significantly greater discrimination of risk of kidney failure with replacement therapy compared to creatinine only based eGFR equations, supporting the Task Force recommendations to increase cystatin testing.7

Laboratory assay overview

This panel is useful in the identification of patients with early Chronic Kidney Disease and management of patients with relatively early diabetes mellitus to assist in avoiding or delaying the onset of diabetic renal disease. See the individual tests as listed in the Directory of Service for detailed information.

Laboratory assay overview

This panel has been established to aid in the diagnosis and management of Chronic Kidney Disease (CKD) and assess metabolic issues and organ function frequently associated with CKD by checking the status of a patient's kidney, glucose level, electrolyte/acid base balance, proteins and liver.

Laboratory assay overview

This panel has been established to aid in the diagnosis and management of Chronic Kidney Disease (CKD), and assess basic metabolic issues frequently associated with CKD by checking the status of a patient's kidney, electrolyte/acid base balance and glucose level. See the individual tests as listed in the Directory of Service for detailed information.