Que - 55 y.o male presented with 5 years history of Type II DM to your clinic. He presented for general check up. His BP is 140/90 which was same 6 months ago. You did fasting urine analysis and then sent to lab which showed elevated ACR (Albumin Creatinine Ratio). What's your best next step?
Ans -
1 - Review again in 6 month
2 - Commence on ACEI
3 - Commence on beta blocker
4 - Commence on CCB
5 - Commence on Nitrites
Ans -
1 - Review again in 6 month
2 - Commence on ACEI
3 - Commence on beta blocker
4 - Commence on CCB
5 - Commence on Nitrites
The correct answer is 2. Patient with diabetes and microalbuminuria will get benefit from ACEI (first line antihypertensive for this patient)even if they are normotensive as long as BP tolerates.
ReplyDeletehello sachin--can u please explain how increased ACR ratio means "microalbuminuria"??
ReplyDeleteHi John,
ReplyDeleteSorry, your comment went in to spam folder somehow.
The ideal thing is to have 24 hour urine collection for albuminuria/proteinuria, but it is not practical and costly. Albumin excretion is varied in spot urine and throughout day - this variation can be reduced if we compare against creatinine.
Increased ACR (Albumin-creatinine ratio in urine) which means patient is loosing more albumin (protein) compare to creatinine in urine. ACR is more sensitive than just proteinuria in spot urine, as if patient will do more exercise then will have proteinuria, but then creatinine (creatinine will not get reabsorbed) excretion will also increased.
Read through this article from pubmed which gives little insight about ACR.
http://www.ncbi.nlm.nih.gov/pubmed/10333950
Hope this answer your question - feel free to ask further if need further clarification.