Instead of simply checking microalbumin levels of our diabetic and hypertensive patients, we have begun to do spot urinalysis for a microalbumin:creatinine ratio. I am not sure how to interpret elevated results. When is it appropriate to refer to a renal specialist? — Linda Szocik, FNP, St. Francis, Wis.

The microalbumin:creatinine ratio is an abbreviated form of a 24-hour urine assay for microalbumin. A simultaneous sampling of serum creatinine and spot urine microalbumin will yield the result.

Although there is no definitive reference range (age, gender, and lab methodology all play a part), the accepted levels are as follows:

  • Normal: 0-30 µg/mg creatinine;
  • Microalbuminuria: 30-300 µg/mg creatinine;
  • Clinical albuminuria: >300 µg/mg creatinine.

Any patient whose ratio is >30 µg should undergo an initial evaluation by a nephrologist. — Sherril Sego, FNP-C, DNP (158-3)