Microalbuminuria (a high albumin level in your urine) is often a marker of diabetic nephropathy (kidney disease). Since microalbuminuria often doesn’t cause symptoms, experts recommend seeing a doctor for regular screenings.

Albumin is an important protein that circulates in your blood. Microalbuminuria (a high albumin level in your urine) can be a sign of reduced kidney function.

This is of particular concern to people with diabetes. Around 2 in 5 U.S. adults with diabetes also develop kidney disease, and diabetes is the leading cause of end stage kidney disease. This is because high blood sugar levels damage your kidneys over time.

Keep reading to learn more about the link between microalbuminuria and diabetes-related kidney disease, including who is most at risk, the available treatment options, and the outlook for this condition.

Your kidneys are made up of millions of tiny filters called nephrons, which filter waste products out of your blood and produce urine. If nephrons don’t work properly, toxic substances might stay in your bloodstream, or other important substances (such as albumin) may exit through your urine instead.

High blood sugar levels due to diabetes can damage blood vessels in your kidneys and nephrons. High blood pressure, a condition that often occurs alongside diabetes, can also damage these blood vessels and nephrons, leading to kidney damage.

In its earliest stages, diabetic nephropathy may show up on tests as low levels of albumin in your urine. Since diabetes can increase your risk of kidney disease and kidney failure, a doctor may request a microalbuminuria test to check for early signs of kidney complications and disease.

Diabetic nephropathy usually does not have any symptoms, especially in the beginning.

However, as albumin levels in your urine rise, you may notice:

Because the condition may not cause symptoms for a long time, regular screening tests for trace amounts of albumin in your urine are crucial. The American Diabetes Association recommends annual microalbuminuria tests for all people with type 2 diabetes (T2D) and for those who have had type 1 diabetes (T1D) for 5 years or longer.

When to contact a doctor

If you’ve lived with diabetes for a long time and you’re experiencing new or worsening symptoms, such as swelling or changes in your urine, contact a doctor.

Regular screenings and appointments with a diabetes doctor or endocrinologist can help you address any concerning symptoms as soon as possible.

The primary way to diagnose microalbuminuric diabetic nephropathy is through a pot urine test called the urine albumin-creatinine ratio. This test measures milligrams of albumin per gram of creatinine (mg/g).

A value of 30 mg/g or higher may indicate microalbuminuria and kidney disease. A value of 300 mg/g or higher may indicate albuminuria, a severely high albumin level.

It takes more than a single test to diagnose diabetic nephropathy. But two or more test results of 30 mg/g or higher separated by at least 3 months may indicate that you have kidney disease.

These tests are usually early morning samples. This is because albumin in your urine has both short- and long-term causes. Short-term causes are only temporary and do not indicate kidney disease or damage.

Levels of 30 mg/g to 299 mg/g put you at moderately increased risk of diabetic nephropathy. A level of 300 mg/g puts you at severely increased risk for diabetic nephropathy.

These results increase your risk of both kidney failure and cardiovascular disease.

The first goal of treatment is to slow the progression of diabetic nephropathy by lowering your blood pressure to 130/80 or less and lowering your hemoglobin A1C levels to 7% or less. However, these parameters can vary based on your individual health history and goals.

Doctors may prescribe any of the following medications to help slow the progression of diabetic nephropathy:

A healthcare professional should closely monitor both your serum creatinine and potassium levels throughout treatment to watch for hyperkalemia (high potassium levels).

Microalbuminuria is caused by kidney damage, specifically when damage occurs in the glomeruli (networks of small blood vessels at the ends of nephrons that are responsible for filtering).

When this damage becomes chronic as a result of high blood sugar levels over a long period, it can develop into diabetic nephropathy.

Short-term albuminuria does not necessarily cause kidney damage and is not always a sign of kidney disease or damage. This is why repeat tests are necessary before a doctor can make a proper diagnosis.

People with both T1D and T2D are at risk of microalbuminuria and diabetic nephropathy, though the risk may be higher for those with T2D.

A 2017 review of studies concluded that about 2% to 3% of people with T1D received diagnoses of microalbuminuria or albuminuria each year, while about 8% of people with T2D did.

People with T2D may be experiencing microalbuminuria when they first receive a T2D diagnosis. However, people with T1D are more likely to develop diabetic nephropathy after 15 to 20 years.

Diabetic nephropathy is more common in African Americans, Native Americans, and Mexican Americans. Reasons for this include genetics, dietary patterns, and systemic factors such as disparities in healthcare access.

According to a 2023 study, other possible risk factors include:

To help prevent microalbuminuric diabetic nephropathy, experts recommend managing your blood pressure, cholesterol, and blood sugar levels. Steps you can take to help with these goals include:

Consult a doctor regularly so they can adjust your medications if necessary. And always talk with your doctor if you experience any new or worsening symptoms.

Kidney damage is not reversible. As the damage worsens, your kidneys will continue to have difficulty cleaning your blood.

Diabetic nephropathy often leads to other complications and even death. Most people with diabetic nephropathy die from end stage kidney disease.

Microalbuminuria is also a risk factor for heart disease-related deaths.

What is a normal microalbumin level for someone with diabetes?

Normal microalbumin levels are less than 30 milligrams of albumin per gram of creatinine (mg/g). This test result may also be expressed as less than 20 micrograms per minute (mcg/min).

What microalbumin level indicates kidney failure?

A microalbuminuria test may indicate your risk of kidney disease, but doctors measure kidney function using your estimated glomerular filtration rate (eGFR).

Your eGFR is a calculation of how well your kidneys filter your blood. According to the National Kidney Foundation, a normal eGFR is 90 or higher. The lowest eGFR is 0. Any eGFR level below 15 indicates kidney failure.

Any microalbumin level higher than 30 mg/g may indicate existing kidney damage and a higher risk of kidney failure.

Can drinking water reduce albumin in urine?

Drinking water can temporarily dilute your urine and reduce the amount of albumin in it. However, doing this will not stop the cause of a protein leak from your kidneys.

If you have albumin in your urine, talk with a doctor about your treatment options.

Kidney disease is a common complication of diabetes. Microalbuminuric diabetic nephropathy is a condition involving chronic high levels of albumin in your urine. Albumin is a protein your kidneys usually filter, but it can be present in your urine if you have kidney damage or kidney disease.

People who have T2D or have lived with T1D for several years may be at risk of developing microalbuminuric diabetic nephropathy. This condition often does not cause symptoms, especially in early stages. Treatment options vary, but a doctor may prescribe an ACE inhibitor or an ARB to slow the progression of the condition.

If you have diabetes, you may be able to help prevent diabetic nephropathy by keeping your blood pressure, blood sugar, and cholesterol levels in healthy ranges. Other beneficial lifestyle habits include exercising regularly, eating a balanced diet, avoiding smoking, and attending regular checkups with a doctor.