Albumin

[Organiker]

If you look at te NICE (uk) recommendations for staging ckd, you will see that ckd is staged according to egfr (1 to 5) and urine albumin levels (A1 to A3). However, it also states that the albumin levels should be relative to a young adult. Does anyone know what that means?

[Dewi]

I assume as kidney disease is/ can be age related.... it compares current levels with the best young expectation

[RickHow]

Actually the classification you see (a1..a3, etc.) is NOT your albumin level. It is called your ACR level. This means Albumin-Creatinine-Ratio. The formula takes your Albumin level, divided by your creatinine level and produces the result. What the "young" reference means is that once your ratio is determined, it is compared to what the average/normal YOUNG adult should be, and then labels you A1, etc. This is a very flawed approach. Just as many find the eGFR classification suspect, so is the ACR as it relates to CKD. While the egfr does take into consideration your age, sex, race, the ACR does NOT. I see many doctors (oncologist, urologist, primary care, cardiologist, kidney). They all of course get the egfr and acr reports as a result of blood and urine testing. They all, even the kidney doctor, tell me the entire egfr and acr approach while flawed, is just a general guideline.. It can NOT just be applied universally to every patient as we all are unique, have other health factors, etc. They tell me there is just one measurement that really matters most and can not be argued with, and that is CREATININE. Think of it. What is the main thing considered in the egfr formula. Creatinine. What is one of the main things considered in the formula for ACR. Creatinine.

Now here too you have to consider the individual. There is a range for "normal" Creatinine. But again, we are all different. For example, I have only one kidney (other removed when I was 67 years old). My creatinine is EXPECTED to be higher. While in young people the removal of a kidney, the other kidney will actually increase and handle the additional "workload". Not completely but a lot. But mine will not. So I am expected to fall outside the "normal" range. This also applies to people on certain medications. Certain other diseases they may have (such as diabetes, cancer). They tell me what you want to monitor is Creatinine and consistency. For example, since removal of my kidney, my creatinine has been consistently 1.7. This is "high" by normal standards. And egfr says I am stage 3b. But for a person with one kidney 1.7 is actually not bad at all. 1.8 or 1.9 can be expected. But since I am consistently at 1.7 it seems my remaining kidney is not deteriorating. So bottom line. Don't spend your time picking apart your labels (a1, a2, stage 3a vs 3b, etc.). They monitor me for consistent Creatinine, and if there is or is not any protein in urine. For these factors you don't need a fancy formula that many doctors find suspect.

[Organiker in reply to RickHow]

Thank you for your kind reply. Appreciated. I was aware that the measurements were ACR.

[Sammi_n_Munk in reply to RickHow]

Wow. Thank you for that information Mr. How. That was very informative and so good to know. Many blessings. 😊👍✌️🙏

[HealthBuddyMelissa]

As we age our kidneys naturally start to show aging and decline, like much of the rest of the body. However, the reference to albumin may have something to do with diet choices of older age groups vs younger age groups. Older people may not consume enough protein, and that is very often true for various reasons.

[Organiker in reply to HealthBuddyMelissa]

This is so true. A low gfr or high urinary albumin would be very much more serious in a 20 year old than the same levels would be in a 70 year old. The effects of low gfr and high urinary albumin are additive but age needs to be factored into the equation for this reason. I think that that was what NICE were factoring in.