I've been getting urine results in the form creatinine and albumin. My last results for example, were:
Creatinine: 11.42 mmol/L
Albumin: 600 mg/ L
This gives a Urine Albumin to Creatinine Ratio (UACR) of 52.6 mg/mmol. Now a UACR of 52.6 sits at the A3 end of the spectrum (A3 being the worst of the three grades, beginning at > 30mg/mmol)
My latest results however, are expressed as urine protein, creatinine and the ratio is PCR (protein to creatinine). The ratio calculates out at 47 mg/mmol.
This would place my proteinuria in the "trace" grade according to the NHS chart attached.
Granted, the only thing I've done in between times is hydration. But surely that can't bump my protein leakage from "well past the worst grade" up to "just outside the healthy range"??
Anyone any insights?
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Skeptix
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I read in one study ...so don't remember which that albumin makes up approximately 60 to 70 percent of the protein. The main problem with it is it's size... larger than the other proteins so can cause a lot of damage.
I skirted around looking for such information: wanting a simple "albumin is X % of total protein" but hit a wall.
I was thinking along those same lines: if it was 60-70% or some such of total protein, then ACR ought to be easy to convert from PCR. Thus converted I could see what progress (or not) from previous bloods.
But that doesn't tally with the ACR showing me well into worst grade and the PCR showing me in the best grade.
Unless, of course spilling has dramatically improved in the space of a couple of months. I ain't saying I wouldn't take it, but it seems highly unlikely...
I"m sure the formula for ACR is standardized, meaning relative to all. So fiddling with the numbers is just fruitless. Looking for treands; however, is the way to go when taking into account statistics.
Agreed. My cholesterol went from 6.6 to 5.2 in a few months (in which the change to plant based) but now back up to 5.5. I was expecting it to have decreased further this lab.. Then iron, which was hovering jist below range at 13 jumped right up to 19 without any particular intervention.
But in the example in the OP there appears to be a marked difference in proteinuria from gross to trace. Maybe a bogey reading and time will tell indeed. But in the first instance I just wanted to covert from PCR to ACR so I can plot in same units on my spreadsheet.
Tell you one thing though. If next bloods I'm trace (and assuming I'm trace now) I'll be breaking out the champers!
Tell me about it!! I am doing a 24 hr. urine today. Let Go and Let God, as they say. But back to the ACR. There are calculators for this online. If this isn't the one you need, there are others: mdapp.co/albumin-creatinine...
Or ... God has a plan for your life. Somehow I don't think he pulls our proteinuria strings unto better results. Best 'o luck with it.
See my post to Stavrosang a little down the page: after converting PCR to ACR. What could explain this? Going from 5mg to 10mg ACE over the last 6 months??
Also depending on how long your have been on that ACE ETC will affect the level.. hydration will as well because more fluid will keep the protein from pounding again your fliler. After you start the ACE, things can take 8-12 months to stabilize. However, in the first three months, the percent drop of albumin that occurs is a predictor of how well the ACE works for you. Obviously the larger the drop in the first 3 months the better it will be at stopping the protein in the long run, but we take what we can get. They generally vstart with the low dose and gradually increase.
I've been maybe 4 years on ACE and never paid attention to it so have no idea how much they impacted. Was put on 5mg (half max dose). It was only recently when I started paying attention to my health that I suggested to my neff that I might be better to bump the meds to bring down the BP which was a bit elevated. Up to 7.5mg I went. Then suggested bumping again after asking my pharmacist what max dose was. On 10mg a few months.
Maybe the doubling of dose (starting say 8 months ago with the jump from 5 to 7.5mg) is still working its way up to max effectiveness??
It's generally not recommended prophylactically for ckd unless you have either high blood pressure, protein leakage, or both. A definite need to keep a watchful eye on potassium if on either.
How does it work? Creatinine starts leaking first (hence eGFR up, hence diagnosis of CKD (sans proteinuria)? Then later, when things degrade, protein starts leaking?
I've never understood how someone can have advanced CKD without proteinuria
I was curious about the same thing and I remember my Neph saying something about ACR is more accurate for smaller numbers. I am not sure on that though.
No real insight but it maybe highlights why the medics are currently less concerned about mum's protein leakage than us. The last time her urine micro-albumin (UA) and creatinine (UC) were BOTH measured, the results were:
Whilst above NHS range shown on her record (0-3.5), it would be "normal" on your Ref table.
Her UC dropped rapidly in her latest results to 1800 umol/l. For some reason, UA was not measured but I doubt if UACR would even be in the "significant proteinuria" category yet.
Hopefully we can prevent it reaching that by DIY treatment!.
I understood UC to be strongly related to hydration and that the point of an ACR is to correct for hydration variations. The creatinine becomes a hydration-compensated reference against which to determine albumin 'leakage'.
That's certainly trace level proteinuria compared to the comparatively gross levels of urea.
Yes. Unless UA had reached 90 ug/ml, then it would enter the Significant category.
That would likely represent a higher rate of albumin increase than observed previously but we will never know since it wasn't measured. Heaven knows why!
Nevertheless it wouldn't alter our goal of trying to slow down the proteinuria naturally.
In comparison proteinuria seems like a minor goal compared to handling urea. The former is relatively trace and the latter not far of my pre diet level - me wot dabbled with stage 4 only to totter back to the lower echelons of 3b largely through the new, 2021 NKF algorithm for calculating eGFR.
My RD does indeed appear to be mixing their units. They quote my figures (correctly) as PCR but are assessing the number against the ACR chart. Measuring in feet and buying in metres.
Double checking establishes that I had an ACR of 78 mg/mmol in April 2022. The worst stage of albuminuria, as defined by KDIGO 2012 is A3 and that commences once you exceed 30 mg/mmol.
Last urine produced a PCR of 46 mg/mmol (October 2021). The normal, healthy range for PCR halts at 15mg/mmol and the next stage halts at 49mg/mmol. So I'm in the second of five descending stages, this second stage is labelled 'trace proteinuria'.
I.O.W. I've gone from gross spillage (2.5 times the worst threshold amount) to trace spillage in the space of 6 months or so.
A correction:
In the OP I said that all that had changed was diet and hydration. I now realise that there was a doubling of ACE meds somewhere in there too. My suspicion however, is that ACE isn't the big contributor given it has this level of effect;
"In controlled trials in CKD, ACE inhibitors and ARBs reduce protein excretion by approximately 35% to 40%, which is greater than other antihypertensive agents, even when the effect of blood pressure reduction on urinary protein excretion has been taken into account"
So what I plan to do is to reduce ACE for a run-in period to next bloods /urine and so, hopefully, better establish what effect (if any) the sVLP diet on its own has had.
I'm not sure I trust spot urine checks either. I'm told they are accurate but I notice bubbles in my pee vary according to the time of day (e.g. more bubbles a few hours after my dinner, often times o bubbles at all). I figure to do a 24 hr collection AND a spot sample next time so as to compare.
Conclusion: it's early days but if, just if, it were possible to significantly rein in proteinuria via diet then that would be fantastic. Proteinuria, a key element in CKD progression, rendered 'trace' through diet. Fingers crossed..
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