For Kidneys Sake
For Kidneys' Sake podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)
This podcast series aims to provide healthcare professionals, particularly primary care professionals, with accessible insights into kidney health.
Each episode offers bite-sized discussions on key topics such as chronic kidney disease management and heart failure and practical updates for improving patient care. With episodes just 15 minutes long, you can listen on your commute, during a break, or while out for a walk. Join us as we explore the latest advancements and strategies in integrated kidney care to empower clinicians and patients alike.
For Kidneys Sake
Decoding Albuminuria: What Low-Level Protein in Urine Really Means
In this episode of For Kidney’s Sake, consultant nephrologists Jeremy Levy and Andrew Frankel discuss albuminuria, focusing on the interpretation and management of low-level abnormal results. They explore how to distinguish between harmless fluctuations and early signs of kidney damage, clarify the coding system (A1, A2, A3), and explain why urine albumin-to-creatinine ratio (ACR) is such a valuable tool for early detection of kidney issues.
The conversation provides practical guidance for primary care teams, including when to repeat tests, when to refer, and how to reassure patients who are worried about ‘abnormal’ flagged results. They also emphasise the importance of annual kidney health checks for those at risk, especially patients with diabetes, hypertension, cardiovascular disease, or a family history of kidney disease.
3 Key Takeaways:
- Know the ACR thresholds:
- A1: <3 mg/mmol (normal)
- A2: 3–30 mg/mmol (moderately increased
- A3: >30 mg/mmol (severely increased, needs action).
Severe proteinuria (>300 mg/mmol) requires urgent management.
- Repeat and confirm abnormal results:
Low-level abnormal ACRs (e.g., 5–20 mg/mmol) should be repeated to rule out temporary factors like exercise or fever. Persistent abnormal ACR—even with a normal eGFR—signals early kidney or vascular damage. - Manage risks early:
Abnormal ACR requires blood pressure control (<130/80), consideration of ACE inhibitors/ARBs and SGLT2 inhibitors (especially in diabetes), and annual kidney health checks. Early optimisation can reverse or reduce albuminuria.
Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE
Northwest London CKD guidelines for primary care Chronic kidney disease (nwlondonicb.nhs.uk)
The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.
The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.
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