How to determine the stage of diabetic nephropathy by urine microalbumin test? -Microalbuminuria refers to the elevated concentration of albumin in the urine, and its elevation range is 20-200ug/min or 20-200mg/L or 30-300mg/24h. If the microalbumin in the urine is within the range of 20-200ug/min, 20mg/L-200mg/L or 30-300mg/24h, it is microalbumin proteinuria. Microalbuminuria is the early stage of kidney damage and can be reversed by active intervention. Urinary microalbumin-to-creatinine ratio (ACR) is also commonly used clinically to evaluate renal condition, and when using random urine, it is recommended that microalbuminuria be defined as an ACR of 17-250 mg/g for men and 25-355 mg/g for women. the difference between the definitions for men and women is due to the difference in daily creatinine production – women produce less creatinine than men. Since the rate of urinary protein excretion and creatinine excretion varies from day to day, two out of three positive tests on different days are required for the diagnosis of microalbuminuria. Microalbuminuria represents an increased level of urine protein and is a signal of changes in the systemic vascular system. Urine microalbumin is a sensitive indicator for predicting vascular damage in diabetes, hypertension, cardiovascular disease and many other diseases, and has important reference values for determining the occurrence, development and prognosis of diseases. In China, with the rapid economic development, more and more people suffer from diabetes and hypertension due to excess nutrition and work pressure, which leads to an increased incidence of microalbuminuria Men and women use different urinary microalbumin to creatinine ratio <30mg/g (3.39mg/mmol) as normal, between 30-300mg/g as microalbuminuria, >300mg/g The prevalence of microalbuminuria is significantly higher in patients with hypertension and diabetes than in the normal population, and some data show that the prevalence of microalbuminuria in type 2 diabetic patients is about 30%-40%. 30% of newly diagnosed type 2 diabetic patients already have increased urinary protein levels, and 75% of these patients will develop microalbuminuria. Of these patients, 75% will develop microalbuminuria and 25% will progress to clinical nephropathy. 1, diabetes and urinary microalbumin: diabetic nephropathy as one of the chronic complications of diabetes, seriously endangering the health and life of patients, causing a great physical, psychological and economic burden to the patients themselves, but also to society has caused great social pressure. If the urinary albumin excretion rate of type 1 and type 2 diabetic patients consistently exceeds 20ug/min, the risk of progressing to the stage of diabetic clinical nephropathy increases 20-fold. As chronic kidney disease progresses, mortality increases, and the 20-year survival rate for patients with diabetic nephropathy is only 50%. increased urinary albumin excretion rate in type 1 diabetics is a highly predictive indicator of clinical progression of diabetic nephropathy, with approximately 50% of type 1 diabetics progressing from nephropathy to end-stage nephropathy within 10 years and over 67% progressing to end-stage nephropathy within 20 years. Therefore, the presence of microalbuminuria is an early predictor of diabetic nephropathy and end-stage renal disease, and if not detected early and treated specifically, 20%-40% of type 2 diabetic patients with microalbuminuria will progress to clinical nephropathy. In diabetic patients, increased urinary albumin excretion is a strong independent predictor of progressive nephropathy, atherosclerosis, mortality from cardiovascular events and all-cause mortality. Therefore, early detection of patients with early renal disease by urine microalbumin measurement and appropriate treatment of these patients can reduce or delay the onset and progression of diabetic clinical nephropathy and end-stage renal disease, and reduce the risk of cardiovascular events in diabetic patients. 2, hypertension and urinary microalbumin: At present, research on primary hypertension has confirmed that target organ damage caused by hypertension has become one of the main causes of death and disability in middle-aged and elderly people, and hypertension is also one of the important factors aggravating the deterioration of renal function. 25% of end-stage renal disease is related to hypertension, and there is also a close relationship between hypertension and urinary albumin excretion rate. Patients with microalbuminuria have significantly higher diastolic blood pressure than those without microalbuminuria, and higher urinary microalbumin levels are closely associated with the staging of hypertension. This suggests that urinary microalbumin can be used as a sensitive indicator for diagnosing early hypertensive kidney damage and detecting the development of the disease. In order to prevent and treat hypertensive kidney damage at an early stage, hypertensive patients should undergo regular urinary microalbumin testing. This not only can determine the condition, but also can detect kidney damage at an early stage, take timely interventions to prevent hypertensive nephropathy, reduce the economic burden of patients and improve the quality of life. 3, cardiovascular disease and urine microalbumin: urine microalbumin is closely related to the occurrence, development and prognosis of atherosclerosis and coronary heart disease. For every 10-fold increase in urinary albumin levels, the risk rate of cardiovascular death rises by 84.5% and the risk rate of myocardial infarction by 41%. The elevated rate of albumin excretion is a biomarker of underlying systemic disease, or is it somehow involved in a fatal causal pathway, including cardiovascular disease. Urinary microalbumin is more important than other established cardiovascular risk factors in predicting disease progression and prognosis. Therefore, regular testing of urinary microalbumin, early detection of abnormal urinary albumin excretion, and early intervention and treatment can reduce or delay the occurrence of cardiovascular disease, thereby stopping or delaying the progression of cardiovascular disease and reducing cardiovascular disease complications and morbidity and mortality. 4, obesity and urine microalbumin: with the increase of obese people, the consequent hypertension, diabetes, coronary heart disease population will also continue to grow. Obesity can not only lead to cardiovascular and cerebrovascular diseases, but also can cause kidney disease. Strengthening the screening of urine microalbumin in obese patients, especially those with abdominal obesity, can lead to early detection, early intervention and treatment, reduce the process of obesity-related diseases and lower the occurrence of complications. In patients with hypertension and diabetes mellitus, urinary microalbumin expression levels are closely associated with the incidence of cardiovascular disease and mortality. Because microalbuminuria lacks obvious clinical symptoms and requires screening to detect, urine microalbumin testing should be given high priority in high-risk groups with diabetes and hypertension. Early detection of abnormal urinary protein excretion, early intervention and treatment, reduce or delay the occurrence of end-stage renal disease and cardiovascular events, assess the development and prognosis of the disease, improve the quality of life of patients, and reduce the economic burden on individuals and society.