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By testing the urine. Diabetic nephropathy should be detected as early as possible. One of the first findings is the presence of very small amounts of protein in the urine. Therefore a urine albumin creatinine ratio (ACR) is an excellent test to determine who has early disease and who will respond to therapy. The urine albumin is measured, preferably on a first voided morning specimen, and compared to the urine creatinine level. This ratio corrects for fluid intake. Normal is < 30 mg albumin/gram creatinine. Microalbuminuria is associated with incipient nephropathy if the ratio is between 30 and 300 mg/gm. Levels over 300 mg suggest overt diabetic nephropathy. Note the difference between albumin and protein. Albumin is one of the proteins in the body, and is more selective for damage to the glomerular filter of the kidney. There are tests that show the amount of protein in the urine. A routine urinalysis performed with "dipstix." shows trace proteinuria, and is equivalent to < 30 mg protein per 24 hours. + protein is equivalent to 30 mg protein.
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