Microalbuminuria Case Study: Lab Interpretation for Nurse Practitioners
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- Опубліковано 2 чер 2024
- Urine microalbumin: you need to check it once a year for patients in diabetes. But interpreting the results-- and knowing what to do with them!-- can be tricky.
In this video, you’ll learn:
- When to order it
- How to interpret the results
- What to do next
- How to treat abnormal levels
And if renal labs and assessment stress you out, join us for the Lab Interpretation Crash Course for New Nurse Practitioners! Head on over to https//www.realworldnp.com/labs to join!
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More Resources:
Lab Interpretation Crash Course: www.realworldnp.com/labs?utm_...
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Diabetes Medication Workshop: www.realworldnp.com/diabetes
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New evidence shows that adding SGLT2 helps decrease microalbinuria by up to 30%. Thanks for your informative videos.
Great option for some patients !
Of course it is at the physicians discretion, but would sglt2 be a potential option for diabetics w/ albuminuria but no gfr decline?
I've learned more from you than 10 doctors in a row! ;) Thank you for your clear concise info. Very helpful
Thank you so much for your kind words - I am so glad these videos are helpful to you!
LITERALLY same here! 💕💕💕💕
You are amazing!!!! Scrupulous education, I learned so much within the 1st 5 minutes and I haven’t even finished watching the video, I subscribed so fast I got whiplash! Thank you so much!! 💕💕💕💕
Wow, thank you!
I love your voice! I could listen to you all day. Wonderful presentation!
I hope it was helpful
@@RealWorldNP helpful
So good. So clear and concise. Thank you.
Glad it was helpful!
Thank you so much for this video!!!
You are so welcome! I hope it was helpful!
Good explanation, thank you.
Glad it was helpful!
Well done... thank you.
Thank you!
What a great video!
Glad you enjoyed it!
This is amazing video, thank you somuch
You're very welcome!
Thanks for wonderful video, Liz! Quick question, I had DM pt who had severe cough reaction to ACE/ARB. She had microalbumin >200mg/day If I remember correctly. She was on Amlodipine which is CCB as well, but I was not sure to switch to verapamil/diltiazem. Would amlodipine be appropriate alternative for her?
Oh interesting, yes in terms of ACE/ARB switching, any of the top 4 HTN choices according to JNC8 guidelines (CCB, thiazide) are appropriate depending on their other comorbids! Although won't protect from microalbuminuria. I'll have to make a post about CCB options!
Thank you 🙏 the case study was helpful as a reference.
So glad!
You have a contagious smile
Thank you
Thanks for the information. Great video. what would be creatinine levels for a bodybuilder 32 years old ?
Thank you! For safety and legal reasons, I can’t advise on that here. We always recommend you follow up with your primary healthcare provider.
Thanks for your helpful lessons, Iam from Somalia junior student at Hargeisa university.
Especially medical laboratory faculty
You from somaliland
@@farhaanaxmed663
Aannu caddaankayagaa iska baadhanee vaarta naga daa😀
Thank you!
Hi Liz! Another great video! Question for you… If a diabetic, patient has persistent but stable microalbuminuria, at what point would you refer to nephrology? I have a diabetic patient with a normal GFR, controlled BP and A1C (6.1), and they are already on an ARB; but they continue to have elevated MAUs. Thank you in advance for your guidance!
Hi Alex, ARB's are the best option for DM with microalbuminuria- per guidelines. MAU may persist but if MAU is > 300mg/day this is consider macroalbuminuria and a referral to nephrology may be helpful.
Thank you for this video! I have also been taught that all patients w/ diabetes should take an ACE-I or ARB for renal protection. Can you help me find a source that you cited where ACE-I/ARB for renal protection should only be with those with HTN? Thank you!
Thank you for this question! It's actually a bit nuanced as there's conflicting resources. The ADA Standards of Diabetes Care 2018 recommends Ace-inhibitors in patients with either microalbuminuria who are normotensive, or patients with hypertension (ace-i are first line for hypertension in diabetes), but doesn't recommend preventative ace-i in patients not in either situation. I haven't read the full 2021 updates yet but on the summary of changes I didn't see any updates. The reason it's nuanced is because there are studies showing that everyone with diabetes could benefit from an ace-i but I don't think it's sufficient data to be included as part of the ADA guidelines. But totally, I also learned everyone is supposed to take one! Perhaps that's splitting hairs, it's unlikely that it would be harmful and is probably beneficial but I like having guidelines to back me up :)
I have a dipstick that is in mmol/l how do you convert that to mg. Mine is showing up high in urine. I had kidney function test, ct scan all showed ok. But the doctor didn’t test for micro albumin only standard protein. I’m trying to figure it out.
Hello! I am sorry, but for legal and safety reasons, I can’t advise on this lab result. We do recommend you follow up with your primary care provider. Thank you!
youre awesome!
Thank you!!
If patients with type 2 diabetes can afford it, the addition of an SGLT2 inhibitor to an ACE inhibitor can be beneficial, provided that the side effects are tolerable and the estimated glomerular filtration rate is satisfactory.
I must admit, I need to make a correction here. The absolute benefit with SGLT2 inhibitors (SGLT2-I) is particularly significant for macroalbuminuria.
I can't express enough how deeply moved I was by this video, especially when it comes to discussing microalbuminuria. The way you began and concluded the video was incredibly heartfelt and touching. It's evident that you genuinely care for your patients, and for that, I am sincerely grateful. Individuals like yourself make this world a truly enjoyable place to live. Thank you.
So glad you find it beneficial.
For a spot sample, the level is 1628mg/l of a 15yrs old girl...can you diagnose it?
Sorry, but for legal and safety reasons, I can't advise on this.
Does the microalbumin ever decrease to normal with controlled DM and HTN? When the gfr, bun/cr is normal
Yes! SO sorry I missed this comment. It can. I don't have great data on how much it'll improve or if it'll go back to normal, but when you improve the offending agents, it can get better.
Can Crestor create all that damage to kidneys (high microalbumin/creatinine ratio)?
Crestor by itself can proteinuria but not thought by most to be benign. In some rare cases rosuvastatin at high doses may effect renal function so its' important to monitor closely.
You said microalbumin 96.8 mg L is okay. Is it true that anything below 30 mg dl of microalbumin is normal?
Hi ! When evaluating microalbumin labs you want to look at the microalbumin/creatinine ratio. The 96.8 microalbumin is not an accurate depiction of renal function. If you want to evaluate just microalbumiin then you will need to collect a 24-hr urine test.
I want to enroll for the lab interpretation ... how?
Hey! It’s going to be opening up again in a few weeks! Head over to realworldnp.com/labs to sign up for the waitlist!
Should the serum and urine creatinine (.77 and 11.7 respectively) tests be done fasted.. does it affect the test if one drinks lots of water prior?
In the case "borderline" alb/creat (26) , A1C (5.7), fasting glucose (101).. how accurate is the estimated GFR spot-test versus the full 24hour GFR test to measure total albumin is < 30mg?
Do you think fasting insulin tests are useful?
Fasting is not necessary for serum creatinine but increasing water take prior to testing can decrease serum creatinine levels. A urine creatinine is usually collected over 24 hrs as these are a more accurate picture of kidney function and gfr. A fasting insulin test is beneficial when considering differentials insulinoma or insulin resistance.
Thank you for the great information. Can dehydration or a high protein diet show a high ACR reading? Should one drink water before the ACR test?
Dehydration and high protein diet can potentially effect ACR readings. Hydration is a good idea prior to testing but should not effect results.
Did he get better?
Lost to follow up unfortunately :(
Good video but you talk very very rapidly and do not forget that many non-Americans are listening. Besides you have a very beautiful face and a very revealing voice. Thank you a lot . I love your videos.
Sorry about that. If you click the wrench under the video you can adjust the playback speed to your preference. Hope this helps.
Sorry I would have love to finish ur explanation but alas u speak so fast for foreigns 11:22
I
I apologize for that. If you clinic the wrench under the video you can adjust the playback speed to your preference. Hope this helps.
You talk way too fast -- slow down!
You can adjust the speed on all the videos. Click on the gear and slow it down to how you need it. And, thanks for the input!
@@RealWorldNP Good to know!
@@RealWorldNP you need to slow down and enunciate your words.
There is a gear on the bottom of the video where you can slow down the speed of the video. I definitely get better in the more recent videos!
Your speed is just fine
In normal language speed please lol
You can click on the gear at the bottom of the playback screen and choose the speed at which to playback the video. It's set to normal, but you can slow it down to a speed that works for you!
I'm sorry but you talk too fast for me. It was hard to understand what you were saying.
If you click the wrench under the video you can adjust the playback speed to your preference. Hope this helps.
U r too fast, i had to go for yranscript, thanks anyway.
Sorry about that if you click the wrench under the video you can adjust the playback speed to your preference. Hope this helps.