How to manage a higher albumin creatinine ratio than the normal ratio?

Hello,

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I saw your history and tests. First thing I need to know about your medical history. Are you hypertensive or diabetic? Are you taking any medicines?

Regarding your question:

1. No, urine albumin creatinine ratio takes care of dilute or concentrated urine. So drinking too much water or little water has no bearing on the albumin creatinine ratio.

2. Regarding my thoughts about your test, it is increased. But one thing is that urine tests for albumin creatinine ratio should be done in the morning. Many times urine albumin can be increased in an upright position. So if you have done urine for albumin creatinine ratio of morning sample of urine, then it is increased, and if not, then you need to repeat with early morning urine for albumin creatinine ratio.

Also, I need to know about your medical history and drug history. If it is persistent, then we can start RAAS (Renin-angiotensin-aldosterone System) inhibition.

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Firstly, regarding your query about low creatinine in urine which has led to a higher albumin creatinine ratio. Low urine creatinine most likely is due to dilute urine. So if creatinine is low due to dilution, albumin will be less due to dilution (it would have been higher if urine was not diluted). That is why we use this ratio to compare both albumin and creatinine. Thus albumin creatinine ratio does not change with the dilution of urine (whether urine is dilute or concentrated, it will be the same). So we have to take cognizance of this urine albumin creatinine ratio.

Now coming to your query of urinalysis showing no protein. Urinalysis is very less sensitive to detecting protein or albumin, especially if urine is dilute. That is why we use urine albumin creatinine ratio. Also, it is better to do an albumin creatinine ratio than a protein creatinine ratio.

Now coming to your high ACR (albumin creatinine ratio) value, it most likely is due to overweight and hypertension. I would suggest decreasing weight (which you are working on) and controlling blood pressure. Since you are taking Telmisartan, it might need to be increased. Rest, you should be fine, but work on your weight, eating habits, and exercise

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To decrease ACR (albumin creatinine ratio), one needs to do certain things.

First, you need to decrease your weight so that your BMI (body mass index) is less than 25. Second, you need to control your blood pressure; your blood pressure should be less than 130/80 mm Hg. Third, you need to decrease salt in your diet (less than 5 grams of salt). Also, you need to avoid a high protein diet (protein to be taken daily should be less than 0.8 grams per kilogram of body weight).

Then you can increase the dose of Telmisartan (to more than 80 mg). We can start Dapaglifozin to decrease ACR.

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Yes, one can wait and see the effect of Telmisartan after three months. Also, the effect of weight loss can be seen. Regarding eggs, they are a good source of protein. One can take 1 to 2 eggs daily. The important thing is to avoid meat and other animal-based proteins.

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Then I would suggest starting Farxiga after consulting with a specialist.

Okay. I am still in favour of starting Forxiga. Rest you need to decrease weight, control blood pressure and also you can increase the dose of telmisartan to 120mg (if you tolerate).