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Transient albuminuria — ESENeph MCQ

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EasyChronic Kidney DiseaseTransient albuminuriaESENeph

A 57-year-old man with CKD G3a has a urine ACR of 32 mg/mmol on a random sample. He has recently had a febrile urinary infection and heavy exercise. Repeat early morning ACR 3 weeks later is 4 mg/mmol and dipstick is negative. What is the most appropriate interpretation?

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Correct answer: A — Transient albuminuria related to intercurrent illness or exercise

Albuminuria should be confirmed, preferably using early morning samples, because infection, fever and exercise can cause transient elevations. The repeat ACR is normal, making persistent A3 albuminuria unlikely. Nephrotic syndrome would require heavy proteinuria and hypoalbuminaemia. The pearl is that CKD classification should not be based on a single abnormal urine test during an acute illness.

Reference: NICE NG203; KDIGO 2024 CKD Guideline