<b>Early Kidney Damage Detection in Diabetes Using Urine Albumin-Creatinine Ratio: A Diagnostic Yield Study</b>

Background: Diabetic kidney disease may begin silently, and serum creatinine can remain normal during early renal injury. Urine albumin-creatinine ratio is a practical screening test for detecting early albuminuria before routine renal function markers become abnormal. Objective: To determine the diagnostic yield of urine albumin-creatinine ratio for detecting microalbuminuria among adult diabetic patients with normal serum creatinine and to assess its association with diabetes duration and blood pressure control. Methods: This diagnostic yield study was conducted at a tertiary-care hospital in Bahawalpur, Punjab, Pakistan. A total of 180 adult diabetic patients with normal serum creatinine were included through consecutive sampling. Patients with known chronic kidney disease, raised serum creatinine, urinary tract infection, pregnancy, fever, heart failure, or acute severe illness were excluded. Microalbuminuria was defined as urine albumin-creatinine ratio of 30–300 mg/g. Associations with diabetes duration and blood pressure control were assessed using chi-square tests. Results: Microalbuminuria was detected in 62 of 180 patients, giving a diagnostic yield of 34.4% with a 95% confidence interval of 27.9–41.6%. Microalbuminuria increased with diabetes duration, from 20.7% in patients with duration below 5 years to 50.9% in those above 10 years. It was also more frequent in patients with uncontrolled blood pressure than controlled blood pressure, 48.6% versus 24.5%. Both associations were statistically significant. Conclusion: Urine albumin-creatinine ratio identified early albuminuria in a substantial proportion of diabetic patients with normal serum creatinine. Longer diabetes duration and uncontrolled blood pressure were associated with higher microalbuminuria frequency