Developments in albuminuria testing: A key biomarker for detection, prognosis and surveillance of kidney and cardiovascular disease—A practical update for clinicians

Abstract

Albuminuria, the abnormal presence of albumin in urine, is a key marker of kidney damage and a strong predictor of kidney and cardiovascular outcomes. Its clinical significance has evolved from early historical observations to its current role in chronic kidney disease (CKD) detection, risk stratification and treatment monitoring. Advances in measurement techniques and evidence from large-scale studies have reinforced its prognostic value, particularly in guiding interventions such as renin-angiotensin-aldosterone system blockade, sodium-glucose cotransporter-2 inhibitors and non-steroidal mineralocorticoid receptor antagonists. Albuminuria assessment is now integrated into CKD staging, cardiovascular risk prediction models and therapy selection. Despite its established utility, challenges remain, including measurement variability, assay standardisation and under-utilisation in clinical practice. This review provides a practical update on albuminuria testing, summarising its historical development, technical aspects and clinical implications, and emphasising its role in CKD management and cardiovascular risk assessment.