Urine albumin (UACR)? 30 mg/g or above
albuminuria-presentNo one has reached this rule yetACE inhibitor or ARB first; SGLT2 inhibitor conditional to 200 mg/g and recommended above it or with heart failure
No clinician has signed off this rule yet. It reflects our reading of the guidelines cited below, which has not been independently checked.
Word for word, as generated for the example person below. Figures in the text are theirs.
You're leaking protein into your urine (60 mg/g). Take that number to your doctor and ask what it changes about your treatment.
Proven in trialsTrials counted real events, like heart attacks, strokes, or deaths, and this changed them.
This is worth being concrete about. Albuminuria is kidney damage measurable before filtration falls, and it raises cardiovascular risk independently — people with protein in the urine have more heart attacks and strokes at every level of kidney function. It typically changes three things: an ACE inhibitor or ARB to reduce the leak, a lower blood pressure target, and — above roughly 200 mg/g or alongside heart failure — an SGLT2 inhibitor, which protects both organs whether or not you have diabetes. We stop short of saying which you should be on, because that depends on your potassium and kidney function together with everything else you take. Also ask for a repeat sample: one reading can be raised by infection, hard exercise, or a fever.
ACC/AHA (US)
ACC/AHA grades the ACEi or ARB (not both) in adults with hypertension, eGFR below 60 and albuminuria of 30 mg/g or more at Class 1, Level B-R, and a systolic goal below 130 mmHg in CKD at Class 1, Level A. The SGLT2 inhibitor part of this recommendation comes from the KDIGO CKD guideline, which grades on its own scale. It was not read for this audit, so no ACC/AHA or ESC grade is shown for it.
2025 AHA/ACC Guideline for the Prevention, Detection, Evaluation and… · Recommendation behind this rule · class and level read from the guideline tables on 2026-09-30
ACEi or ARB for adults with diabetes, hypertension and CKD (eGFR below 60 or albuminuria 30 mg/g or more)
2025 AHA/ACC Guideline for the Prevention, Detection, Evaluation and… · Graded separately within the same recommendation · class and level read from the guideline tables on 2026-09-30
Why this is a question. It would need a recent potassium level, everything else you're currently taking. This tool doesn't ask for that, so it stays a question.
KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD · Class 1 · Level B-R
“Heart failure with a weak pump” — an illustrative profile, not a real user.
Cited by the recommendations above.
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Runs in lib/engine/preventionEssentials.ts as albuminuria-present.