OBJECTIVES: To determine the prevalence of microalbuminuria, macroalbuminuria and renal insufficiency at the time of screening for diabetes and impaired fasting glucose in the semi-rural area of Kisantu/DR Congo, and to identify determinants of pathological urinary albumin excretion (UAE). METHODS: Step 1: diabetes (81 cases) and impaired fasting glucose (148 cases) tracking in the population (1898 subjects selected by a systematic survey). Step 2: urinary albumin and serum creatinine were measured and glomerular filtration rate was estimated (modification of the diet in renal disease [MDRD] equation). The determinants of pathological UAE were assessed by logistic regression. RESULTS: The prevalence of macroalbuminuria and microalbuminuria in diabetes was 12.0 and 45.2% respectively versus 0 and 13.7% in impaired fasting glucose. Determinants of pathological UAE were: diabetes (adjusted OR [aOR]: 7.01; 95% CI: 3.48-14.11), central obesity (aOR: 2.36 [1.16-4.80]), age less that 60 years (aOR: 2.12 [1.05-4.40]), hypertension [aOR: 3.30 (1.39-7.82)] and diabetic retinopathy (aOR: 3.12 [1.54-6.26]). Renal insufficiency (MDRD<60ml/min/1.73m(2)) prevalence was 21.4% in diabetes and 3.8% in impaired fasting glucose. CONCLUSION: Microalbuminuria and macroalbuminuria are frequently detected during screening for diabetes and impaired fasting glucose in a semi-rural area in DR Congo. They are especially associated with age above 60 years, central obesity and hypertension. Early and integrated management of diabetes is essential to prevent renal failure in the population.