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Screening for microalbuminuria: which measurement?

S M Marshall1

  • 1Department of Medicine, University of Newcastle upon Tyne, UK.

Diabetic Medicine : a Journal of the British Diabetic Association
|October 1, 1991
PubMed

Insights

Screening Type 1 diabetic patients for microalbuminuria is crucial. The albumin-to-creatinine ratio in early morning urine samples is a reliable method for early detection and management.

Area of Science:

  • Nephrology
  • Diabetology
  • Clinical Chemistry

Background:

  • Microalbuminuria is an early indicator of diabetic nephropathy in Type 1 diabetes.
  • Early detection and intervention, including blood glucose and blood pressure control, can slow disease progression.
  • The gold standard for microalbuminuria diagnosis, albumin excretion rate (AER) in timed urine, is impractical for routine screening.

Purpose of the Study:

  • To evaluate the reliability of albumin concentration and albumin-to-creatinine ratio in random and early morning urine samples for screening microalbuminuria.
  • To determine the most practical and accurate screening method for microalbuminuria in Type 1 diabetic patients.

Main Methods:

  • Correlation analysis of albumin concentration and albumin-to-creatinine ratio in random and early morning urine samples against AER.
  • Assessment of sensitivity and specificity of various cut-off values for predicting microalbuminuria.

Main Results:

  • Weak correlations were found for albumin concentration and albumin-to-creatinine ratio in random urine samples.
  • Stronger correlations were observed for both albumin concentration and albumin-to-creatinine ratio in early morning urine samples compared to AER.
  • Albumin-to-creatinine ratio in early morning urine samples demonstrated high sensitivity (88-100%) and specificity (81-100%) for microalbuminuria screening.

Conclusions:

  • Measurement of albumin-to-creatinine ratio in early morning urine samples is the most reliable and practical method for screening microalbuminuria in Type 1 diabetes.
  • A threshold of ≤3.5 mg mmol-1 suggests normoalbuminuria, requiring annual re-screening.
  • A threshold of ≥10.0 mg mmol-1 warrants confirmation of microalbuminuria via timed urine collection and initiation of therapy.

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