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Microalbuminuria in clinical practice
M J McKenna1, C Arias, C S Feldkamp
1Division of Endocrinology and Metabolism, Henry Ford Hospital, Detroit, Mich. 48202.
Archives of Internal Medicine
|September 1, 1991
Summary
Early detection of diabetic nephropathy is valuable. Quantitative immunoassay testing for albumin excretion rate in a 24-hour urine sample is preferred over semiquantitative tests for diagnosing kidney disease in diabetes patients.
Area of Science:
- Nephrology
- Endocrinology
- Clinical Chemistry
Background:
- Diabetic nephropathy is a major complication of diabetes mellitus.
- Early detection of diabetic nephropathy is crucial for preventing progressive renal disease.
- Albuminuria is a key indicator of early diabetic nephropathy.
Purpose of the Study:
- To evaluate the diagnostic value of albumin excretion rate (AER) for early diabetic nephropathy detection.
- To compare quantitative immunoassay methods with semiquantitative tests for AER measurement.
- To identify predictors of AER in patients with diabetes mellitus.
Main Methods:
- Albumin excretion rate was determined in 276 patients using quantitative immunoassay on single 24-hour urine samples.
- Statistical analysis was performed to identify predictors of AER.
- Results were categorized into normal, microalbuminuric, and macroproteinuric ranges.
Main Results:
- 66% of patients had normal AER, 27% were in the microalbuminuric range, and 7% were in the macroproteinuric range.
- Hypertension and glycosylated hemoglobin levels predicted AER in type 1 diabetes.
- Years since diagnosis predicted AER in type 2 diabetes.
- A semiquantitative test showed limited diagnostic value.
Conclusions:
- Routine testing for early diabetic nephropathy provides valuable clinical information.
- Quantitative immunoassay determination of AER from a single 24-hour urine sample is the preferred method.
- Optimal screening frequency and thresholds for progressive renal disease require further investigation.