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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

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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.

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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.