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Screening for Early Diabetic Nephropathy: Which Sample to Detect Microalbuminuria?
Author(s) -
Gatling W.,
Knight C.,
Hill R. D.
Publication year - 1985
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.1985.tb00681.x
Subject(s) - microalbuminuria , medicine , urine , morning , creatinine , diabetic nephropathy , renal function , urology , predictive value , proteinuria , albumin , diabetes mellitus , population , albuminuria , excretion , endocrinology , kidney , environmental health
In a study to monitor the acceptability of using a timed overnight urine collection to measure microalbuminuria in a large diabetic population, it was found that only 184 (69.4%) of 265 diabetics returned the urine collection to the hospital laboratory. Three proposals for an initial screening test to predict high risk microalbuminuria were analysed Proposal I: a random urinary albumin concentration (RAC) >25 μg/ml predicts an overnight albumin excretion rate (AER) >30 μg/min. In 159 diabetics, the sensitivity of this screening test was 56%, specificity 81%, and predictive value 15%. Proposal II: an albumin concentration >20 μg/ml in an early morning urine sample predicts an overnight AER >30 μg/min. In 175 diabetics, the sensitivity of this screening test was 86%, specificity 97%, and predictive value 71%. Proposal III: an albumin/creatinine ratio (albumin mg/l creatinine mmol/l) >3.5 in an early morning urine sample predicts an overnight AER >30 μg/minute. In 171 diabetics, the sensitivity of this screening test was 100%, specificity 95%, and predictive value 64%. It is concluded that an albumin/creatinine ratio performed on an early morning urine sample brought to the diabetic clinic would be a useful initial screening test to detect an overnight AER >30 μg/min.