A Comparative Evaluation of Various Methods for Microalbuminuria Screening

Sarafidis, Pantelis A.; Riehle, Jessica; Bogojevic, Zvezdana; Basta, Emad; Chugh, Atul R.; Bakris, George L.

doi:10.1159/000111825

Cited by 36 publications

(24 citation statements)

References 19 publications

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“…Conventional qualitative tests (chemical strips or "dipsticks") for albuminuria do not detect the small increases of urinary albumin excretion. For this purpose, tests to detect albumin concentrations are used (Table 7) (322)(323)(324). Low levels of albuminuria have been defined by the Joint National Committee (JNC) 7 and the ADA and have more recently been redefined by the Kidney Disease: Improving Global Outcomes Committee (21,(325)(326)(327) as excretion of 30 -300 mg of albumin/24 h, 20 -200 g/min, or 30 -300 g/mg creatinine ( Table 8) on 2 of 3 urine collections.…”

Section: B (Moderate)mentioning

confidence: 99%

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Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

et al. 2011

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BACKGROUND Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. APPROACH An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence Based Laboratory Medicine Committee of the AACC jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. CONTENT In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A1c (Hb A1c) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of Hb A1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. SUMMARY The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended.

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Section: B (Moderate)mentioning

confidence: 99%

“…One dipstick was found to have Ͼ95% sensitivity (322,324 ). One such study evaluated an office-screening test that uses a monoclonal antibody against human serum albumin (ImmunoDip; Genzyme Diagnostics) (322 ).…”

Section: Gppmentioning

confidence: 99%

Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

et al. 2011

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“…It is still unknown whether screening for microalbuminuria will be better than screening for macroalbuminuria in terms of overall secondary prevention of progressive renal disease (26). Accurate, reliable, inexpensive, and rapid point-of-service methods or devices that measure low, but abnormal levels of albumin excretion are now available and studies are in progress to better define their value in the overall screening paradigm (27). Because targeted screening involves identification of individuals with at least two modifiable risk factors, diabetes and hypertension, one can logically ask whether the addition of another screening maneuver (e.g., eGFR) will contribute materially to the prevention of disease, over and above the management of the already identified risk factors.…”

Section: Egfr Should Not Be Used In Isolation As a Means For Screeninmentioning

confidence: 99%

Screening for CKD with eGFR

Glassock

Winearls

2008

Clinical Journal of the American Society of Nephrology

156

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The early identification of chronic kidney disease (CKD) is a legitimate enterprise if it provides meaningful opportunities for effective and safe interventions that reduce the risk of death, end-stage renal disease, or complications of renal dysfunction. The screening of unselected populations not already known to be at risk of CKD has the potential of harm and has not been shown to be cost-effective. The application of formulas for the estimation of GFR (eGFR) to the guidelines for staging of chronic kidney disease (Kidney Disease Outcomes Quality Initiative, K/DOQI) as universal screening tools is of dubious value and has inherent dangers. This conclusion is based both on the unreliability of current formulas for determining eGFR and flaws in the K/DOQI schema for staging of CKD. The failure to take into account the normal age-and gender-associated decline in GFR and the lack of a requirement for other evidence of kidney disease in CKD stage 3 leads to an erroneous categorization of large numbers of mostly elderly and female subjects as having an intermediate stage of a lethal disease. Criteria for CKD staging should take into account the percentile distribution of eGFR by age and gender. Targeted screening for CKD is likely to be more cost-effective than universal screening. Whether early identification and treatment of subjects with "reduced" levels of GFR within the normal range for their age/gender, but without any other manifestations of kidney disease, will reduce the subsequent risk of cardiovascular events or progression to end-stage-renal disease is currently unproven.

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“…Microalbuminuria is currently defined as a urinary albumin excretion (UAE) of 30-300 mg/24 h, if measured in a 24-h urine collection, in spot urine samples urinary albumin concentration (UAC) of 20-200 mg/l [18] and albumin: creatinine ratio (ACR) of 30-300 mg/g, in both men and women [19]. These guidelines do not take into account sex differences in creatinine excretion [3,19], for the ACR to define microalbuminuria.…”

Section: Introductionmentioning

confidence: 99%

“…These guidelines do not take into account sex differences in creatinine excretion [3,19], for the ACR to define microalbuminuria. …”

Section: Introductionmentioning

confidence: 99%

A Comparative Study of Clinical Utility of Spot Urine Samples with 24-h Urine Albumin Excretion for Screening of Microalbuminuria in Type 2 Diabetic Patients

et al. 2011

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Twenty-four hour urinary albumin excretion (UAE) is considered as gold standard method for albuminuria measurement, but collection of 24-h urine is inconvenient. The aim of present study was to evaluate whether albumin: creatinine ratio (ACR) and urinary albumin concentration (UAC) in different spot urine samples correlate or not with 24-h UAE for screening of microalbuminuria in type 2 diabetic patients. We collected first morning void (FMV), random urine sample (RUS) and 24-h urine, separately on consecutive days from 104 type 2 diabetic patients. ACR and UAC in each spot urine sample compared with 24-h UAE with regard to Pearson correlation coefficient. Pearson's correlation of albumin: creatinine ratio (ACR) with 24-h UAE was (r = 0.802 and 0.623) in first morning void (FMV) and random urine sample (RUS), respectively. Pearson's correlation coefficient of urinary albumin concentration (UAC) compared with 24-h UAE was (r = 0.943 and 0.920), in FMV and RUS, respectively, P \ 0.01. Results revealed that values in first morning void (FMV) were better correlated with 24-h urinary albumin excretion (UAE), than the values in random urine sample (RUS). We conclude that the first morning void (FMV) may be able to replace 24-h urine collection, preferably urinary albumin concentration (UAC) in the initial screening of microalbuminuria in diabetic patients.

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A Comparative Evaluation of Various Methods for Microalbuminuria Screening

Cited by 36 publications

References 19 publications

Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

Screening for CKD with eGFR

A Comparative Study of Clinical Utility of Spot Urine Samples with 24-h Urine Albumin Excretion for Screening of Microalbuminuria in Type 2 Diabetic Patients

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