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Microalbuminuria in Clinical Practice

Microalbuminuria in Clinical Practice Abstract Albumin excretion rate measured by new immunoassays and semiquantitative tests is advocated as a means for early detection of diabetic nephropathy. We determined albumin excretion rate in 276 patients. Albumin excretion rate was normal in 66%, within the microalbuminuric range in 27%, and within the macroproteinuric range in 7%. Significant predictors of albumin excretion rate included presence of hypertension and glycosylated hemoglobin level in type I diabetes mellitus, and years since diagnosis in type II diabetes mellitus. A semiquantitative test was deemed to be of limited diagnostic value. We conclude that testing for early diabetic nephropathy in routine clinical practice gives valuable information and that determination by a quantitative immunoassay based on a single 24-hour urine sample is preferable. The optimal frequency of screening and the levels that determine progressive renal disease have yet to be established. (Arch Intern Med. 1991;151:1745-1747) References 1. Selby JV, FitzSimmons SC, Newman JM, Kats PP, Sepe S, Showstack J. The natural history and epidemiology of diabetic nephropathy . JAMA. 1990;263:1954-1960.Crossref 2. Viberti G, Keen M. The patterns of proteinuria in diabetes mellitus . Diabetes. 1984;33:686-691.Crossref 3. Mogensen CE. Microalbuminuria as a predictor of clinical diabetic nephropathy . Kidney Int. 1987;31:673-689.Crossref 4. McKenna MJ, Feldkamp CS. Microalbuminuria: the key to preventing renal failure in diabetes mellitus . Am Assoc Clin Chem Endocrinol. 1989;8:5-13. 5. American Diabetes Association. Clinical practice recommendations . Diabetes Care. 1991;14( (suppl 2) ):1-81.Crossref 6. McKenna M, Amin V, Feldkamp C, Pimputkar M, Good E, Whitehouse FW. Albumin excretion rate is the preferred way to report microalbuminuria: a study in normal people . J Clin Immunoassay. 1987;10:151-155. 7. Schmitz A. Microalbutest: a new screening method for detecting microalbuminuria in diabetes mellitus . Uremia Invest. 1986;9:79-84. 8. Watts GF, Hodgson B, Morris RW, Shaw KM, Polak A. Side-room tests to screen for microalbuminuria in diabetes mellitus . Diabetic Med. 1987;5:298-303.Crossref 9. Howey JEA, Browning MCK, Fraser CG. Selecting the optimum specimen for assessing slight albuminuria, and a strategy for clinical investigation: novel uses of data on biological variation . Clin Chem. 1987;33:2034-2038. 10. Hutchison AS, Paterson KR. Collecting urine for microalbumin assay . Diabetic Med. 1988;5:527-532.Crossref 11. Stehouwer CDA, Fisher HRA, Hackeng WHL, den Ottlander GJH. Identifying patients with incipient diabetic nephropathy . Arch Intern Med. 1990;150:373-375.Crossref 12. Mathiesen ER, Ronn B, Jensen T, Storm B, Deckert T. Relationship between blood pressure and urinary albumin excretion in development of microalbuminuria . Diabetes. 1990;39:245-249.Crossref 13. Chase PH, Garg SK, Harris S, Hoops SL, Marshall G. High-normal blood pressure and early diabetic nephropathy . Arch Intern Med. 1990;150:639-641.Crossref 14. Chauers BM, Bilbous RW, Ellis EN, Steffes MW, Mauer SM. Glomerular lesions and urinary albumin excretion in type I diabetes without overt proteinuria . N Engl J Med. 1989;320:966-970.Crossref 15. Feldkamp CS, McKenna MJ. Microalbumin . Am Assoc Clin Chem Endocrinol. 1989;8:7-15. 16. Neumann RG, Bonomini LV, Braunstein SN. Evaluation of new rapid office test for microalbuminuria and its comparison to fully quantitative radioimmunoassay . Diabetes Care. 1990;13:1069-1073.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400090047009
Publisher site
See Article on Publisher Site

Abstract

Abstract Albumin excretion rate measured by new immunoassays and semiquantitative tests is advocated as a means for early detection of diabetic nephropathy. We determined albumin excretion rate in 276 patients. Albumin excretion rate was normal in 66%, within the microalbuminuric range in 27%, and within the macroproteinuric range in 7%. Significant predictors of albumin excretion rate included presence of hypertension and glycosylated hemoglobin level in type I diabetes mellitus, and years since diagnosis in type II diabetes mellitus. A semiquantitative test was deemed to be of limited diagnostic value. We conclude that testing for early diabetic nephropathy in routine clinical practice gives valuable information and that determination by a quantitative immunoassay based on a single 24-hour urine sample is preferable. The optimal frequency of screening and the levels that determine progressive renal disease have yet to be established. (Arch Intern Med. 1991;151:1745-1747) References 1. Selby JV, FitzSimmons SC, Newman JM, Kats PP, Sepe S, Showstack J. The natural history and epidemiology of diabetic nephropathy . JAMA. 1990;263:1954-1960.Crossref 2. Viberti G, Keen M. The patterns of proteinuria in diabetes mellitus . Diabetes. 1984;33:686-691.Crossref 3. Mogensen CE. Microalbuminuria as a predictor of clinical diabetic nephropathy . Kidney Int. 1987;31:673-689.Crossref 4. McKenna MJ, Feldkamp CS. Microalbuminuria: the key to preventing renal failure in diabetes mellitus . Am Assoc Clin Chem Endocrinol. 1989;8:5-13. 5. American Diabetes Association. Clinical practice recommendations . Diabetes Care. 1991;14( (suppl 2) ):1-81.Crossref 6. McKenna M, Amin V, Feldkamp C, Pimputkar M, Good E, Whitehouse FW. Albumin excretion rate is the preferred way to report microalbuminuria: a study in normal people . J Clin Immunoassay. 1987;10:151-155. 7. Schmitz A. Microalbutest: a new screening method for detecting microalbuminuria in diabetes mellitus . Uremia Invest. 1986;9:79-84. 8. Watts GF, Hodgson B, Morris RW, Shaw KM, Polak A. Side-room tests to screen for microalbuminuria in diabetes mellitus . Diabetic Med. 1987;5:298-303.Crossref 9. Howey JEA, Browning MCK, Fraser CG. Selecting the optimum specimen for assessing slight albuminuria, and a strategy for clinical investigation: novel uses of data on biological variation . Clin Chem. 1987;33:2034-2038. 10. Hutchison AS, Paterson KR. Collecting urine for microalbumin assay . Diabetic Med. 1988;5:527-532.Crossref 11. Stehouwer CDA, Fisher HRA, Hackeng WHL, den Ottlander GJH. Identifying patients with incipient diabetic nephropathy . Arch Intern Med. 1990;150:373-375.Crossref 12. Mathiesen ER, Ronn B, Jensen T, Storm B, Deckert T. Relationship between blood pressure and urinary albumin excretion in development of microalbuminuria . Diabetes. 1990;39:245-249.Crossref 13. Chase PH, Garg SK, Harris S, Hoops SL, Marshall G. High-normal blood pressure and early diabetic nephropathy . Arch Intern Med. 1990;150:639-641.Crossref 14. Chauers BM, Bilbous RW, Ellis EN, Steffes MW, Mauer SM. Glomerular lesions and urinary albumin excretion in type I diabetes without overt proteinuria . N Engl J Med. 1989;320:966-970.Crossref 15. Feldkamp CS, McKenna MJ. Microalbumin . Am Assoc Clin Chem Endocrinol. 1989;8:7-15. 16. Neumann RG, Bonomini LV, Braunstein SN. Evaluation of new rapid office test for microalbuminuria and its comparison to fully quantitative radioimmunoassay . Diabetes Care. 1990;13:1069-1073.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Sep 1, 1991

References