中老年人群尿白蛋白与肌酐比值的性别差异研究

尿自蛋白排出量是诊断糖尿病肾病最重要的指标，为了采取标本方便，采用次尿（即晨尿或随机一次尿）测定尿白蛋白与肌酐比值（ACR）来判断其排出量。2005年IDF全球指南和亚太地区IDF指南均提出男女之间有差别的ACR标准，分别为男性≥2．5mg／mmol（22mg／g），女性≥3．5mg／mmol（31mg／g）。我国人群ACR的性别特异性切点的研究目前尚无报道。我们比较了非糖尿病人群ACR测定的结果，为修改我国目前采用的2005年微量白蛋白尿（MAU）诊断标准ACR切点提供数据。     

尿微量白蛋白对腹部大手术后病人预后预测价值研究

目的 研究尿微量白蛋白与腹部大手术后病人预后的关系。方法 选择江汉大学附属医院2007年9月至2009年4月期间收治的118例腹部大手术病人,连续动态监测腹部大手术后48h内尿微量白蛋白/尿肌酐值（ACR）、入ICU时动脉血乳酸值（LAC）、PaO2/FiO2值和术后各种并发症的发生。ROC曲线比较ACR、POSSUM评分、LAC、PaO2/FiO2值预测术后并发症的价值。结果 术后13例（11%）出现并发症,并发症组入ICU后0、6、12、18、24和48h ACR值显著高于无并发症组（P≤0.001）,相关分析显示入ICU后24h 、48h ACR与POSSUM评分（r=0.374, P＜0.001,r=0.390, P＜0.001）、LAC（r=0.381, P<0.001,r=0.296, P=0.001）呈正相关,与PaO2/FiO2值（r=-0.27, P=0.003,r=－0.251, P=0.006)存在负相关。ROC曲线显示24h ACR ROC曲线为0.857,48h ACR ROC曲线为0.946,而POSSUM评分ROC曲线为0.89,24h ACR值取临界值5.0g/mol时,其预测敏感度86.7%, 特异度33.3％,死亡的阳性预测值16.9%,阴性预测值94.1%。结论 动态监测尿微量白蛋白可作为预测术后并发症的可靠指标。     

免疫比浊法测定微量白蛋白尿以早期诊断糖尿病肾病

目的：（１）通过比较ＤＣＡ２０００测定仪（免疫比浊法）与常规放射免疫法测定尿白蛋白结果，评价使用ＤＣＡ２０００测定尿白蛋白的可靠性及准确性；（２）比较不同标本采集方式对尿白蛋白结果及糖尿病肾病分期的影响。方法：（１）用１１７名病人的夜间８ｈ尿标本分别进行ＤＣＡ２０００免疫比浊法和放射免疫法测定；（２）以ＤＣＡ２０００测定仪测定３４例患者的晨尿、８ｈ及２４ｈ尿白蛋白、肌酐浓度。结果：（１）ＤＣＡ２０     

尿NGAL和血、尿胱抑素C对早期糖尿病肾脏疾病诊断价值的研究

目的:探讨中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和胱抑素C(Cys C)对糖尿病肾脏疾病(DKD)的早期诊断价值和临床意义。方法:选取2型糖尿病(T2DM)患者60例,根据尿白蛋白/肌酐比(ACR)分为3组,正常白蛋白尿(NA)组20例,ACR≤30 mg/g;微量白蛋白尿(MA)组20例,30 mg/gACR300 mg/g;大量白蛋白尿(CA)组20例,ACR≥300 mg/g;选择同期的健康查体者20例作为对照组(NC)。留取晨尿和空腹血液标本,用ELISA法检测尿NGAL、血和尿Cys C水平,分析其与肾小球滤过率(e GFR)之间的相关关系,应用受试者操作特征(ROC)曲线评价其对DKD早期诊断的敏感性和特异性。结果:(1)DKD各组的尿NGAL、血和尿Cys C水平,除NA组与NC组比较血Cys C差异无统计学意义(P0.05)、NA组与MA组比较尿Cys C差异无统计学意义(P0.05)外,其他各组间差异均有统计学意义(P0.05)。(2)糖尿病患者尿NGAL、血和尿Cys C水平与e GFR均呈负相关(r值分别为-0.82,-0.787,-0.716,P0.05)。(3)DKD患者尿NGAL、血和尿Cys C的ROC曲线下面积分别为0.821,0.79和0.734。结论:DKD患者尿NGAL与血和尿Cys C,与e GFR均具有相关性,且尿NGAL较血和尿Cys C更为敏感,尿NGAL可作为早期诊断DKD的敏感指标。     

复方积雪草加味汤对早期糖尿病肾病尿微量白蛋白干预效应

目的：通过对早期糖尿病肾病患者尿微量白蛋白（MAU）的检测,采用复方积雪草加味汤对MAU阳性患者干预治疗,探讨中医药对早期糖尿病肾病干预作用.方法：随机选择在2010年11月~2011年6月在我院门诊及内科住院治疗的糖尿病患者和健康体检者.对照组健康正常人65例,均为在我院健康体检人员,尿常规定性均为阴性,无高血压、糖尿病以及其他急慢性肾损伤疾病.糖尿病组共68例,均确诊为2型糖尿病患者,且病史≤5年.尿常规蛋白定性均为阴性,排除其他疾病导致急慢性肾损伤.糖尿病组与健康对照组在年龄、性别、体重等身体各项指标差异无统计学意义（P〉0.05）.采用透射比浊法对MAU进行全定量测定;标准参考：MAU≤30 mg/L正常,MAU〉30 mg/L即呈阳性.并对糖尿病组阳性患者行复方积雪草加味汤（积雪草30 g、黄芪30 g、桃仁6 g、当归6 g、金樱子10 g、芡实10 g、制大黄5 g）进行干预治疗,共4周.结果：两组MAU检出情况对照组和糖尿病组相比,前者未检出尿MAU阳性,阳性率为0%,糖尿病组中检出尿MAU阳性41例,阳性率为39.8%,两者检测结果差异有统计学意义（P〈0.05）;对阳性组治疗前MAU（141.45±24.89）mg/L,复方积雪草加味汤治疗后MAU（51.57±15.56）mg/L,两者检测结果差异有统计学意义（P〈0.05）.结论：糖尿病组与健康人组比较,尿微量白蛋白阳性率明显增高,表明糖尿病与尿微量白蛋白有一定的相关性.阳性组经复方积雪草加味汤治疗后,尿微量白蛋白明显减少,提示复方积雪草加味汤具有减少早期糖尿病尿微量白蛋白作用.     

2型糖尿病患者微量白蛋白尿与骨密度的关系

目的 研究2型糖尿病患者微量白蛋白尿与骨密度的关系.方法 正常对照组55例,2型楮尿病患者86例.糖尿病患者根据尿白蛋白排泄率(UAE)分成正常白蛋白尿组及微量白蛋白尿组.使用双能X线骨密度测量仪测量左前臂、左髋部及腰椎的骨密度(BMD).结果 女性2型糖尿病微量白蛋白尿组各部位BMD较正常白蛋白尿组差异无显著性(P>0.05),但腰椎BMD较无糖尿病组增高(P<0.05).男性2型糖尿病微量白蛋白尿组各部位BMD较另两组男性差异无显著性(P>0.05).结论 2型糖尿病伴微量白蛋白尿的患者无明显骨量减少或骨质疏松.     

马来酸罗格列酮对2型糖尿病微量尿白蛋白的影响

目的观察马来酸罗格列酮对2型糖尿病患者尿微量白蛋白的影响。方法40例2型糖尿病患者分为两组：治疗组26例及对照组14例，治疗组加用马来酸罗格列酮4mg／d，共治疗12周。分别测定治疗前后空腹静脉血浆葡萄糖（FPG）、糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）、胰岛素抵抗指数（IRI）、尿微量白蛋白（UAE）、血脂、血压等。结果患者用马来酸罗格列酮后UAE与治疗前及对照组相比明显下降（P〈0．01），治疗前后FIG、HbA1c、FINS、IRI均下降（P〈0．05），血脂水平变化不明显。马来酸罗格列酮具有良好的耐受性，无明显肝肾毒性。结论马来酸罗格列酮治疗2型糖尿病患者除有效降低血糖、胰岛素抵抗指数以外，能明显降低尿白蛋白的排泄，可达到改善糖尿病肾病的目的。     

老年人尿微量白蛋白相关因素的研究

目的：通过分析老年人尿微量白蛋白（MA）的相关因素，来寻找减少老年人MA排泄的途径。方法：对465例老年人进行问卷调查、24h动态血压检测、实验室检查和MA检测，运用Logistic回归分析方法筛选影响老年人MA排泄的相关因素。结果：老年人MA排泄的独立相关因素有24h收缩压（OR=1．065，95％CI1．047～1．084，P〈0．001）、空腹血糖（OR=1．410，95％CI1．137～1．683，P〈0．01）、载脂蛋白B100（OR=1．386，95％CI1．1431．629，P〈0．05）。结论：积极采取有效措施，降低24h收缩压、空腹血糖和载脂蛋白B100的水平，是减少老年人MA排泄的重要途径。     

点时间尿蛋白与尿肌酐比值检测的临床应用评价

目的研究晨尿和随意尿的尿蛋白/尿肌酐(P/C)是否可以替代24h尿蛋白定量,用于监测尿蛋白的排出情况。方法选取本科住院患者68例共116份标本,对其晨尿P/C及随意尿P/C与24h尿蛋白定量进行相关分析。采用ROC曲线分析确定晨尿P/C相对于24h尿蛋白定量为1g及3g的诊断界点。再选取门诊肾脏病患者22例,研究活动对尿P/C检测的影响。结果住院患者晨尿P/C(及随意尿P/C)与24h尿蛋白定量中度相关。按肾功能分组的进一步分析显示,Ccr≤10ml/min时两者不相关,Ccr>10ml/min时高度相关。应用ROC曲线计算晨尿P/C相应24h尿蛋白定量1g及3g的诊断界点分别为0.94g/gcr及2.84g/gcr时敏感性和特异性最佳。晨尿P/C与随意尿P/C之间具有高度相关性。门诊患者随意尿P/C明显高于晨尿P/C。结论监测尿蛋白排出情况时,Ccr>10ml/min的患者点时间尿P/C可以替代24h尿蛋白定量,门诊患者以晨尿P/C为最佳。     

危重病患者尿微量白蛋白水平变化与APACHE Ⅱ评分的关系

目的：探讨危重病患者尿标本中微量白蛋白(MA)水平的变化与APACHEⅡ评分及疾病严重程度和预后的关系。方法：采用速率散射比浊法检测尿MA,全自动生化分析仪检测尿肌酐(Cr),APACHEⅡ评分采用相应软件。结果：正常对照组尿MA/Cr水平为1．8+0．4mg/mmolCr,危重病患者组进入ICU 6h尿MA/Cr水平为11．7士9．7mg/mmolCr,两者比较有显著性差异(P＜0．01)。尿MA/Cr比率与APACHEⅡ评分有良好的相关性。死亡组与存活组患者MA/Cr比率分别为24．5±15．1mg/mmolCr和8．3±2．4mg/mmolCr,两者比较差异显著(P＜0．01)。结论：早期检测尿微量白蛋白与APACHEⅡ评分均能不同程度地反映危重病患者病情及预后,两者同步测定有助于更准确地判断患者的病情及预后和决定IC收治标准、治疗范围和强度,在临床上推广应用有实用参考价值。     

The validity of screening based on spot morning urine samples to detect subjects with microalbuminuria in the general population

BACKGROUND: No study has yet investigated the validity of prescreening by albumin measurements in a spot morning urine sample to identify in the general population subjects with microalbuminuria. We therefore tested the diagnostic performance of urinary albumin concentration (UAC) and albumin-creatinine ratio (ACR), measured in a spot morning urine sample, in predicting a urinary albumin excretion (UAE) > or =30 mg in subsequent 24-hour urines (microalbuminuria). METHODS: Subjects (2527) participating in the PREVEND study, a representative sample from the general population, collected a spot morning urine sample and, on average, 77 days later, two 24-hour urine collections. RESULTS: The ROC curve of UAC in predicting microalbuminuria has an area-under-the-curve of 0.92 with a discriminator value of 11.2 mg/L. Using this cut-off value for UAC, sensitivity in predicting microalbuminuria is 85.0%, and specificity 85.0%. For ACR these values are, respectively: area-under-the-curve 0.93, discriminator value 9.9 mg/g, sensitivity 87.6%, and specificity 87.5%. Sensitivity for UAC in predicting microalbuminuria does not differ significantly from the sensitivity for ACR, whereas the difference between the specificities of UAC and ACR reaches statistical significance, but is numerically very small. In various subgroups characterized by differences in urinary creatinine excretion, the area-under-the-ROC curve, sensitivity, as well as specificity, do not increase relevantly compared to the results in the overall study population. This holds true for ACR as well as UAC. CONCLUSION: The diagnostic performance of measuring UAC in a spot morning urine sample in predicting microalbuminuria in subsequent 24-hour urine collections is satisfactory, and, moreover, comparable to that of measuring ACR. In order to keep the burden and costs involved in population screening for microalbuminuria as low as possible, we therefore propose prescreening by measuring UAC in a spot morning urine sample. Those subjects with a UAC above a certain predefined level (e.g., 11 mg/L) should be asked to collect timed urine samples.     

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??Microalbuminuria as predictor of outcome after major abdominal surgery ZHU Guo-chao, LI Rong??QUAN Zhuo-yong??et al.Department of Surgery , the Affiliated Hospital of Jianghan University, Wuhan 430015,China
Corresponding author : LI Rong??E-mail: rongman@163.com
Abstract Objective To evaluate microalbuminuria as predictor of outcome after major abdominal surgery. Methods Microalbuminuria (ACR) was measured in 48 hours post-operation and arterial lactate, PaO2/FiO2 ratio at ICU admission. Receiver-operator curves (ROC) were constructed to compare ACR, physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) score, LAC and PaO2/FiO2 ratio to predict outcome. Results A total of 13 postoperative complications were recorded in 118 patients (11%). ACR at ICU admission and 6, 12, 18, 24 and 48 hours at ICU was significantly higher in patients with postoperative complications than in those without complications ??P≤0.001??. ACR at 24 and 48 hours were positively correlated with POSSUM ??r=0.374, P??0.001??r=0.390, P??0.001????LAC??r=0.381, P<0.001??r=0.296, P=0.001??and LAC ??r=0.381, P<0.001??r=0.296, P=0.001??and inversely correlated with mean PaO2/FiO2??r=-0.27, P=0.003??r=-0.251, P=0.006). The area of ROC of ACR at ICU 24, 48 hour and POSSUM to morbidity was statistically higher than 0.5 (0.857 vs 0.946 vs 0.89). Using a cutoff for ACR at ICU 24 hour of 5.0g/mol. The sensitivity for complication was 86.7%, with specificity of 33.3% and the positive predictive value of death was 16.9%, with negative predictive value of 94.1%. Conclusion ACR is a valuable predictor of in-hospital outcome after major abdominal surgery.     

Microalbumin measurement alone or calculation of the albumin/creatinine ratio for the screening of hypertension patients?

BACKGROUND: Spot urine sampling seems to be a reliable screening method for the detection of microalbuminuria in hypertensive patients. It remains unclear whether microalbumin measurement alone or calculation of the albumin/creatinine ratio (ACR) are more reliable for the detection of microalbuminuria in non-selected hypertensive patients. METHODS: Following collection of a spot, midstream urine sample, urine was collected for 24 h for the measurement of microalbumin in 264 hypertensive patients. We compared microalbumin concentration in the spot urine with microalbumin measured in the 24-h urine sample and examined the utility of the ACR in evaluating microalbuminuria in hypertensive patients. Pathologic microalbuminuria was assumed when the microalbumin concentration exceeded 30 mg/l in the 24-h urine sample. Diagnostic performance is expressed in terms of specificity, sensitivity, positive (PPV) and negative predictive value (NPV), and area under receiver operating characteristics curve (AUC). RESULTS: A total of 47 samples (17.8%) showed pathologic microalbuminuria in the 24-h urine sample. The diagnostic performance expressed as AUC was 0.94 (95% CI 0.90-0.98) for microalbumin measurement alone and 0.94 (95% CI 0.89-0.97) for ACR. The PPV and NPV were 44.2 and 97.9% for microalbumin measurement alone. ACR revealed a PPV of 29.3% and a NPV of 96.2% for males and 42.9 and 98% for females, if a cut-off value of 2.5 mg/mmol for males and of 4.0 mg/mmol for females was used. CONCLUSIONS: The ACR did not provide any advantage compared with microalbumin measurement alone, but requires an additional determination of creatinine and the use of gender-specific cut-off values. Therefore, measurement of microalbuminuria alone in the spot urine sample is more convenient in daily clinical practice and should be used as the screening method for hypertensive patients.     

Use of the albumin/creatinine ratio to detect microalbuminuria: implications of sex and race

The recommended albumin (microg)/creatinine (mg) ratio (ACR) (30 microg/mg) to detect microalbuminuria does not account for sex or racial differences in creatinine excretion. In a nationally representative sample of subjects, the distribution of urine albumin and creatinine concentrations was examined by using one ACR value (> or =30 microg/mg) and sex-specific cutpoints (> or =17 microg/mg in men and > or =25 microg/mg in women) measured in spot urine specimens. Mean urine albumin concentrations were not significantly different between men and women, but urine creatinine concentrations were significantly higher (P < 0.0001). Compared with non-Hispanic whites, urine creatinine concentrations were significantly higher in non-Hispanic blacks (NHB) and Mexican Americans, whereas urine albumin concentrations were significantly higher in NHB (P < 0.0001) but not Mexican Americans. When a single ACR is used, the prevalence of microalbuminuria was significantly lower among the men compared with women (6.0 versus 9.2%; P < 0.0001) and among non-Hispanic whites compared with NHB (7.2 versus 10.2%; P < 0.0001). No significant difference in the prevalence of microalbuminuria between men and women was noted when sex-specific ACR cutpoints were used. In the multivariate adjusted model, female sex (odds ratio, 1.62; 95% confidence interval, 1.29 to 2.05) and NHB race/ethnicity (odds ratio, 1.34; 95% confidence interval, 1.12 to 1.61) were independently associated with microalbuminuria when a single ACR threshold was used. When a sex-specific ACR was used, NHB race/ethnicity remained significantly associated with microalbuminuria but sex did not. The use of one ACR value to define microalbuminuria may underestimate microalbuminuria in subjects with higher muscle mass (men) and possibly members of certain racial/ethnic groups.     

Total cholesterol to high-density lipoprotein cholesterol ratio is independently associated with CKD progression

Purpose

Although dyslipidemia can cause kidney damage, whether it independently contributes to the progression of chronic kidney disease (CKD) remains controversial. The research aims to evaluate the predictive value of serum lipids and their ratios in the progression of CKD.

Methods

The retrospective, case–control study included 380 adult subjects with CKD stage 3–4 (G3-4) at baseline. The end point of follow-up was the progression of CKD, defined as a composite of renal function rapid decline [an annual estimated glomerular filtration rate (eGFR) decline?>?5 mL/min/1.73 m²] or the new-onset end-stage renal disease (ESRD) [eGFR?<?15 mL/min/1.73 m²]. Logistic regression analysis was performed to examine the association between CKD progression and lipid parameters. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive power of lipid parameters in the progression of CKD.

Results

Over a median follow-up of 3.0 years, 96 participants (25.3%) developed CKD progression. In multivariable logistic regression analysis, logarithm-transformed urinary albumin-to-creatinine ratio (log ACR) [odds ratio (OR) 1.834;95% confidence interval (CI) 1.253–2.685; P?=?0.002] and total cholesterol to high-density lipoprotein cholesterol ratio (TC/HDL-C) [OR 1.345; 95% CI 1.079–1.677; P?=?0.008] were independently associated with CKD progression. The ROC curve showed the combined predictor of ACR and TC/HDL-C ratio was acceptable for CKD progression diagnosis (area under the ROC curve [AUC]?=?0.716, sensitivity 50.0%, specificity 84.2%), and the cut-off value was ? 0.98.

Conclusions

The combination of TC/HDL-C ratio and ACR had predictive value in the progression of CKD, and may help identify the high-risk population with CKD.

     

ImmunoDip: an improved screening method for microalbuminuria

BACKGROUND: It is important to test for microalbuminuria in patients with diabetes, hypertension and possible insulin resistance syndrome. Current screening methods are suboptimal. This study evaluates a new office screening test for microalbuminuria that utilizes a monoclonal antibody against human serum albumin (ImmunoDip). METHODS: 182 urine samples were collected from patients attending diabetes, nephrology or hypertension clinics. The ImmunoDip screening test was carried out in the 182 samples after which albumin and creatinine concentrations were measured quantitatively in a reference laboratory. RESULTS: Screening the 182 patient samples with ImmunoDip and designating an albumin:creatinine ratio of > or =30 microg/mg as positive yielded a sensitivity of 96%, a specificity of 80%, a positive predictive value (PPV) of 66% and a negative predictive value (NPV) of 98%. The reduced specificity and PPV were not due to an intrinsic inaccuracy with ImmunoDip screening of these samples, but rather was shown to be due to the discordance between the accepted upper limits of normal for the albumin:creatinine ratio (30 microg/mg) and the albumin concentration (20 mg/l), the latter corresponding to a ratio of 20 microg/mg. In 35 samples with albumin concentrations of 20-50 mg/l, ImmunoDip screening yielded only one false negative (FN) result. CONCLUSIONS: ImmunoDip is an excellent screening tool for microalbuminuria.     

Albuminuria as a predictor of cardiovascular and renal outcomes in people with known atherosclerotic cardiovascular disease

BACKGROUND: Microalbuminuria predicts elevated cardiovascular risk in those with and without diabetes. In diabetes, microalbuminuria also heralds overt diabetic nephropathy. The predictive value of albuminuria below the microalbuminuria cutoff, and the development of overt nephropathy in nondiabetics with microalbuminuria, have not been well studied. We review findings of the HOPE Study. METHODS: The HOPE Study database includes data on first morning urine albumin/creatinine ratio (ACR) in 9043 participants at baseline, and in 7674 participants at baseline and at last follow-up. Inclusion criteria were known vascular disease or diabetes, plus one other cardiovascular risk factor; exclusion criteria included heart failure or known impaired left ventricular function, dipstick-positive proteinuria (> 1+), and serum-creatinine > 2.3 mg/dL (200 micromol/L). Microalbuminuria was defined as an ACR > or = 2 mg/mmol. RESULTS: Microalbuminuria at baseline approximately doubled the relative risk (RR) of the primary outcome (myocardial infarction, stroke, or CV death). For every 1 mg/mmol rise of ACR, even below the level of microalbuminuria, the adjusted hazard of the primary outcome increased by about 15%. Baseline microalbuminuria predicted subsequent clinical proteinuria, RR 17.5, similarly in participants without and with diabetes. New microalbuminuria developed in 1542 participants, and clinical proteinuria in 317. CONCLUSION: Albuminuria is a continuous risk factor for CV events even below the level of microalbuminuria. Microalbuminuria predicts clinical proteinuria in nondiabetics.     

Use of albumin creatinine ratio and urine albumin concentration as a screening test for albuminuria in an Indo-Asian population.

BACKGROUND: Albuminuria (>30 mg/day) based on 24 h urine albumin excretion is one of the criteria for chronic kidney disease (CKD) and a predictor of cardiovascular disease (CVD). Differences in urine albumin concentration and creatinine excretion rates between Indo-Asians and other populations may require different threshold values for detection of albuminuria. We compared the use of spot urine albumin concentration and urine albumin to creatinine excretion ratio for detection of albuminuria in this population. METHODS: A total of 577 subjects aged >or=40 years, 54% of whom were women, were recruited from the general population in Karachi, Pakistan. Albumin concentration (mg/l) and albumin to creatinine ratio (mg/g of creatinine) were determined in a spot morning urine sample, and albuminuria (30 mg/day or greater) measured in a 24 h urine collected on the subsequent day. RESULTS: The median (25-75 percentile) of urine albumin excretion was 4.8 (3.6-10.3) mg/day: 5.4 (3.7-12.5) mg/day in men and 4.5 (3.8-8.9) mg/day in women. The overall prevalence (95% CI) of albuminuria was 11.8% (7.2-12.0%): 14.8% in men and 9.2% in women (P = 0.04). The areas under the receiver operator characteristic (ROC) curves for urine albumin concentration were 0.86 (0.82-0.90) and 0.88 (0.84-0.92), respectively, in women and men. The areas under the ROC curves for albumin to creatinine ratio were 0.86 (0.82-0.89) and 0.90 (0.86-0.93), respectively, in women and men. For urine albumin concentration, the sensitivity and specificity were 37 and 97%, respectively, in women and 69 and 94%, respectively, in men at the conventionally recommended value of 2 mg/dl. The discriminator value of urine albumin concentration identified in the analysis was 0.5 mg/dl in women (sensitivity of 87% and specificity of 75%) and 1.7 mg/dl in men (sensitivity of 74% and specificity of 93%). For the albumin to creatinine ratio, the sensitivity and specificity were 46 and 95%, respectively, in women and 60 and 97%, respectively, in men at cut-off value of 30 mg/g. CONCLUSION: Both urine albumin concentration and albumin to creatinine ratio are acceptable tests for population screening for albuminuria in Indo-Asians. While sensitivities may be suboptimal, particularly in women, lowering the existing thresholds would compromise specificity. Those who screen positive need evaluation and management of CKD and prevention of CVD.     

Evaluation of tests for microalbuminuria screening in patients with diabetes.

BACKGROUND: The first step in the diagnosis of diabetic nephropathy is to measure albumin in a spot urine sample. The aim of this study was to assess the accuracy of urinary albumin concentration (UAC), urinary albumin-to-creatinine ratio (UACR), and the Micral-Test II in a random urine specimen (RUS) for microalbuminuria screening in diabetes mellitus. METHODS: Two hundred and seventy-eight patients collected 24 h timed urine specimens followed by RUS. Albumin (immunoturbidimetry) and creatinine were measured in protein-negative (Combur-Test) urine samples. Samples were classified as normoalbuminuric [24 h urinary albumin excretion rate (UAER) <20 microg/min; n = 189] and microalbuminuric (UAER =20-199 microg/min; n = 89). Micral-Test II readings were performed in 130 RUS. Receiver operating characteristics (ROC) curves were constructed using UAER as the reference standard. RESULTS: The areas under the ROC curves were similar for UAC (0.934+/-0.032) and UACR (0.920+/-0.035; P = 0.626), but the Micral-Test II had lower accuracy to diagnose microalbuminuria (area = 0.846+/-0.047) than UAC (P = 0.014). The first cutoff point with 100% sensitivity for UAC was 14.4 mg/l (specificity =77.2%), and 15.7 mg/g for UACR (specificity =73.0%). Concerning the Micral-Test II, sensitivity and specificity for the 20 mg/l cutoff point were 90.0 and 46.0%, respectively. The agreement between UAER and the Micral-Test II for microalbuminuria diagnosis was 55.8% (kappa = 0.22; P < 0.001). The cost of diagnosing microalbuminuria was 1.74 dollars(UAC), 2.00 dollars (UACR) and 4.09 dollars (Micral-Test II) per patient. CONCLUSIONS: Measurement of UAC in a RUS was the best choice for the diagnosis screening of microalbuminuria in diabetic patients, considering cost and accuracy.     

The clinical course of microalbumiuria in 4 burn patients

BACKGROUND: In burn patients, microvascular permeability is increased. It is difficult to decide the time to administer albumin because it may induce pulmonary edema in the re-filling period. One report shows that microalbuminuria is correlated with endothelial injury and systemic microvascular permeability. METHODS: We measured urinary albumin/creatinine ratio (ACR) in 4 burn patients for 48 hours after injury. RESULTS: In all patients, ACR was elevated in the early period after injury. Moreover, ACR in 2 severe burn patients with burn total body area of over 30% was above the normal range. CONCLUSIONS: The present results show that ACR seems to be correlated with the level of microvascular permeability in 4 burn patients. We conclude that ACR may be a useful indicator to decide the time to administer albumin to a burn patient. However, further investigation is required to decide the threshold value of ACR in a severe burn patient whose ACR are kept above the normal range in the long-term.