Evaluation of tests for microalbuminuria screening in patients with diabetes.

@article{citeulike:2873259, abstract = {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.}, address = {Endocrine Division, Hospital de Cl\'{i}nicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.}, author = {Incerti, J. and Zelmanovitz, T. and Camargo, J. L. and Gross, J. L. and de Azevedo, M. J. }, citeulike-article-id = {2873259}, issn = {0931-0509}, journal = {Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association}, keywords = {dn, method, proteinuria}, month = {November}, number = {11}, pages = {2402--2407}, posted-at = {2008-06-08 09:06:56}, priority = {2}, title = {Evaluation of tests for microalbuminuria screening in patients with diabetes.}, url = {http://view.ncbi.nlm.nih.gov/pubmed/16105865}, volume = {20}, year = {2005} }

TY - JOUR ID - citeulike:2873259 L3 - citeulike-article-id:2873259 TI - Evaluation of tests for microalbuminuria screening in patients with diabetes. JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association VL - 20 IS - 11 SP - 2402 EP - 2407 AD - Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. SN - 0931-0509 N2 - 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. KW - dn KW - method KW - proteinuria AU - Incerti, J AU - Zelmanovitz, T AU - Camargo, JL AU - Gross, JL AU - de Azevedo, MJ PY - 2005/11// UR - http://view.ncbi.nlm.nih.gov/pubmed/16105865 ER -