title: The use of the Micral-Test strip to identify the presence of microalbuminuria in people with insulin dependent diabetes mellitus (IDDM) participating in the EUCLID study.
abstract: In IDDM, microalbuminuria (urinary albumin excretion rate (AER) of 20-200 micrograms/min) is a predictor of persistent proteinuria and diabetic nephropathy. Early intervention may prevent or reduce the rate of progression of renal complications. The Micral-Test strip can be used to establish a semi-quantitative estimate of AER. We assessed the field performance of the Micral-Test strip in detecting microalbuminuria in the EUCLID study, an European wide, 18 centre study of 530 IDDM participants, aged 20 to 59 years. People with macroalbuminuria were excluded. On entry, all participants had albumin concentrations from two overnight urine collections measured by a central laboratory, and the corresponding Micral-Test performed on the two collections locally. a cut off of > or = mg/l albumin from the first Micral-Test, to detect a centrally measured albumin concentration > or = 20 mg/l, yielded 29 (5.8%) false negative results and 58 (11.6%) false positive results (sensitivity 70%, specificity 87%). The mean AER, from two collections, was compared with the corresponding 'pooled' Micral-Test results (mean of the two readings). Receiver Operating Characteristic (ROC) curves were used to assess if there was a suitable 'pooled' Micral-Test result for screening microalbuminuria. A 'pooled' Micral-Test result (> or = 15 mg/l) was used to detect mean AER > or = 20 micrograms/min (sensitivity 78%, specificity 77%). This 'pooled cut-off' had already been used for screening on to the study and led to an over-estimate (154 vs. 77) of the true number of microalbuminuric participants on the study. In conclusion, our findings suggest that the Micral-Test strip is not an effective screening tool for microalbuminuria, using the 'pooled' result from two measurements did not improve the sensitivity of the test.
authors.affiliation: Eurodiab, Department of Epidemiology and Public Health, University College London, UK. david@public-health.ucl.ac.uk
authors.forename: D J
authors.initials: DJ
authors.lastname: Webb
authors.forename: D J
authors.initials: DJ
authors.lastname: Newman
authors.forename: N
authors.initials: N
authors.lastname: Chaturvedi
authors.forename: J H
authors.initials: JH
authors.lastname: Fuller
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000175:diagnosis*; D015415:Biomarkers / Q000652:urine; D003404:Creatinine / Q000652:urine; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology / Q000652:urine*; D003928:Diabetic Nephropathies; D018450:Disease Progression; D005060:Europe; D006801:Humans; D007118:Immunoassay / Q000379:methods; D008875:Middle Aged; D009391:Nephelometry and Turbidimetry / Q000379:methods; D011507:Proteinuria; D011934:Reagent Strips; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D011934:Reagent Strips; D003404:Creatinine