Screening for microalbuminuria to prevent nephropathy in patients with diabetes: a systematic review of the evidence.
OBJECTIVE
Our goal was to evaluate whether screening patients with diabetes for microalbuminuria (MA) is effective according to the criteria developed by Frame and Carlson and those of the US Preventive Services Task Force.


METHODS
We searched the MEDLINE database (1966-present) and bibliographies of relevant articles.


METHODS
We evaluated the impact of MA screening using published criteria for periodic health screening tests. The effect of the correlation between repeated tests on the accuracy of a currently recommended testing strategy was analyzed.


RESULTS
Quantitative tests have reported sensitivities from 56% to 100% and specificities from 81% to 98%. Semiquantitative tests for MA have reported sensitivities from 51% to 100% and specificities from 21% to 100%. First morning, morning, or random urine sampling appear feasible. Assuming an individual test sensitivity of 90%, a specificity of 90%, and a 10% prevalence of MA, the correlation between tests would have to be lower than 0.1 to achieve a positive predictive value for repeated testing of 75%.


CONCLUSIONS
Screening for MA meets only 4 of 6 Frame and Carlson criteria for evaluating screening tests. The recommended strategies to overcome diagnostic uncertainty by using repeated testing are based on expert opinion, are difficult to follow in primary care settings, do not improve diagnostic accuracy sufficiently, and have not been tested in a controlled trial. Although not advocated by the American Diabetes Association, semiquantitative MA screening tests using random urine sampling have acceptable accuracy but may not be reliable in all settings.
Scheid
D C
DC
Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 900 NE 10th Street, Oklahoma City, OK 73104, USA.
McCarthy
L H
LH
Lawler
F H
FH
Hamm
R M
RM
Reilly
K E
KE
D000419:Albuminuria / Q000175:diagnosis* / Q000209:etiology* / Q000652:urine; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D016009:Chi-Square Distribution; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003928:Diabetic Nephropathies / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D019317:Evidence-Based Medicine; D005189:False Positive Reactions; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000191:economics / Q000379:methods* / Q000523:psychology / Q000592:standards; D010342:Patient Acceptance of Health Care / Q000523:psychology; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000191:economics / Q000379:methods / Q000592:standards; D011788:Quality of Life; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013997:Time Factors
D000806:Angiotensin-Converting Enzyme Inhibitors