title: Microalbuminuria in diabetes mellitus: efficacy of a new screening method in comparison with timed overnight urine collection.
abstract: Diabetic nephropathy and end-stage renal failure are still a major cause of mortality amongst patients with diabetes mellitus (DM). In this study, we evaluated the Clinitek-Microalbumin (CM) screening test strip for the detection of microalbuminuria (MA) in a random morning spot urine in comparison with the quantitative assessment of albuminuria in the timed overnight urine collection ("gold standard"). One hundred thirty-four children, adolescents, and young adults with insulin-dependent DM Type 1 were studied at 222 outpatient visits. Because of urinary tract infection and/or haematuria, the data of 13 visits were excluded. Finally, 165 timed overnight urine were collected in the remaining 209 visits (79% sample per visit rate). Ten (6.1%) patients presented MA of > or =15 microg/min. In comparison however, 200 spot urine could be screened (96% sample/visit rate) yielding a significant increase in compliance and screening rate (P<.001, McNemar test). Furthermore, at 156 occasions, the gold standard and CM could be directly compared. The sensitivity and the specificity for CM in the spot urine (cut-off > or =30 mg albumin/l) were 0.89 [95% confidence interval (CI) 0.56-0.99] and 0.73 (CI 0.66-0.80), respectively. The positive and negative predictive value were 0.17 (CI 0.08-0.30) and 0.99 (CI 0.95-1.00), respectively. Considering CM albumin-to-creatinine ratio, the results were poorer than with the albumin concentration alone. Using CM instead of quantitative assessment of albuminuria is not cost-effective (35 US dollars versus 60 US dollars/patient/year). In conclusion, to exclude MA, the CM used in the random spot urine is reliable and easy to handle, but positive screening results of > or =30 mg albumin/l must be confirmed by analyses in the timed overnight collected urine. Although the screening compliance is improved, in terms of analysing random morning spot urine for MA, we cannot recommend CM in a paediatric diabetic outpatient setting because the specificity is far too low.
authors.affiliation: Division of Paediatric Endocrinology and Diabetology, University Children's Hospital, Inselspital, CH-3010 Bern, Switzerland.
authors.forename: U
authors.initials: U
authors.lastname: Meinhardt
authors.forename: R A
authors.initials: RA
authors.lastname: Ammann
authors.forename: C
authors.initials: C
authors.lastname: Flück
authors.forename: P
authors.initials: P
authors.lastname: Diem
authors.forename: P E
authors.initials: PE
authors.lastname: Mullis
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D000419:Albuminuria / Q000175:diagnosis* / Q000652:urine*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000652:urine*; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000401:mortality / Q000652:urine*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality; D008297:Male; D008403:Mass Screening / Q000379:methods; D013048:Specimen Handling / Q000379:methods*