title: [Analysis of microalbuminuria with immunonephelometry and high performance liquid chromatography. Evaluation of new criteria].
abstract: BACKGROUND
  Hypertension as well as type 2 diabetes mellitus is a major factor in population mortality. Both diseases damage the endothelium, the early sign of which is microalbuminuria, which can be screened by dipstick and can be diagnosed by using immuno-based and high performance liquid chromatography methods. Using high performance liquid chromatography, the non-immunoreactive albumin can be detected as well.
  
  
  OBJECTIVE
  The authors aimed at the examination of albuminuria in the case of immunonephelometrically negative patients with high performance liquid chromatography, in diabetic and hypertensive and non-diabetic hypertensive populations. The authors also wanted to compare the present (albumin-creatinine ratio: male: > or =2.5 mg/mmol, female: > or =3.5 mg/mmol) and a new criteria of the Heart Outcomes Prevention Evaluation study (patients without diabetes: immunological method, > or =0.7 mg/mmol; high performance liquid chromatography, > or =3.1 mg/mmol; individuals with diabetes: immunological method, > or =1.4 mg/mmol; high performance liquid chromatography, > or =5.2 mg/mmol) of microalbuminuria.
  
  
  METHODS
  Examination of fresh urines of 469 microalbuminuria negative patients by dipstick were performed by immunonephelometry. Patients, who were microalbuminuria negative by immunonephelometry as well, were further analyzed by high performance liquid chromatography using the Accumintrade mark Kit, based on size-exclusion chromatography.
  
  
  RESULTS
  Three times higher albuminuria were found with high performance liquid chromatography than with immunonephelometry. The intraindividual coefficient of variation did not differ in the two methods (37 +/- 31% vs. 40 +/- 31%, p = 0.869; immunonephelometry vs. high performance liquid chromatography; mean +/- standard deviation). Using the present criteria for microalbuminuria, 43% of immunonephelometrically negative patients proved to be microalbuminuric by high performance liquid chromatography. Using the new criteria of the Heart Outcomes Prevention Evaluation study, the rate of microalbuminuria positivity among the immunonephelometrically negative patients decreased to 14.5% by high performance liquid chromatography and the decrease in the number of microalbuminuria positive cases by high performance liquid chromatography could be observed mainly in the diabetic and hypertensive group (49% vs. 7.5%), while slighter decrease could be observed in the non-diabetic hypertensive group (37% vs. 26.5%). Applying the traditional criteria, the strongest predictor was the male gender by the logistic regression analysis. In 28% of microalbuminuria negative patients by immunonephelometry the diagnosis of microalbuminuria can be established using high performance liquid chromatography.
  
  
  CONCLUSIONS
  Almost in one-third of microalbuminuria negative patients by immunonephelometry the diagnosis of microalbuminuria can be established by high performance liquid chromatography for which diagnosis three constitutive urine examinations are still needed. New criteria determined by the Heart Outcomes Prevention Evaluation study can be used neither in case of diabetic and hypertensive patients, nor in the case of non-diabetic hypertensive patients. The gender as the most important predictor of microalbuminuria cannot be ignored.
authors: Pécsi Tudományegyetem, Altalános Orvostudományi Kar II. Belgyógyászati Klinika és Nefrológiai Centrum Pécs Pacsirta u. 1. 7624.
authors: Lajos
authors: L
authors: Markó
authors: Gergo Attila
authors: GA
authors: Molnár
authors: Zoltán
authors: Z
authors: Wagner
authors: Tamás
authors: T
authors: Koszegi
authors: Zoltán
authors: Z
authors: Matus
authors: Márton
authors: M
authors: Mohás
authors: Mónika
authors: M
authors: Kuzma
authors: István András
authors: IA
authors: Szijártó
authors: István
authors: I
authors: Wittmann
mesh_terms: D000328:Adult; D000368:Aged; D000418:Albumins / Q000378:metabolism; D000419:Albuminuria / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D015415:Biomarkers / Q000378:metabolism; D002851:Chromatography, High Pressure Liquid; D003404:Creatinine / Q000097:blood; D048909:Diabetes Complications / Q000175:diagnosis; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D009391:Nephelometry and Turbidimetry / Q000379:methods; D012015:Reference Standards; D012737:Sex Factors
chemical_list: D000418:Albumins; D015415:Biomarkers; D003404:Creatinine