title: Audit of microalbumin excretion in children with type I diabetes.
abstract: OBJECTIVE
  To investigate prevalence, persistence and clinical correlates of increased microalbumin excretion in random urine samples collected in a paediatric diabetes clinic.
  
  
  METHODS
  Random urine samples were collected annually in patients >10 years attending the diabetes clinic in the Royal Hospital for Sick Children, Edinburgh. Albumin excretion is expressed as albumin:creatinine ratio (ACR) and classified as normal (10 mg/mmol), or macroalbuminuria (>47 mg/mmol in females, >35 mg/mmol in males). We analyzed retrospectively results on 421 urine samples collected from 217 patients (109 males), of a median age of 12.3 years (94% 10-16 years) over 3 years. For each sample, the corresponding mean HbA1c over the previous year was calculated.
  
  
  RESULTS
  Prevalence of micro- and macro-albuminuria in individual samples was 1% and 0.5% respectively. ACR was equivocal in 10.1% and 4.7% in samples from females and males respectively (p=0.03). HbA1c showed borderline significant differences across ACR groups (p=0.06). Equivocal ACR excretion was associated with slightly higher mean HbA1c (9.5±1.3%) compared to normal albuminuria (9.0±1.1%, p3.5 mg/mmol. The 14-16 years age group patients were most likely to have ACR >3.5 mg/mmol (p=0.05).
  
  
  CONCLUSIONS
  Female sex and increasing age, but not HbA1c, were independently associated with increased ACR. A robust mechanism for collection of repeat early morning urine samples from patients with increased ACR in random urine samples, and follow-up of those patients who have persistently high microalbumin excretion are important. It is also important to confirm the usefulness of ACR measurements in random urine samples as a marker of incipent nephropathy.
authors.affiliation: Division of Endocrinology and Diabetes, Department of Pediatrics, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey. filizcizmeci@gmail.com
authors.forename: Filiz Mine
authors.initials: FM
authors.lastname: Cizmecioğlu
authors.forename: Kathryn
authors.initials: K
authors.lastname: Noyes
authors.forename: Louise
authors.initials: L
authors.lastname: Bath
authors.forename: Chris
authors.initials: C
authors.lastname: Kelnar
mesh_terms: D000293:Adolescent; D000419:Albuminuria / Q000150:complications / Q000453:epidemiology / Q000652:urine*; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000652:urine; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000652:urine*; D003928:Diabetic Nephropathies / Q000150:complications / Q000652:urine; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012737:Sex Factors; D055815:Young Adult
chemical_list: D003404:Creatinine; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human