title: Second Morning ACR Could Be the Alternative to First Morning ACR to Assess Albuminuria in Elderly Population.
abstract: BACKGROUND
  Albumin/creatinine ratio (ACR) from a first morning urine is recommended as a early indicator for diabetic nephropathy. However, it is not always feasible to collect the first morning urine for outpatients. We aimed to explore whether ACR from a second morning urine had a good consistency with that from a first morning urine to predict albuminuria in Chinese elderly citizens.
  
  
  METHODS
  One hundred and ninety-one elderly citizens (≧60 years old) from Junliangcheng community, Dongli district, Tianjin, China were included. A first and second morning urine was collected from each participants, successfully and detected the urinary albumin and creatinine of each urine sample. Albumin to creatinine ratio from a first morning urine (ACR1) was compared with that from a second morning urine (ACR2), and the ability of ACR1 and ACR2 to predict albuminuria was assessed.
  
  
  RESULTS
  ACR1 and ACR2 were highly correlated (r = 0.901), especially in male and hypertension group (r = 0.938 and 0.904). The slope and intercept were 0.93 and 0.11 after log-transformed. And there was no statistical difference between values of ACR1 and ACR2 (P = 0.271). Overall, 26.2% participants were detected with albuminuria when judged by ACR1 and 28.3% by ACR2. A good concordance of ACR category (normal or albuminuria) was found between ACR1 and ACR2 (Kappa value = 0.815 in overall; in male and hypertension group were 0.900 and 0.850).
  
  
  CONCLUSIONS
  A second morning urine ACR could be the alternative to a first morning urine ACR for albuminuria detection in elderly population.
authors.affiliation: Graduate School of Tianjin Medical University, People's Republic of China.
authors.forename: Hua-Bin
authors.initials: HB
authors.lastname: Wang
authors.affiliation: Graduate School of Tianjin Medical University, People's Republic of China.
authors.forename: Rong
authors.initials: R
authors.lastname: Li
authors.affiliation: Department of Clinical Laboratory, Tianjin Union Medicine Center, People's Republic of China.
authors.forename: Rui
authors.initials: R
authors.lastname: Liu
authors.affiliation: Department of Clinical Laboratory, Tianjin Union Medicine Center, People's Republic of China.
authors.forename: Xiao-Fan
authors.initials: XF
authors.lastname: Cui
authors.affiliation: Department of Clinical Laboratory, Tianjin Union Medicine Center, People's Republic of China.
authors.forename: Wen-Jie
authors.initials: WJ
authors.lastname: Pan
authors.affiliation: Department of Clinical Laboratory, Tianjin Jun Liangcheng hospital, People's Republic of China.
authors.forename: Ao
authors.initials: A
authors.lastname: Sun
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000175:diagnosis* / Q000652:urine*; D003404:Creatinine / Q000652:urine*; D005260:Female; D006801:Humans; D008297:Male
chemical_list: D003404:Creatinine
keywords: albumin to creatinine ratio; albuminuria; elderly population; first morning urine voids; second morning urine voids