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NDT Advance Access published online on August 16, 2005
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfi074
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received March 22, 2005
Accepted July 22, 2005

Original Articles

Evaluation of tests for microalbuminuria screening in patients with diabetes

Juliane Incerti 1, Themis Zelmanovitz 1, Joiza Lins Camargo 2, Jorge Luiz Gross 1, and Mirela Jobim de Azevedo 1*

1 Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
2 Clinical Pathology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

* To whom correspondence should be addressed.
Mirela Jobim de Azevedo, E-mail: mirelaazevedo{at}terra.com.br



  Abstract

Background. The first step in the diagnosis of diabetic nephropathy is to measure albumin in a spot urine sample. The aim of this study was to assess the accuracy of urinary albumin concentration (UAC), urinary albumin-to-creatinine ratio (UACR), and the Micral-Test II in a random urine specimen (RUS) for microalbuminuria screening in diabetes mellitus.

Methods. Two hundred and seventy-eight patients collected 24 h timed urine specimens followed by RUS. Albumin (immunoturbidimetry) and creatinine were measured in protein-negative (Combur-Test) urine samples. Samples were classified as normoalbuminuric [24 h urinary albumin excretion rate (UAER) <20 µg/min; n = 189] and microalbuminuric (UAER =20-199 µg/min; n = 89). Micral-Test II readings were performed in 130 RUS. Receiver operating characteristics (ROC) curves were constructed using UAER as the reference standard.

Results. The areas under the ROC curves were similar for UAC (0.934±0.032) and UACR (0.920±0.035; P = 0.626), but the Micral-Test II had lower accuracy to diagnose microalbuminuria (area = 0.846±0.047) than UAC (P = 0.014). The first cutoff point with 100% sensitivity for UAC was 14.4 mg/l (specificity =77.2%), and 15.7 mg/g for UACR (specificity =73.0%). Concerning the Micral-Test II, sensitivity and specificity for the 20 mg/l cutoff point were 90.0 and 46.0%, respectively. The agreement between UAER and the Micral-Test II for microalbuminuria diagnosis was 55.8% ({kappa} = 0.22; P<0.001). The cost of diagnosing microalbuminuria was U$1.74 (UAC), U$2.00 (UACR) and U$4.09 (Micral-Test II) per patient.

Conclusions. Measurement of UAC in a RUS was the best choice for the diagnosis screening of microalbuminuria in diabetic patients, considering cost and accuracy.

Keywords: diabetes mellitus; diabetic nephropathy; Micral-Test II; microalbuminuria; screening tests; urinary albumin excretion rate.
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