Evaluation of tests for microalbuminuria screening in patients with diabetes
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 microg/min; n = 189] and microalbuminuric (UAER =20-199 microg/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 1.74 dollars(UAC), 2.00 dollars (UACR) and 4.09 dollars (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.
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It is cost-effective to screen all people with diabetes and/or kidney disease for albuminuria.
“Published studies have also demonstrated that it is costeffective to screen all people with diabetes and/or kidney disease for albuminuria (461,462).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [462]
The Cost of microalbuminuria diagnosis section compares per-patient costs of three screening tests in patients with diabetes, and the Discussion identifies the lowest-cost test. It does not establish that screening all people with diabetes is cost-effective, or assess screening people with kidney disease generally. (LLM, conf=0.87)
Experimental — accuracy not yet measuredOthers have validated the reliability of a first morning void sample.
“Others have validated the reliability of a first morning void sample (462,492, 493).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [462]
The Discussion reports that albumin measurements from first-morning urine correlate more closely with 24-hour protein excretion than measurements from random spot samples. However, the study itself tested random spot samples, not first-morning voids, so it reports evidence for their reliability rather than independently validating them. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMost studies have found that the spot urine albumin-creatinine concentration in the first morning void is the most practical and reliable technique compared to 24-h urinary excretion or timed collection.
“Most studies have found that the spot urine albumin-creatinine concentration in the first morning void, rather than the 24-h urinary excretion of albumin or the timed collection, is the most practical and reliable technique (346,350,351).”
From Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus (2011) · cites this paper as [346]
Published studies have demonstrated that it is cost-effective to screen all patients with diabetes and/or kidney disease for albuminuria.
“Published studies have demonstrated that it is cost-effective to screen all patients with diabetes and/or kidney disease for albuminuria (346,347).”
From Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus (2011) · cites this paper as [346]
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- Authors
- Incerti, J., Zelmanovitz, T., Camargo, J. L., Gross, J. L., & de Azevedo, M. J.
- Affiliations
- Universidade Federal do Rio Grande do Sul (BR)
- Corresponding author
- Incerti, Juliane
- Venue
- Nephrology Dialysis Transplantation
- Publisher
- Oxford University Press (OUP)
- Published
- 2005-08-16
- Volume
- 20
- Issue
- 11
- Pages
- 2402-2407
- ISSN
- 0931-0509 (ISSN-L)
- 1460-2385
- OpenAlex
- W2118525653
- Semantic Scholar
- df3a240718c2f30a4a6a3b02f35e6899d7b06d65
- Cited by
- 93
- References
- 21
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 5 · 2021: 2 · 2020: 6 · 2019: 5 · 2018: 1 · 2017: 3 · 2016: 5 · 2015: 5 · 2014: 6 · 2013: 7 · 2012: 12
- FWCI
- 2.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nephrology Dialysis Transplantation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
- Hospital de Clínicas de Porto Alegre
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- microalbuminuria, diabetic nephropathy, diabetes mellitus, albumin-creatinine ratio, diagnostic accuracy, sensitivity and specificity, test agreement
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Albuminuria, Cost-Benefit Analysis, Creatinine, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Humans, Male, Mass Screening, Middle Aged, Nephelometry and Turbidimetry, ROC Curve, Reproducibility of Results, Urinalysis
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