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Albumin to Creatinine Ratio Is Fairly Correlated with Albumin Excretion Rate in Chronic Kidney Disease
American Journal of Laboratory Medicine
Volume 3, Issue 6, November 2018, Pages: 48-52
Received: Oct. 30, 2018; Accepted: Nov. 27, 2018; Published: Dec. 24, 2018
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Safauldeen Ahmed Alhajim, Department of Medicine, College of Medicine, University of Basrah, Basrah, Iraq
Ahmed Aubed Sherhan, Department of Medicine, College of Medicine, University of Basrah, Basrah, Iraq
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Measurement of urine albumin excretion rate (AER) over a 24-h period is considered the gold standard technique for detecting albuminuria. However, the procedure is highly inconvenient for most patients. This study aimed to assess the accuracy of albumin to creatinine ratio in spot urine (UACR) as a surrogate to 24-h urine AER in patients with chronic kidney disease (CKD). This cross-sectional study included 92 patients with CKD (51 men and 41 women) admitted to Al-Basrah Teaching Hospital from January to October 2014. The 24-h AER was obtained using 24-h urine samples and the UACR was determined from a morning-void urine sample. Serum creatinine level was determined and general urine examination was performed using standard methods. Patients were divided into three groups according to glomerular filtration rate (GFR; ≥60, 30–59, and 15–29 mL/min/1.73 m2). Pearson’s correlation coefficients for ACR vs. 24-h AER were 0.609 (P < 0.0001) and 0.532 (P < 0.0001) for men and women, respectively. In the GFR groups, Pearson’s correlation coefficients were, in the order listed above, 0.681 (P = 0.0001), 0.820 (P = < 0.001), 0.865 (P = 0.002) in men, and 0.721 (P = 0.01), 0.865 (P = 0.002), and 0.756 (P = 0.04) in women. In conclusion UACR determined using morning urine samples is fairley correlated with 24-h urine AER and is more practical and convenient for both the patient and the physician.
Albuminuria, Chronic Kidney Disease, Diabetes Mellitus, Diabetic Nephropathy, Urine Sample
To cite this article
Safauldeen Ahmed Alhajim, Ahmed Aubed Sherhan, Albumin to Creatinine Ratio Is Fairly Correlated with Albumin Excretion Rate in Chronic Kidney Disease, American Journal of Laboratory Medicine. Vol. 3, No. 6, 2018, pp. 48-52. doi: 10.11648/j.ajlm.20180306.11
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Burtis C, Ashwood E, Bruns D (2008) Tietz text book of clinical chemistry and molecular diagnosis, 4th edn. Elsevier, Missouri, USA, pp 822, 1241–1245, 1687–1694.
Rowe DJ, Bagga H, Betts PB (2009) Normal variations in rate of albumin excretion and albumin to creatinine ratios in overnight and daytime urine collections in non-diabetic children. Br Med J (Clin Res Ed) 291: 693–694.
Côté AM, Firoz T, Mattman A, Lam EM, von Dadelszen P, Magee LA (2008) The 24-hour urine collection: Gold standard or historical practice? Am J Obstet Gynecol 199: 625. e1-6.
Newman DJ, Pugia MJ, Lott JA, Wallace JF, Hiar AM (2000) Urinary protein and albumin excretion corrected by creatinine and specific gravity. Clin Chim Acta 294: 139–155.
Chronic Kidney Disease Prognosis Consortium, Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, Coresh J, Gansevoort RT (2010) Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: A collaborative meta-analysis. Lancet 375: 2073–2081.
Hemmelgarn BR, Manns BJ, Lloyd A, James MT, Klarenbach S, Quinn RR, Wiebe N, Tonelli M; Alberta Kidney Disease Network (2010) Relation between kidney function, proteinuria, and adverse outcomes. JAMA 303: 423–429.
Ruggenenti P, Gaspari F, Perna A, Remuzzi G (1998) Cross sectional longitudinal study of spot morning urine protein: creatinine ratio, 24-hour urine protein excretion rate, glomerular filtration rate, and end stage renal failure in chronic renal disease in patients with diabetes. BMJ 316: 504–509.
Looker H, Nelson R. Reading the three leaves- how to enrich clinical trials of diabetic kidney disease. Kidney International 2017, vol 92, Iss 1, p23-5.
Akif A, Arsalan M, Hasan S, Sana A, Aquil A. Protein Creatinine Index: An Alternative for Screening Nephropathy in Hypertensives. J Clin Diag Res 2018, vol 12, Issue 3, p15-18.
Mishra V, Goyal P, Priyankur R, Choudhary S, Aggarwal R, Gandhi K, et al. evaluation of spot urinary albumin-creatinine ratio as screening tool in pre-eclampsia in early pregnancy. J Obst Gyn India 2017. Vol 67, iss 6, pp 405-8.
Johnson D, Caring for Australians with Renal Impairment (CARI) (2005) The CARI guidelines: Evaluation of renal function. Nephrology (Carlton) 10 Suppl 4: S133–S176.
Ng WY, Lui KF, Thai AC (2000) Evaluation of a rapid screening test for microalbuminuria with a spot measurement of urine albumin-creatinine ratio. Ann Acad Med Singapore 29: 62–65.
Incerti J, Zelmanovitz T, Camargo JL, Gross JL, de Azevedo MJ (2005) Evaluation of tests for microalbuminuria screening in patients with diabetes. Nephrol Dial Transplant 20: 2402–2407.
National Kidney Foundation. (2002) K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Am J Kidney Dis 39 (2 Suppl 1): S1–S266.
Kidney Disease Outcomes Quality Initiative (K/DOQI) (2004) K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis 43 (5 Suppl 1): S1–S290.
Han JH, Kim KS, Yoon JY (2007). The enhanced diffusional mixing for latex immunoagglutination assay in a microfluidic device. Anal Chim Acta 584: 252–259.
Eknoyan G, Hostetter T, Bakris GL, Hebert L, Levey AS, Parving HH, Stefes MW, Toto R (2003) Proteinuria and other markers of chronic kidney disease: A position statement of the national kidney foundation (NKF) and the national institute of diabetes and digestive and kidney diseases (NIDDK). Am J Kidney Dis 42: 617–622.
Jafar TH, Chaturvedi N, Hatcher J, Levey AS (2007) Use of albumin creatinine ratio and urine albumin concentration as a screening test for albuminuria in an Indo-Asian population. Nephrol Dial Transplant 22: 2194–2200.
Mattix HJ, Hsu CY, Shaykevich S, Curhan G (2002) Use of albumin/ creatinine ratio to detect microalbuminuria: Implication of sex and race. J Am Soc Nephrol 13: 1034–1039.
Gatling W, Knight C, Mullee MA, Hill RD (1988) Microalbuminuria in diabetes: A population study of the prevalence and an assessment of three screening tests. Diabet Med 5: 343–347.
American Diabetes Association (2007) Standards of medical care in diabetes -- 2007. Diabetes Care 30 [Suppl 1]: S4–S41.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. (2003) Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42: 1206–1252.
Miller WG, Bruns DE, Hortin GL, Sandberg S, Aakre KM, McQueen MJ, et al. (2009) Current issues in measurement and reporting of urinary albumin excretion. Clin Chem 55: 24–38.
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