Diabetic nephropathy is one of diabetic complications characterized by proteinuria and impaired renal function. Confirmation of diagnosis based either on urine value of albumin excretion rate (AER) 30-300 mg/24 hours or albumin creatinine ratio (ACR) 30-300 mg/g or total protein creatinine ratio (TPCR) 150-500 mg/g. It is reported that TPCR measurement is more acceptable since it is convenient, fast and does not require special preparation. The aim of this study was to investigate the accuracy of TPCR for diagnosis of diabetic nephropathy among patients with type 2 diabetes (type 2 DM). A diagnostic test study was conducted which involved 86 patients with type 2 DM where urine TPCR value equal or more than 150mg/g was independently and blindly compared with AER as a refference standard to diagnose diabetic nephopathy. The inclusion criteria were patients with type 2 DM who suspected suffer from diabetic nephropathy (suffer from DM more than 4 years) and agree to participate in this study. Those whom were suffer from at least on of the following diseases urinary tract infection, congestive heart failure, liver dysfunction, pregnancy, multiple myeloma, microangiopathy hemolytic anemia (MAHA) and incomplete data were excluded from the study. Contingency (2x2) table analysis was used to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio for positive test result/LR(+), likelihood ratio for negative test result/ LR(-), and accuracy. The average of TPCR among diabetic nephropathy patient was 248.07 mg/g. It was significantly higher than compared to those non diabetic nephropathy patient (103.52 mg/g). It was found 75 true positive, 9 true negative, and 2 false positive. The result showed that TPCR had a sensitivity, specificity, PPV, and NPV of 97.4%, 100%, 100%, and 81,8% respectively to diagnose diabetic nephropathy.The TPCR with value equal or more than 150 mg/g in the morning sample urine can be used to diagnose diabetic nephropathy. 75 positif benar, 9 negatif benar, dan 2 positif palsu. Hasil pemeriksaan menunjukkan bahwa TPCR memiliki sensitifitas 97,4%, spesifisitas 100%, NPP 100%, dan NPN 81,8% untuk diagnosis nefropati diagnostik. TPCR dengan nilai sama atau lebih dari 150 mg/g pada sampel urin pagi dapat digunakan untuk diagnosis nefropati diabetik.

Diabetic nephropathy (DN) is one of complications in diabetic patients manifested by microalbuminuria with minimal level of 30 mg/24 hour which is measured at least 2 times in the period of 3 to 6 months. Microalbuminuria can be measured either albumin excretion rate (AER) or albumin creatinine ratio (ACR). Measurement of ACR is an alternative parameter recommended by WHO in 2011 to diagnose diabetic nephropathy since it is more convenient, fast and not requires special preparation. The purpose of this study was to investigate accuracy of ACR to diagnose DN in type 2 diabetes mellitus (T2DM) patients.This was a diagnostic test study involving 80 T2DM patients. In this study ACR value equal or more than 30 mg/g was independently and blindly compared with AER as the gold standard. The data were analyzed using 2x2 tables in order to calculate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Other data were analyzed using statistic descriptive. Eighty T2DM patients consisting of 38 males and 42 females participated in this study. They had suffered from T2DM on average 9.5 years, and the average of ACR value was 55.5 mg/g. Total result of true positive and true negative was 77. Three result were false negative but none of false positive result. The ACR value equal or more than 30 mg/g had sensitivity, specificity, PPV, and NPV of 95.9%, 100%, 100%, and 66.7% respectively. In conclusion, the ACR value equal or more than 30 mg/g derived from morning urine sample can be used to diagnose DN in T2DM patients.