Albumin to creatinine catio: A screening test with limitations

Houlihan, Christine; Tsalamandris, Con; Akdeniz, Aysel; Jerums, George

doi:10.1053/ajkd.2002.33388

Cited by 94 publications

(63 citation statements)

References 17 publications

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“…16 In a study by Houlihan et al the sensitivity was found to be 95.7% in males and 93.35% in females. 17 The sensitivity at different cut off levels of ACR in the present study was found to vary from 97% at cut off of 1mg/mmol to 55% at 8mg/mmol in males and in females it was found to be 92% at cut off of 1 mg/mmol and 78% at cut off of 8mg/mmol. The specificity was 63% at 1 mg/mmol and 98% at 8mg/mmol in males and 50% at 1mg/mmol and 99% at 8mg/mmol in females indicating its role in diagnosing normoalbuminuric patients at lower range and patients with high microalbuminuria at higher range.…”

Section: Resultssupporting

confidence: 41%

Role of Urinary Albumin to Creatinine Ratio and Spot Albuminuria in Predicting Significant Albuminuria in Patients of Diabetic Nephropathy

Gitanjali¹,

Goyal²,

Panag³

2014

jemds

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INTRODUCTION:Diabetic nephropathy is the most common cause of End Stage Renal Disease (ESRD).The earliest clinical evidence of nephropathy is microalbuminuria. The commonly used investigations to diagnose microalbuminuria include 24 hours urinary Albumin Excretion Rate (AER), Albumin to Creatinine ratio (ACR) and spot microalbuminuria. These latter two methods have been found to be convenient, cost effective and efficient in screening patients of microalbuminuria when compared with 24 hour collections.AIM OF STUDY: The present study was conducted to know whether ACR or spot microalbuminuria alone can predict and quantify microalbuminuria in patients with Diabetic Nephropathy.METHODOLOGY:100 known patients of type II DM were enrolled for the study. 24 hour urinary sample was taken to quantify albuminuria and spot urine sample was taken for ACR and microalbuminuria. The results obtained by ACR and spot microalbuminuria were compared with the gold standard 24 hours urinary protein measurement.RESULTS:Sensitivity and specificity for predicting true microalbuminuria were found to be 91% and 75% respectively for ACR. Its positive predictive value was 57% and negative predictive value was 90%. Sensitivity and specificity were found to be 92% and 82% for spot microalbuminuria with positive predictive value of 40% and negative predictive value of 95%.CONCLUSION:The low specificity and low positive predictive value of ACR and spot microalbumin does not support their use for quantifying urinary albumin excretion and it was concluded that these methods alone cannot be relied upon for quantification of albuminuria. However the high sensitivity and negative predictive value of the tests suggests that these are good routine outdoor screening tests for finding out those patients who should undergo quantification by 24 hours urine albumin excretion.

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Section: Resultssupporting

confidence: 41%

Role of Urinary Albumin to Creatinine Ratio and Spot Albuminuria in Predicting Significant Albuminuria in Patients of Diabetic Nephropathy

Gitanjali¹,

Goyal²,

Panag³

2014

jemds

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“…A 24-h urine collection for the diagnosis of albuminuria remains the gold standard; however, because of the inconvenience and errors associated with a timed urine sample, a spot urine sample using either albumin-specific dipstick or albumin-to-creatinine ratio is now an accepted screening method (22,29). Houlihan et al (30) assessed the characteristics of the albumin-to-creatinine ratio as a screening test and found sensitivities Ͼ90% for both men and women, with excellent accuracy reflected by area under the receiver operator characteristics curve. Recently, both the Prevention of Renal and Vascular Endstage Disease (PREVEND) study group in Europe (29) and Jafar et al (31) in an Indo-Asian population assessed the validity of urinary albumin concentration and the albumin-to-creatinine ratio to detect individuals with microalbuminuria in subsequent 24-h urine samples.…”

Section: Definition and Tests For Ckd Screeningmentioning

confidence: 99%

Principles of Screening for Chronic Kidney Disease

Jaar¹,

Khatib²,

Plantinga³

et al. 2008

Clinical Journal of the American Society of Nephrology

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“…The ACR ratio was expressed in mg/g. Cutoff values for microalbuminuria were gender-and ageadjusted according to Houlihan et al 18 Macroalbuminuria was defined as ACRX300 mg/g. Three cases were positive for urinary nitrites and they were excluded from the analysis.…”

Section: Biochemical Measurementsmentioning

confidence: 99%

How well are hypertension and albuminuria treated in type II diabetic patients?

et al. 2003

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The purpose of this study was to assess the management of both hypertension and micro/macroalbuminuria in a cohort of type II diabetic patients. In the first 6 months of the year 2000, 5815 diabetic patients were identified through prescriptions for antidiabetic drugs in our sanitary district (191 568 inhabitants). In all, 65% (3810) of these type II diabetic patients were also given prescriptions for antihypertensive drugs. A total of 400 diabetic patients were randomly selected and 171 entered the study (gender: 94/77 M/F; age: 66.6 7 8 years; diabetes duration: 12 7 9 years): 100 patients (group DT) were treated with antihypertensive drugs and 71 (group DU) were untreated. Blood pressure, urine albumin-to-creatinine ratio (ACR), and glycated haemoglobin were measured in the two groups. A total of 80% (57/71) of DU patients were hypertensive (BPX130/ 85 mmHg). Specifically, 24.4% had diastolic hypertension (BPX85 mmHg) and 79% systolic hypertension (BPX130 mmHg). Only 63% (100/157) of the hypertensive patients were treated with antihypertensive drugs (two drugs/patient on average, range 1-5). In addition, only 13% of the DT patients were adequately controlled (BPo130/85 mmHg), while the others had above target blood pressure levels (14%: 130-139/85-89 mmHg; 40%: 140-159/90-95 mmHg, and 33%X160/ 95 mmHg). Angiotensin converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) were included in the antihypertensive medical regimen in 70% of the DT patients (ACE-I: 62%; ARB: 8%; diuretics: 39%; dihydropyridine calcium antagonists: 38%; a-blockers: 20%, b-blockers: 17%; clonidin: 8%; nondihydropyridine calcium antagonists: 5%). Only 33% of type II diabetic patients underwent a screening for microalbuminuria as assessed on clinical records. The same percentage of micro-and macroalbuminuric patients (13.5%) was observed in the DT group, whereas 25% micro vs 3% macro were found in the DU group. In all, 73% of microalbuminuric patients were not on ACE-I/ARB. Hypertensive type II diabetic patients were often left untreated and only a minority of those treated were optimally controlled. The importance of an elevated systolic pressure is underestimated and the number of antihypertensive drugs prescribed insufficient. Screening and treatment of albuminuria are inadequate.

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Albumin to creatinine catio: A screening test with limitations

Cited by 94 publications

References 17 publications

Role of Urinary Albumin to Creatinine Ratio and Spot Albuminuria in Predicting Significant Albuminuria in Patients of Diabetic Nephropathy

Role of Urinary Albumin to Creatinine Ratio and Spot Albuminuria in Predicting Significant Albuminuria in Patients of Diabetic Nephropathy

Principles of Screening for Chronic Kidney Disease

How well are hypertension and albuminuria treated in type II diabetic patients?

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