First Morning Voids Are More Reliable Than Spot Urine Samples to Assess Microalbuminuria

Witte, Elsbeth C.; Heerspink, Hiddo J L; Zeeuw, Dick de; Bakker, Stephan J. L.; Jong, Paul E. de; Gansevoort, Ronald

doi:10.1681/asn.2008030292

Cited by 225 publications

(162 citation statements)

References 21 publications

Supporting

Mentioning

149

Contrasting

Unclassified

Order By: Relevance

“…First, we used 24-hour urine collection, which is the gold standard for assessing albumin and damage marker excretions. Other studies use spot urine, which induces more variation (42). Second, in contrast to most studies investigating the value of these markers in CKD, we measured not only one but a panel of markers, reflecting damage to different parts of the nephron.…”

Section: Discussionmentioning

confidence: 99%

Glomerular and Tubular Damage Markers in Individuals with Progressive Albuminuria

Nauta

Scheven

Meijer

et al. 2013

Clinical Journal of the American Society of Nephrology

Self Cite

View full text Add to dashboard Cite

SummaryBackground and objectives Albuminuria is associated with risk for renal and cardiovascular disease. It is difficult to predict which persons will progress in albuminuria. This study investigated whether assessment of urinary markers associated with damage to different parts of the nephron may help identify individuals that will progress in albuminuria.Design, setting, participants, & measurements Individuals were selected from a prospective community-based cohort study with serial follow-up and defined as "progressors" if they belonged to the quintile of participants with the most rapid annual increase in albuminuria, and reached an albuminuria $150 mg/d during follow-up. Patients with known renal disease or macroalbuminuria at baseline were excluded. Each progressor was matched to two control participants, based on baseline albuminuria, age, and sex. Furthermore, damage markers were measured in a separate set of healthy individuals.Results After a median follow-up of 8.6 years, 183 of 8394 participants met the criteria for progressive albuminuria. Baseline clinical characteristics were comparable between progressors and matched controls (n=366). Both had higher baseline albuminuria than the overall population. Urinary excretion of the glomerular damage marker IgG was significantly higher in progressors, whereas urinary excretion of proximal tubular damage markers and inflammatory markers was lower in these individuals compared with controls. Healthy individuals (n=109) had the lowest values for all urinary damage markers measured.Conclusions These data suggest that albuminuria associated with markers of glomerular damage is more likely to progress, whereas albuminuria associated with markers of tubulointerstitial damage is more likely to remain stable.

show abstract

Section: Discussionmentioning

confidence: 99%

Glomerular and Tubular Damage Markers in Individuals with Progressive Albuminuria

Nauta

Scheven

Meijer

et al. 2013

Clinical Journal of the American Society of Nephrology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Single random assessment of ACR is the norm for excluding microalbuminuria during annual review in primary care owing to the convenience of acquiring the sample [19]. Retinopathy was assessed from the patient's first retinal eye screen.…”

Section: Methodsmentioning

confidence: 99%

The clinical characteristics at diagnosis of type 2 diabetes in a multi-ethnic population: the South London Diabetes cohort (SOUL-D)

et al. 2013

View full text Add to dashboard Cite

Aims/hypothesis This study aimed to investigate the clinical features of newly diagnosed type 2 diabetes in an urban multi-ethnic cohort. Methods A population-based cross-sectional design was used. People diagnosed with type 2 diabetes in the preceding 6 months were recruited from primary care practices in three adjacent inner-city boroughs of South London, serving a population in which 20% of residents are of black African or Caribbean ethnicity. Sociodemographic and biomedical data were collected by standardised clinical assessment and from medical records. Multiple logistic regression methods were used to report associations between ethnicity and diabetes-complication status.Results From 96 general practices, 1,506 patients were recruited. Their mean age was 55.6 (±11.07) years, 55% were men, 60% were asymptomatic at diagnosis and 51%, 38% and 11% were of white, black and South Asian/other ethnicity, respectively. Compared with white participants, black and South Asian/other participants were: younger (mean age 58.9 [±10.09], 52.4 [±11.19] and 51.5 [±10.42] years, respectively; p<0.0001); less likely to have neuropathy (10.1%, 3.6% and 4.4%; p<0.0001) or report coronary artery disease (12.7%, 4.8% and 7.3%; p<0.0001). In logistic regression, compared with white participants, black participants had lower levels of macrovascular complications (OR 0.52, 95% CI 0.32, 0.84; p = 0.01). Male sex was independently associated with microvascular disease (OR 1.69, 95% CI 1.26, 2.28; p<0.0001). Conclusions/interpretation The prevalence of complications at time of diagnosis was lower than expected, especially in black and South Asian/other ethnic groups. However, in multi-ethnic inner-city populations, onset of type 2 diabetes occurred almost 10 years earlier in nonwhite populations than in white participants, predicating a prolonged morbidity.

show abstract

“…A series of drawbacks is attributed to urinalysis specimens (63), including (i) medical indication, i.e., when the patient is not informed about the medical need of the test, the outcome is questionable. Urinalysis as a ''routine'' screening is no longer indicated; (ii) patient preparation, i.e., oral and written instructions to the patient help in minimizing intraindividual physiological variation, e.g., by reducing excretion of water and by avoiding posture-related proteinuria (65). Written instructions in the language of the patient are helpful to avoid losses in suitability of the specimen; (iii) sample collection, i.e., mid-stream urine needs detailed illustrations on how to collect a suitable sample.…”

Section: Preanalytical Variability In Urinalysismentioning

confidence: 99%

Preanalytical quality improvement: from dream to reality

Lippi

Chance

Church³

et al. 2011

Clinical Chemistry and Laboratory Medicine

286

187

View full text Add to dashboard Cite

Laboratory diagnostics (i.e., the total testing process) develops conventionally through a virtual loop, originally referred to as ''the brain to brain cycle'' by George Lundberg. Throughout this complex cycle, there is an inherent possibility that a mistake might occur. According to reliable data, preanalytical errors still account for nearly 60%-70% of all problems occurring in laboratory diagnostics, most of them attributable to mishandling procedures during collection, handling, preparing or storing the specimens. Although most of these would be ''intercepted'' before inappropriate reactions are taken, in nearly one fifth of the cases they can produce inappropriate investigations and unjustifiable increase in costs, while generating inappropriate clinical decisions and causing some unfortunate circumstances. Several steps have already been undertaken to increase awareness and establish a governance of this frequently overlooked aspect of the total testing process. Standardization and monitoring preanalytical variables is of foremost importance and is associated with the most efficient and well-organized laboratories, resulting in reduced operational costs and increased revenues. As such, this article is aimed at providing readers with significant updates on the total quality management of the preanalytical phase to endeavour further improvement for patient safety throughout this phase of the total testing process.

show abstract

First Morning Voids Are More Reliable Than Spot Urine Samples to Assess Microalbuminuria

Cited by 225 publications

References 21 publications

Glomerular and Tubular Damage Markers in Individuals with Progressive Albuminuria

Glomerular and Tubular Damage Markers in Individuals with Progressive Albuminuria

The clinical characteristics at diagnosis of type 2 diabetes in a multi-ethnic population: the South London Diabetes cohort (SOUL-D)

Preanalytical quality improvement: from dream to reality

Contact Info

Product

Resources

About