Urinary Total Protein as the Predictor of Albuminuria in Diabetic Patients

Abstract

BackgroundIn order to detect nephropathy, measurement of total (24 hrs) urinary albumin or albumin/creatinin ratio in random urine samples is being recommended. But methods of albumin measurement are not available in all laboratories and also cost about 6 times more than that of urinary total protein measurement.ObjectivesThis Study was performed to determine appropriate cut off point in 24 hours urine total protein to diagnose micro- and macroalbuminuria in patients with diabetes mellitus.Patients and MethodsIn this study, 204 patients with diabetes mellitus type I and II were selected. In collected 24 hours urine from patients, protein and albumin were measured by using Pyrogallol and Immunoturbidimetry methods, respectively.ResultsNormoalbuminuri (albumin < 30 mg/24 hrs urine), microalbuminuri (albumin = 30-300 mg/24 hrs urine), and macroalbuminuri (albumin > 300 mg/24 hrs urine) were detected in 130, 51, and 23 patients, respectively. In 24 hrs urine collections, amounts of protein and albumin were compared to calculate cut off point of exerted protein for nephropathy diagnosis. cut off point of 73 mg/day for urinary total protein had appropriate sensitivity (94.5 %, CI = 91.4 % -97.6 %) and specificity (77.9 %, CI = 72.8 % -82.9 %) for microalbuminuria, while cut off point of 514 mg/day (sensitivity 95.7 %; specificity 98.9 %) was detected for diagnosis macroalbuminuria. Urine protein exertion of 150 mg/day that is currently considered as a normal value in most laboratory kits had a sensitivity of 73.1 % by which 30 % of microalbuminuric cases remained undiagnosed.ConclusionsUrinary total protein cut-off points of 73 mg/day and 514 mg/day were diagnostic for micro- and macroalbuminuria, respectively.

Targeted Clinical Metabolite Profiling Platform for the Stratification of Diabetic Patients

“…Albuminuria is a pathological condition where the protein albumin is present in the urine in abnormal amounts. In healthy subjects (normo-albuminuric), only trace amounts of albumin (<30 mg/24 h) are present in the urine while subjects with elevated amounts of albumin in the urine, on the other hand, can be classified as either micro-albuminuric (c = 30–299 mg/24 h) or macro-albuminuric (c ≥ 300 mg/24 h) [41]. Albuminuria is a sign of diabetic kidney disease, which often occurs especially in subjects with type 1 diabetes [36,41,42].…”

“…In healthy subjects (normo-albuminuric), only trace amounts of albumin (<30 mg/24 h) are present in the urine while subjects with elevated amounts of albumin in the urine, on the other hand, can be classified as either micro-albuminuric (c = 30–299 mg/24 h) or macro-albuminuric (c ≥ 300 mg/24 h) [41]. Albuminuria is a sign of diabetic kidney disease, which often occurs especially in subjects with type 1 diabetes [36,41,42]. In type 2 diabetes (T2D), microalbuminuria is an independent risk factor for the prevalence of diabetic retinopathy [42,43].…”

Sensitivity of total protein creatinine ratio in urine for diagnosis diabetic nephropathy

“…The cut-off in this study was based on a recommendation of AACE/ACE 2015 which states the value of microalbuminuria set using TPCR value in the range of 150-500 mg/g. It was also based on research by Hashemapour et al, 11 using a cut-off of 150 mg/g. 8,11 Hashemapour et al, 11 report that TPCR had sensitivity of 94.5% and a specificity of 78.2%.…”

“…It was also based on research by Hashemapour et al, 11 using a cut-off of 150 mg/g. 8,11 Hashemapour et al, 11 report that TPCR had sensitivity of 94.5% and a specificity of 78.2%. Another study conducted in Japan by Yamamoto et al, 13 which involved 1,033 outpatients to detect microalbuminuria with TPCR using 150 mg/g as the cut-off.…”

“…The examination is influenced by several factors such as infections, high-protein diet, pregnancy and physical activity, hepatic dysfunction and congestive heart failure. 11 In Indonesia, especially in the Yogyakarta Special Region, the use of TPCR for the diagnosis of diabetic nephropathy in patients with type 2 DM has not been routinely performed. Therefore, this study was conducted to evaluate the diagnostic performance of TPCR to detect the present of microalbuminuria in patients with type 2 DM.…”