Use of the Albumin/Creatinine Ratio in Patient Care and Clinical Studies

  • James H. Warram
  • Andrzej S. Krolewski

Abstract

In patients with diabetes, elevated urinary albumin excretion (UAE) indicates the existence of functional as well as morphological abnormalities in the kidney [1–3]. Therefore, measurement of UAE is used for the early diagnosis of diabetic kidney disease as well as for monitoring its natural course and the effectiveness of treatment. Quantitative and semiquantitative methods are used to measure UAE.

Keywords

Diabetic Nephropathy Cumulative Incidence Diabetic Kidney Disease IDDM Patient Albumin Creatinine Ratio 
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References

  1. 1.
    Hostetter TH, Rennke HG, Brenner BM. The case of intrarenal hypertension in the initiation and progression of diabetic and other glomerulopathies. Am J Med 1982; 72:375–380.PubMedCrossRefGoogle Scholar
  2. 2.
    Chavers BM, Bilous RW, Ellis EN, Steffes MW, Mauer SM. Urinary albumin excretion as a predictor of renal structure in type I diabetic patients without overt proteinuria. N Engl J Med 1989; 320:966–970.PubMedCrossRefGoogle Scholar
  3. 3.
    Walker JD, Close CF, Jones SL, et al. Glomerular structure in type I (insulin-dependent) diabetic patients with normo- and microalbuminuria. Kidney Int 1992; 41:741–748.PubMedCrossRefGoogle Scholar
  4. 4.
    Mogensen CE. Urinary albumin excretion in early and long term juvenile diabetes. Scand J Clin Lab Invest 1971; 28:183–193.PubMedCrossRefGoogle Scholar
  5. 5.
    Mogensen CE. Microalbuminuria as a predictor of clinical diabetic nephropathy. Kidney Int 1987; 31:673–89.PubMedCrossRefGoogle Scholar
  6. 6.
    Ginsberg JM, Chang BS, Maltarese RA, Garella S. Use of single-voided urine samples to estimate quantitative proteinuria. N Engl J Med 1983; 309:1543–1546.PubMedCrossRefGoogle Scholar
  7. 7.
    Nathan D, Rosenbaum C, Protasowiski D. Single void urine samples can be used to estimate quantitative microalbuminuria. Diabetes Care 1987; 10:414–418.PubMedCrossRefGoogle Scholar
  8. 8.
    Dunn PJ, Jury DR. Random urine albumin.creatinine ratio measurments as a screening test for diabetic microalbuminuria-a five year follow-up. N Z Med J 1990; 103:562–564PubMedGoogle Scholar
  9. 9.
    Warram JH, Gearin G, Laffel L, Krolewski AS. Effect of duration of type I diabetes on the prevalence of stages of diabetic nephropathy defined by urinary albumin/creatinine ratio. J Am Soc Nephrol 1996; 7:930–937.PubMedGoogle Scholar
  10. 10.
    Watts GF, Kubal C, Chinn S. Long-term variability of overnight albumin excretion in insulin-dependent diabetes mellitus: Some practical recommendations for monitoring microalbuminuria. Diabetes Res Clin Pract 1990; 9:169–177.PubMedCrossRefGoogle Scholar
  11. 11.
    Jensen JE, Nielsen SH, Foged L, Holmegaaard SN, Magid E. The M1CRAL test for diabetic microalbuminuria: predictive values as a function of prevalence. Scand J Clin Invest 1996; 56:117–122.PubMedCrossRefGoogle Scholar
  12. 12.
    Pegoraro A, Singh A, Bakir AA, Arruda AL, Dunea G. Simplified screening for microalbuminuria. Ann Intern Med 1997; 127:817–819.PubMedCrossRefGoogle Scholar
  13. 13.
    Cohen SE, Warram JH, Hanna LS, Laffel L, Krolewski AS. Threshold effect of hyperglycemia on the progression of microalbuminuria in type I diabetes. J Am Soc Neph 1997; 8:109A (abstract).Google Scholar
  14. 14.
    Lewis EJ, Hunsicker LG, Bain RP, Rohde RD, for the Collaborative Study Group. The effect of angiotensin-converting enzyme inhibition on diabetic nephropathy. New Engl J Med 1993; 329:1456–1462.PubMedCrossRefGoogle Scholar
  15. 15.
    Viberti GC, Mogensen CE, Groop LC, Pauls JF, for the European Microalbuminuria Captopril Study Group. Effect of Captopril on progression to clinical proteinuria in patients with insulin-dependent diabetes mellitus and microalbuminuria. JAMA 1994; 271:275–279.PubMedCrossRefGoogle Scholar
  16. 16.
    Laffel LMB, McGill JB, Gans DJ, on behalf of the North American Microalbuminuria Study Group. The beneficial effect of angiotensin-converting enzyme inhibition with Captopril on diabetic nephropathy in normotensive IDDM patients with microalbuminuria. Am J Med 1995; 99:497–504.PubMedCrossRefGoogle Scholar
  17. 17.
    Kasiske BL, Kalil RSN, Ma JZ, Liao M, Keane WF. Effect of antihypertensive therapy on the kidney in patients with diabetes: a meta-regression analysis. Ann Intern Med 118:128–138,1993.CrossRefGoogle Scholar
  18. 18.
    Ravid M, Savin H, Jutrin I, Bental T, Katz B, Lishner M: Long term stabilizing effect of angiotensin converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Aim Intern Med 1993; 118:577–581.CrossRefGoogle Scholar
  19. 19.
    Morrison AS. Screening in chronic disease. New York, Oxford University Press, 1992, pp 1–20.Google Scholar
  20. 20.
    Bennett PH, Haffner S, Kasiske BL, Keane WF, Mogensen CE, Parving HH, Steffes MW, Striker GE. Screening and management of microalbuminuria in patients with diabetes mellitus: recommendation to the scientific advisory board of the nNational Kidney Foundation from and ad hoc committee of the Council on Diabetes Mellitus of the National Kidney Foundation. Am J Kid Dis 1995; 25:107–112.PubMedCrossRefGoogle Scholar
  21. 21.
    Mogensen CE, Keane WF, Bennett PH, Jerums G, Parving HH, Passa P, Steffes MW, Striker GE, Viberti GC. Prevention of diabetic renal disease with special reference to microalbuminuria. Lancet 1995;346:1080–1084.PubMedCrossRefGoogle Scholar
  22. 22.
    Krolewski AS, Laffel LMB, Krolewski M, Quinn M, Warram JH. Glycated hemoglobin and risk of microalbuminuria in patients with insulin-dependent diabetes mellitus. New Engl J Med 1995; 332:1251–1255.PubMedCrossRefGoogle Scholar
  23. 23.
    Connell SJ, Hollis S, Tieszen KL, McMurray JR, Doman TL. Gender and the clinical usefulness of the albumin:creatinine ratio. Diabetic Med; 11:32–6,1994.PubMedCrossRefGoogle Scholar
  24. 24.
    Vestbo E, Damsgaard EM, Froland A, Mogensen CE. Urinary Albumin excretion in a population based cohort. Diabet Med 1995; 12:488–493.PubMedCrossRefGoogle Scholar
  25. 25.
    Siegel JE, Krolewski AS, Warram JH, Weinstein MC. Cost-effectiveness of screening and early treatment of nephropathy in patients with insulin-dependent diabetes mellitus. J Am Soc Neph 1992; 3:S111–S119.Google Scholar
  26. 26.
    Viberti GC, Hill RD, Jarrett RJ, Argyropoulos A, Mahmud U, Keen H. Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet 1982; 1:1430–1432.PubMedCrossRefGoogle Scholar
  27. 27.
    Mogensen CE, Christensen CK. Predicting diabetic nephropathy in insulin-dependent patients. New Engl J Med 1984; 311:89–93.PubMedCrossRefGoogle Scholar
  28. 28.
    Mathiesen ER, Oxenboll B, Johansen K, Svendsen PA, Deckert T. Incipient nephropathy in Type (insulin-dependent) diabetes. Diabetologia 1984; 26:406–410.PubMedCrossRefGoogle Scholar
  29. 29.
    Bach LA, Gilbert RE, Cooper ME, Tsalamandris C, Jerums G. Prediction of persistent microalbuminuria in patients with diabetes mellitus. J Diab Comp 1993; 7:67–72.CrossRefGoogle Scholar
  30. 30.
    Almdal T, Norgaard K, Feldt-Rasmussen B, Deckert T. The predictive value of microalbuminuria in IDDM Diabetes Care 1994; 17:120–125.PubMedCrossRefGoogle Scholar
  31. 31.
    Forsblom CM, Groop PH, Ekstrand A, Groop LC. Predictive value of microalbuminuria in patients with insulin-dependent diabetes of long duration. BMJ 1992; 305:1051–1053.PubMedCrossRefGoogle Scholar
  32. 32.
    Janner M, Knill SE, Diem P, Zuppinger KA, Mullis PE. Persistent microalbuminuria in adolescents with type I (insulin-dependent) diabetes mellitus is associated to early rather than late puberty. Results of a prospective logitudinal study. Eur J Pediatr 1994; 153:403–408.PubMedCrossRefGoogle Scholar
  33. 33.
    Kostraba JN, Dorman JS, Orchard TJ, Becker DJ, Ohki Y, Ellis D, Doft BH, Lobes LA, LaPorte RE, Drash AL. Contribution of diabetes duration before puberty to development of microvascular complications in IDDM subjects. Diabetes Care 1989; 12:686–693.PubMedCrossRefGoogle Scholar
  34. 34.
    Krolewski M, Eggers PW, Warram JH. Magnitude of end-stage reanl disease in IDDM: a 35 year follow-up study. Kidney Int 1996; 50:2041–2046.PubMedCrossRefGoogle Scholar
  35. 35.
    Rudberg S, Ullman E, Dahlquist G. Relationship between early metabolic control and the development of microalbuminuria — a longitudinal study in children with Type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1993; 36:1309–1314.PubMedCrossRefGoogle Scholar
  36. 36.
    Stephenson JM, Fuller JH. Microalbuminuria is not rare before 5 years of IDDM. J Diab & Comp 1994; 8:166–173.CrossRefGoogle Scholar
  37. 37.
    Orchard TJ, Dorman JS, Maser RE, et al. Pittsburgh epidemiology of diabetes complications study. II. Prevalence of complications in IDDM by sex and duration. Diabetes 1990; 39:1116–1124.PubMedCrossRefGoogle Scholar
  38. 38.
    Andersen AR, Christiansen JS, Andersen JK, Kreiner S, Deckert T. Diabetic nephropathy in type I (insulin-dependent) diabetes: an epidemiological study. Diabetologia 1983; 25:496–501.PubMedCrossRefGoogle Scholar
  39. 39.
    Krolewski AS, Warram JH, Christlieb AR, Busick EJ, Kahn CR. The changing natural history of nephropathy in Type 1 diabetes Am J Med 1989; 78:785–794.CrossRefGoogle Scholar
  40. 40.
    Nelson RG, Kunzelman CL, Pettitt DJ, Saad MF, Bennett PH, Knowler WC. Albuminuria in Type 2 (non-insulin-dependent) diabetes mellitus and impaired glucose tolerance in Pima Indians. Diabetologia 1989; 32:870–876.PubMedCrossRefGoogle Scholar
  41. 41.
    Pugia MJ, Lott JA, Clark LW, Parker DR, Wallace JF, Willis TW. Comparison of urine dipsticks with quantitative methods for microalbuminuria. Eur J Clin Chem CLin Biochem 1997; 35:693–700.PubMedGoogle Scholar
  42. 42.
    Poulsen PL, Mogensen CE. Clinical evaluation of a test for immediate and quantitative determination of urinary albumin-to-creatinine ratio. Diabetes Care 1998; 21:97–98.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1998

Authors and Affiliations

  • James H. Warram
    • 1
  • Andrzej S. Krolewski
    • 1
  1. 1.Section on Genetics and Epidemiology Joslin Diabetes CenterBostonUSA

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