Measurement of Albumin and Other Urinary Proteins in Low Concentration in Diabetes Mellitus: Techniques and Clinical Significance

  • D. J. F. Rowe
  • W. Gatling


Independent clinical studies have indicated that urinary albumin excretion increased above normal but below the level of detection by Albustix (»microalbuminuria«) predict accurately the development of clinical nephropathy and end-stage renal failure in adults with insulin-dependent diabetes (IDD) [1–3].


Diabetic Nephropathy Urinary Protein Urinary Albumin Urinary Albumin Excretion Albumin Excretion Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Mogensen CE, Christensen CK. Predicting diabetic nephropathy in insulin-dependent patients. N Engl J Med 1984; 311: 89–93.PubMedCrossRefGoogle Scholar
  2. 2.
    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; I: 1430–1432.CrossRefGoogle Scholar
  3. 3.
    Mathiesen ER, Oxenb0ll B, Johansen K, Svendsen PAa, Deckert T. Incipient nephropathy in type 1 (insulin-dependent) diabetes. Diabeto logia 1984; 26: 406–410.Google Scholar
  4. 4.
    Gibb DM, Tomlinson PA, Dalton NR, et al. Renal tubular proteinuria and microalbuminuria in diabetic patients. Arch Dis Child 1989; 64: 129–134.PubMedCrossRefGoogle Scholar
  5. 5.
    Davies AG, Price DA, Postlethwaite RJ, et al. Renal function in diabetes mellitus. Arch Dis Child 1985; 60: 299–304.PubMedCrossRefGoogle Scholar
  6. 6.
    Rowe DJF, Hayward M, Bagga H, Betts P. Effect of glycaemic control and duration of disease on overnight albumin excretion in diabetic children. BMJ 1984; 289: 957–959.PubMedCrossRefGoogle Scholar
  7. 7.
    Mogensen CE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med 1984; 310: 356–360.PubMedCrossRefGoogle Scholar
  8. 8.
    Marshall SM, Alberti KGMM. Comparison of the prevalence and associated features of abnormal albumin excretion in insulin-dependent and non-insulin-dependent diabetes. Q J Med 1989; 261: 61–71.Google Scholar
  9. 9.
    Christensen CK. The pre-proteinuric phase of diabetic nephropathy. Dan Med Bull 1991; 38: 145–159.PubMedGoogle Scholar
  10. 10.
    Ellekilde G, Holm J, von Eyben FE, Hemmingsen L. Above-normal urinary excretion of albumin and retinol-binding protein in chronic heart failure. Clin Chem 1992; 38: 593–594.PubMedGoogle Scholar
  11. 11.
    Gero G, Anthony F, Davis M, et al. Retinol binding protein, albumin and total protein excretion patterns during normal pregnancy. J Obstet Gynecol 1987; 8: 104–108.CrossRefGoogle Scholar
  12. 12.
    Damsgaard EM, Froland A, Jorgensen OD, Mogensen CE. Microalbuminuria as predictor of increased mortality in elderly people. BMJ 1990; 300: 297–300.PubMedCrossRefGoogle Scholar
  13. 13.
    Yudkin JS, Forrest RD, Jackson CA. Microalbuminuria as predictor of vascular disease in non-diabetic subjects. Lancet 1988; 2: 530–533.PubMedCrossRefGoogle Scholar
  14. 14.
    Bernard AM, Moreau D, Lauwreys R. Comparison of retinol-binding protein and B2-microglobulin determination in urine for the early detection of tubular proteinuria. Clin Chim Acta 1982; 126: 1–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Forsblom CM, Groop P-H, Ekstrand A, Groop LC. Predictive value of microalbuminuria in patients with insulin-dependent diabetes of long duration. BMJ 1992; 305: 1051–1053.PubMedCrossRefGoogle Scholar
  16. 16.
    Mansell P, Twyman SJ, Rowe DJF, et al. Urinary albumin excretion in longitudinal samples in a young diabetic population. British Diabetic Association meeting; Spring 1993, University of Liverpool: A15.Google Scholar
  17. 17.
    Chavers BM, Bilous RW, Ellis En, Steffes MW, Mauer SM. Glomerular lesions and urinary albumin excretion in type 1 diabetes without overt proteinuria. N Engl J Med 1989; 320: 966–970.PubMedCrossRefGoogle Scholar
  18. 18.
    Watts GF, Powell M, Rowe DJF, Shaw KM. Low molecular weight proteinuria in insulin-dependent diabetes mellitus: a study of the urinary excretion of B2-microglobulin and retinol-binding protein in alkalinised patients with and without microalbuminuria. Diabetes Res 1989; 12: 31–36.PubMedGoogle Scholar
  19. 19.
    Elving LD, Bakkeren JAJM, Jansen MJH, et al. Screening for microalbuminuria in patients with diabetes mellitus: frozen storage of urine samples decreases their albumin content. Clin Chem 1989; 35: 308–310.PubMedGoogle Scholar
  20. 20.
    Pontuch P, Jensen T, Deckert T, et al. Urinary excretion of retinol-binding protein in type 1 (insulin-dependent) diabetic patients with microalbuminuria and clinical diabetic nephropathy. Acta Diabetol 1992; 28: 206–210.PubMedCrossRefGoogle Scholar
  21. 21.
    Lervang H-H, Jensen S, Brochner-Mortensen J, Ditzel J. Does increased glomerular filtration rate or disturbed tubular function early in the course of childhood type 1 diabetes predict the development of nephropathy. Diabetic Med 1992; 9: 635–640.PubMedCrossRefGoogle Scholar
  22. 22.
    Walton C, Bodansky HJ, Wales JK, et al. Tubular dysfunction and microalbuminuria in insulin dependent diabetes. Arch Dis Child 1988; 63: 244–249.PubMedCrossRefGoogle Scholar
  23. 23.
    Holm J, Hemmingsen L, Nielsen NV, Thomsen M. Increased urinary excretion of the retinol-binding protein in insulin-dependent diabetes mellitus in the absence of microalbuminuria. Clin Chim Acta 1987; 170: 345–350.PubMedCrossRefGoogle Scholar
  24. 24.
    Holm J, Hemmingsen L, Nielsen NV. Relationship between the urinary excretion of albumin and retinol-binding protein in insulin-dependent diabetics. Clin Chim Acta 1988; 177: 101–106.PubMedCrossRefGoogle Scholar
  25. 25.
    Groop L, Makipernaa A, Stenman S, et al. Urinary excretion of kappa light chains in patients with diabetes mellitus. Kidney Int 1990; 37: 1120–1125.PubMedCrossRefGoogle Scholar
  26. 26.
    Skrha J, Haas T, Sperl M, et al. A six-year follow-up of the relationship between n-acetyl B-D glucosaminidase and albuminuria in relation to retinopathy. Diabetic Med 1991; 8: 817–821.PubMedCrossRefGoogle Scholar
  27. 27.
    Jung K, Pergande M, Schimke E, et al. Urinary enzymes and low-molecular-mass proteins as indicators of diabetic nephropathy. Clin Chem 1988; 34 544–547.PubMedGoogle Scholar
  28. 28.
    Twyman SJ, Rowe DJF. Relationship of n-acetyl B-D-glucosaminidase, retinol-binding protein and albumin to glycaemic control in young diabetic subjects. Ann Clin Biochem 1993; Proceedings of National Meeting C53.Google Scholar
  29. 29.
    Twyman SJ, Rowe DJF. The reduction in excretion of a tubular protein and albumin by improved glycaemic control in diabetics. Ann Biol Clin 1993; 51: Eur Cong of Clin Chem Abstr 175.Google Scholar
  30. 30.
    Rowe DJF, Anthony F, Polak A, et al. Retinol binding protein as a small molecular weight marker of renal tubular function in diabetes mellitus. Ann Clin Biochem 1987; 24: 477–482.PubMedGoogle Scholar
  31. 31.
    Miltenyi M, Körner A, Tulassay T, Szabo A. Tubular dysfunction in type 1 diabetes mellitus. Arch Dis Child 1985; 60: 929–931.PubMedCrossRefGoogle Scholar
  32. 32.
    Catalano C, Winocour PH, Gillespie S, Gibb I, Alberti KGMM. Effect of posture and acute glycaemic control on the excretion of retinol-binding protein in normoalbuminuric insulin-dependent diabetic patients. Clin Sei 1993; 84: 461–467.Google Scholar
  33. 33.
    Rowe DJF, Twyman SJ, Mansell P, Bisson D. Excretion of retinol-binding protein in non-diabetic subjects undergoing a glucose and insulin clamp. British Diabetic Association, Autumn meeting, September 1993.Google Scholar
  34. 34.
    Cooper T, Davies R, Linton D, Rowe DJF. The effect of strenuous exercise on urinary excretion of albumin and retinol-binding protein. Ann Clin Biochem 1989; Proceedings of National Meeting: No 204.Google Scholar
  35. 35.
    Gatling W, Rowe DJF, Hill RD. Microalbuminuria: an appraisal of assay techniques and urine collection procedures for measuring urinary albumin at low concentrations. In Mogensen CE (ed). The Kidney and Hypertension in Diabetes Mellitus. Boston: Martinus Nijhoff Publishing; 1988; pp 41–50.Google Scholar
  36. 36.
    Watts GF, Bennett JE, Rowe DJ, et al. Assessment of immunochemical methods for determining low concentrations of albumin in urine. Clin Chem 1986; 32: 1544–1548.PubMedGoogle Scholar
  37. 37.
    Rowe DJF, Dawnay A, Watts GF. Microalbuminuria in diabetes mellitus: review and recommendations for the measurement of albumin in urine. Ann Clin Biochem 1990; 27: 297–312.PubMedGoogle Scholar
  38. 38.
    Manley SE, Burton ME, Fisher KE, et al. Decreases in albumin/creatinine and N-Acetylglucosaminidase/creatinine ratios in urines samples stored at -20°C. Clin Chem 1992; 38: 2294–2299.PubMedGoogle Scholar
  39. 39.
    Gatling W, Knight C, MuUee MA, Hill RD. Microalbuminuria in diabetes: a population study of the prevalence and an assessment of three screening tests. Diabetic Med 1988; 5: 343–347.PubMedCrossRefGoogle Scholar
  40. 40.
    Marshall SM. Screening for microalbuminuria: which measurement. Diabetic Med 1991; 8: 706–711.PubMedCrossRefGoogle Scholar
  41. 41.
    Kouri TT, Viikari JS, Mattila KS, líjala KM. Microalbuminuria: Invalidity of simple concentration-based screening tests for early nephropathy due to urinary volumes of diabetic patients. Diabetes Care 1991; 14: 591–593.PubMedCrossRefGoogle Scholar
  42. 42.
    Bouhanick B, Beirut G, Chameau AM, et al. Predictive value of testing random urine sample to detect microalbuminuria in diabetic subjects during outpatient visit. Diabete Metab 1992; 18: 54–58.PubMedGoogle Scholar
  43. 43.
    Connell SJ, Hollis S, Tieszen KL, McMurray JR, Doman TL. Gender and the clinical usefulness of the albumin:creatinine ratio. Diabetic Med 1994; 11: 32–36.PubMedCrossRefGoogle Scholar
  44. 44.
    Rowe DJF, Bagga H, Betts P. Normal variation in the rate of albumin excretion and albumin to creatinine ratios in overnight and daytime urine collections in non-diabetic children. BMJ 1985; 291: 693–694.PubMedCrossRefGoogle Scholar
  45. 45.
    Watts GF, Morris RW, Khan K, Polak A. Urinary albumin excretion in healthy adult subjects: reference values and some factors affecting their interpretation. Clin Chim Acta 1988; 172: 191–198.PubMedCrossRefGoogle Scholar
  46. 46.
    Collins ACG, Sethi M, MacDonald FA, Brown D, Viberti GC. Storage temperature and differing methods of sample preparation in the measurement of urinary albumin. Diabetologia 1993; 36: 993–997.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • D. J. F. Rowe
  • W. Gatling

There are no affiliations available

Personalised recommendations