Korean Journal of Nephrology 2011;30(6):601-606.
The Efficacy of Urinary Albumin-to-Osmolality Ratio in Predicting 24-hour Urine Albumin Excretion in Type 2 DM Patients
Ju Hyun Lee, M.D., So Young Kim, M.D., Min Ji Lee, M.D., Soon Ae Kim, M,D., Sung Joon Shin, M.D. and Kyung Soo Kim, M.D.
Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
원저 : 제2형 당뇨병 환자에서 24시간 소변 알부민 배설량 예측을 위한 알부민/삼투압 비의 유용성
이주현, 김소영, 이민지, 김순애, 신성준, 김경수
동국대학교 일산병원 내과
Purpose: Microalbuminuria is a predictive marker for early diabetic nephropathy and an independent risk factor for cardiovascular disease. Screening for the presence of microalbuminuria is one of the best ways to detect early kidney damage in patients with diabetes or other disease, and also is of great significance in prevention of cardiovascular disease. Recently spot urine albumin-to-creatinine ratio (ACR) has been proposed as a screening test for microalbuminuria. However, the creatinine level is affected by diet, drugs, age, muscle mass and race, etc. The cutoff value for ACR has generated some controversy. In this report, we evaluated the efficacy of spot urine albumin-to-osmolality ratio (AOR) in order to predict 24-hour urine albumin excretion (AER). Methods: Seventy-three patients diagnosed as type 2 DM in DUIH were recruited. Urine was collected for 24 hours for the measurement of microalbumin and first morning urine was obatined for the measurement of ACR and AOR. We evaluated the correlation of AER and ACR or AOR. Results: Correlation between spot urine AOR and 24 hour urine AER (Spearmans' rho=0.804, p<0.01) was similar to that between ACR and AER (Spearman's rho=0.872, p<0.01). Also correlation analysis revealed that AOR is closely correlated with ACR (Spearman's rho=0.939, p<0.01). We evaluate accuracy of spot urine ACR and AOR using receiver operating characteristics (ROC) curve, AUC were 0.97, 0.94, respectively. Conclusion: AOR correlates closely with AER. Both AOR and ACR are effective predictors of microalbuminuria. Therefore AOR is an alternative to ACR in the detection and follow-up of microalbuminuria in patients with DM.
Key Words: Albuminuria, Diabetic nephropathies, Diabetes mellitus type 2
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