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      Can Total Urinary Protein Measurements Predict Microalbuminuria?

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          We re-addressed the question of whether routine total urinary protein determinations can be used to predict the presence of microalbuminuria by studying 61 patients who attended a diabetic clinic and tested negative or had one positive protein by dipstick. Total urinary protein was measured by the Biorad dye-binding method in undialyzed urine (UND), in dialyzed urine (DIAL), and in dialyzed urine in which albumin and globulins were separated, measured separately with albumin and globulin standards and the results added together to obtain total urinary protein (A + G). The results were compared with albumin measurements obtained by radioimmunoassay (RIA). Compared to DIAL, urinary protein measurements were 43% higher with A + G and 22% higher with UND. Microalbuminuria correlated moderately with UND (r = 0.81) and better with the other methods (r = 0.87 for DIAL, r = 0.91 for A + G). None of the methods predicted microalbuminuria reliably. Taking a protein-to-creatinine ratio of 0.15 and an albumin-to-creatinine ratio of 0.03 as upper limits of normal, we found that UND had a 72% positive predictive value (28% false positives) and 85% negative predictive value (15% false negatives). DIAL had 90% positive predictive value (10% false positives) and 78% negative predictive value (22% false negatives). A + G had 65% positive predictive value (35% false positives) but 91% negative predictive value (9% false negatives). A + G, which uses the correct standards, would be the most suitable method for screening, having the least number of false negatives, but has more false positives because it is more sensitive. In practice, most routine chemical laboratories find it expedient to use only UND, but physicians interpreting the results of this method should be aware of its limitations.

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          Quantitation of proteinuria by the use of protein-to-creatinine ratios in single urine samples.

          Measurements of protein-to-creatinine ratios in single-voided urine samples were compared with 24-hour urinary protein excretions for quantitation of proteinuria in inpatients and outpatients. Patients included those representing a broad spectrum of renal diseases, a wide range of proteinuria, and various degrees of reduction in glomerular filtration rate. Protein-to-creatinine ratios in single-voided urine samples correlated well with measurements of 24-hour urinary protein. This simple single-voided test is reliable and useful in the screening, assessment, and follow-up of proteinuria and avoids the problems associated with 24-hour urine collection.

            Author and article information

            Am J Nephrol
            American Journal of Nephrology
            S. Karger AG
            August 1998
            05 June 1998
            : 18
            : 4
            : 285-290
            Divisions of Nephrology, Cook County Hospital, University of Illinois at Chicago, WSVAMC, and Hektoen Institute for Medical Research, Chicago, Ill., USA
            13352 Am J Nephrol 1998;18:285–290
            © 1998 S. Karger AG, Basel

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            Page count
            Figures: 6, Tables: 1, References: 11, Pages: 6
            Self URI (application/pdf):
            Clinical Study

            Cardiovascular Medicine, Nephrology

            Microalbuminuria, Urinary protein, Urinary albumin


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