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Question:

From Croatia:

I have had type 1 for 20 years, with no complications, so far. Most of the time, my A1cs were between 6 and 7%, but, last year, I tightened my control and last three results were even lower: 5.2, 5.8 and 5.5. Albumin to creatinine ratio was always between 1.5 to 2.8 mg/mmol, and the highest amount of albumin in a 24 hour urine test was 11 mg (test done one year ago).

Can you tell me if it is possible to have these results at the same time:

  • creatinine (in blood) = 77 micromol/L
  • albumin/creatinine ratio (random sample of urine) = 1.6 mg/mmol
  • total amount of albumin in 24 hour urine = 95 mg

According to the total albumin, there is microalbuminuria present (more than 30 mg/24 hour urine, less than 150). However, to my knowledge, this ACR result doesn't indicate there is microalbuminuria present. Which test is more reliable for detecting early kidney damage?

The results for ACR and creatinine was performed in one laboratory and 24 hour urine albumin in another one, within the time period of couple of weeks. There was no urinary infection.

Answer:

It is standard care to screen with a random urine for albumin/creatinine ratio in patients seen in the clinic. Levels less than 30 mcg/milligram of creatinine are considered normal. Similarly, for twenty-four hour urines, less than 30 mg/24 hours is considered normal on a twenty-four hour urine test. It is possible to have transient elevations in albumin excretion that can be seen with both the random urine albumin/creatinine ratio and the twenty-four hour urine that then go back to normal. This is because there is a degree of interindividual variability in the test. Multiple specimens should be obtained to document any progression. My recommendation is to repeat the twenty-four hour urine and collect for albumin and creatinine. They can do a simultaneous ratio on the twenty-four hour collection, as well.

You bring up very good questions. Previously reported studies have suggested the spot urine is similar to the twenty-four hour urine collection. Reasons for false elevations in albumin excretion include very high blood sugars that occurred during the collection, a high-protein diet, an increase in blood pressure, an intercurrent illness, or extreme exercise.

JTL

DTQ-20051014101920
Original posting 22 Oct 2005
Posted to Complications

  
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Last Updated: Tuesday April 06, 2010 15:10:04
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