-
Views
-
Cite
Cite
W. Greg Miller, David E. Bruns, Laboratory issues in measuring and reporting urine albumin, Nephrology Dialysis Transplantation, Volume 24, Issue 3, March 2009, Pages 717–718, https://doi.org/10.1093/ndt/gfp022
Close - Share Icon Share
Extract
Urine albumin is an important biomarker for kidney damage, and its measurement is recommended by clinical practice guidelines in many countries for identifying and managing patients with kidney disease. A recent publication reviewed current practices in measurement and reporting of urine albumin concentrations and made recommendations for improvement [ 1 ]. The paper reflected the work of the Laboratory Working Group of the National Kidney Disease Education Program (NKDEP, USA) and the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Joint Committee for Standardization of Albumin in Urine.
Historically, the concentration of albumin excreted in 24 h was used to evaluate kidney function. The difficulty of collecting 24 h urine samples has lead to the common recommendation to use an untimed urine collection and to report the ratio of the albumin concentration to the creatinine concentration. This albumin:creatinine ratio (ACR) is widely viewed as an acceptable surrogate for the albumin excretion rate. The recommendations from various professional organizations, however, vary regarding the type of urine samples to collect for measurement of ACR (e.g. first-morning void, random), the reporting units to use and the criteria for interpretation of the results. Most recommendations use a single decision threshold to identify patients with clinically significant albuminuria, despite the variation of both the albumin and creatinine excretion rates with time of day, exercise, gender, race and other factors. Further complicating the use of a single decision threshold is the increasing evidence that albumin excretion functions as a continuous variable in predicting a progressive increase in risk for complications related to decreased kidney function [ 2,3 ].
Comments