Urinary albumin strip assay as a screening test to replace quantitative technology in certain conditions

2018 ◽  
Vol 57 (2) ◽  
pp. 204-209 ◽  
Author(s):  
Maria Salinas ◽  
Maite López-Garrigós ◽  
Emilio Flores ◽  
Javier Lugo ◽  
Carlos Leiva-Salinas
Keyword(s):  
Chronic Kidney Disease ◽  
Gold Standard ◽  
Quantitative Methods ◽  
Quantitative Measurement ◽  
Clinical Laboratory ◽  
Urinary Albumin ◽  
Economic Effects ◽  
Ph Indicator ◽  
Urine Albumin ◽  
Strip Test

Abstract Background The clinical laboratory plays a crucial role in the diagnosis and monitoring of chronic kidney disease. The quantitative measurement of urine albumin in a spot sample, expressed as ratio per creatinine (ACR) is the most frequently used biomarker for such a purpose. Our aim was to evaluate the diagnostic performances of a strip for measuring ACR for differentiating patients who are candidates for subsequent albumin quantification, and to evaluate the economic effects of its implementation. Methods We systematically measured strip analysis when quantitative urinary albumin was requested. Semiquantitative urinary albumin was measured using a UC-3500 (Sysmex, Kobe, Japan), based on the protein error of a pH indicator. We collected and reviewed all the values of quantified urinary albumin and their corresponding results in ACR strip tests. We calculated the diagnostic indicators for ACR at different albumin and creatinine values using the quantitative ACR measurement as a “gold standard”. We also studied the economic effects based on both tests prices (€1.31 for quantitative albumin plus creatinine, and €0.04 for an albumin strip). Results The study included 9148 patients (mean age 63, 46.3% men). The results at different albumin and creatinine cutoffs showed the best performance when 10 mg/L and above 50 mg/dL, respectively. Based on our results, we would have saved 3506 urine albumin and creatinine tests in the study period, corresponding to €4226.94. Conclusions The present study supports the use of the ACR strip test to identify pathological albuminuria values to be measured through quantitative methods. Considerable economic savings are possible.

scholarly journals Comparison between Immunoturbidimetry, Size-Exclusion Chromatography, and LC-MS to Quantify Urinary Albumin

2008 ◽  
Vol 54 (9) ◽  
pp. 1504-1510 ◽  
Author(s):  
Aisha Shaikh ◽  
Jesse C Seegmiller ◽  
Timothy M Borland ◽  
Bradley E Burns ◽  
Paula M Ladwig ◽  
...  
Keyword(s):  
Precise Measurement ◽  
Clinical Laboratory ◽  
Urinary Albumin ◽  
Size Exclusion ◽  
Specific Method ◽  
Potential Measurement ◽  
Urine Albumin ◽  
Exclusion Chromatography ◽  
Size Exclusion Hplc ◽  
Measurement Biases

Abstract Background: The accurate and precise measurement of urinary albumin is critical, since even minor increases are diagnostically sensitive indicators of renal disease, cardiovascular events, and risk for death. To gain insights into potential measurement biases, we systematically compared urine albumin measurements performed by LC-MS, a clinically available immunoturbidimetric assay, and size-exclusion HPLC. Methods: We obtained unused clinical urine samples from 150 patients who were stratified by degrees of albuminuria (<20 mg/L, 20–250 mg/L, >250 mg/L) as determined by the immunoturbidimetric assay used in our clinical laboratory (Roche Hitachi 912). Urine albumin was then remeasured via LC-MS and HPLC (Accumin™) assays. Results: The immunoturbidimetric assay, calibrated using manufacturer-supplied serum-derived calibrators (Diasorin), underestimated albumin compared with LC-MS. After calibration with purified HSA, this immunoturbidimetric assay correlated well with LC-MS. HPLC overestimated albumin compared with both LC-MS and immunoturbidimetry. The current LC-MS and HPLC assays both performed poorly at concentrations <20 mg/L. Conclusions: Efforts are needed to establish gold-standard traceable calibrators for clinical assays. LC-MS is a specific method to quantify albumin in native urine when concentrations exceed 20 mg/L, and therefore could be employed for standardization among assays.

scholarly journals Chronic Kidney Disease Testing Among At-Risk Adults in the U.S. Remains Low: Real-World Evidence From a National Laboratory Database

2021 ◽  
Author(s):  
David Alfego ◽  
Jennifer Ennis ◽  
Barbara Gillespie ◽  
Mary Jane Lewis ◽  
Elizabeth Montgomery ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
At Risk ◽  
Kidney Disease ◽  
Clinical Laboratory ◽  
Clinical Care ◽  
National Laboratory ◽  
The United States ◽  
Urine Albumin ◽  
Diagnosis Codes ◽  
Patients With Diabetes

<p><i>Objective:</i> An estimated 37 million Americans have chronic kidney disease (CKD). Nearly 90% do not know about their condition because of low awareness about the importance of CKD testing and diagnosis among practitioners and people at-risk for CKD. This study utilizes data from a national clinical laboratory to identify guideline-recommended CKD testing rates across the United States.</p> <p><i>Research Design and Methods:</i> Patients with Laboratory Corporation of America® Holdings (Labcorp®) testing between 2013 and 2019 were defined as at-risk for CKD if they had any testing ordered with diagnosis codes for diabetes and/or hypertension. Guideline-concordant CKD assessment was defined by estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR) testing within the study year.</p> <p><i>Results:</i> We identified 28,295,982 at-risk patients (mean age 60.6 ± 14.8 y, 53.6% women): 16.2% had diabetes, 63.8% had hypertension and 20.1% had both comorbidities. Of these, 80.3% did not receive guideline-concordant assessment during the study period. Furthermore, only 21.0% had uACR testing versus 89.6% with eGFR. CKD assessment occurred at least once in 28.7% of patients with diabetes, 10.5% of hypertensive, and 41.4% of those with both. In a state-by-state comparison, annual testing rates ranged from 5% - 30%. The nationwide rate increased modestly each year between 2013 and 2018 (10.7% to 15.2%).</p> <p><i>Conclusions:</i> Despite guideline recommendations, testing for CKD with uACR and eGFR in U.S. adults with diabetes and hypertension is low in routine clinical care. These data highlight the need for strategies to improve routine CKD assessment nationwide.</p>

scholarly journals Chronic Kidney Disease Testing Among At-Risk Adults in the U.S. Remains Low: Real-World Evidence From a National Laboratory Database

2021 ◽  
Author(s):  
David Alfego ◽  
Jennifer Ennis ◽  
Barbara Gillespie ◽  
Mary Jane Lewis ◽  
Elizabeth Montgomery ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
At Risk ◽  
Kidney Disease ◽  
Clinical Laboratory ◽  
Clinical Care ◽  
National Laboratory ◽  
The United States ◽  
Urine Albumin ◽  
Diagnosis Codes ◽  
Patients With Diabetes

<p><i>Objective:</i> An estimated 37 million Americans have chronic kidney disease (CKD). Nearly 90% do not know about their condition because of low awareness about the importance of CKD testing and diagnosis among practitioners and people at-risk for CKD. This study utilizes data from a national clinical laboratory to identify guideline-recommended CKD testing rates across the United States.</p> <p><i>Research Design and Methods:</i> Patients with Laboratory Corporation of America® Holdings (Labcorp®) testing between 2013 and 2019 were defined as at-risk for CKD if they had any testing ordered with diagnosis codes for diabetes and/or hypertension. Guideline-concordant CKD assessment was defined by estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR) testing within the study year.</p> <p><i>Results:</i> We identified 28,295,982 at-risk patients (mean age 60.6 ± 14.8 y, 53.6% women): 16.2% had diabetes, 63.8% had hypertension and 20.1% had both comorbidities. Of these, 80.3% did not receive guideline-concordant assessment during the study period. Furthermore, only 21.0% had uACR testing versus 89.6% with eGFR. CKD assessment occurred at least once in 28.7% of patients with diabetes, 10.5% of hypertensive, and 41.4% of those with both. In a state-by-state comparison, annual testing rates ranged from 5% - 30%. The nationwide rate increased modestly each year between 2013 and 2018 (10.7% to 15.2%).</p> <p><i>Conclusions:</i> Despite guideline recommendations, testing for CKD with uACR and eGFR in U.S. adults with diabetes and hypertension is low in routine clinical care. These data highlight the need for strategies to improve routine CKD assessment nationwide.</p>

Economic Effects of Treatment of Chronic Kidney Disease with Low-Protein Diet

2013 ◽  
Author(s):  
Francesco Saverio Mennini ◽  
Simone Russo ◽  
Andrea Marcellusi ◽  
Giuseppe Quintaliani ◽  
Denis Fouque
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Economic Effects ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Low Protein

scholarly journals MicroRNA-451 as an Early Predictor of Chronic Kidney Disease in Diabetic Nephropathy

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Mostafa Abdelsalam ◽  
A. M. Wahab ◽  
Maysaa El Sayed Zaki ◽  
Mohamad Motawea
Keyword(s):  
Chronic Kidney Disease ◽  
Diabetic Nephropathy ◽  
Kidney Disease ◽  
Early Diagnosis ◽  
Serum Creatinine ◽  
High Sensitivity ◽  
Urinary Albumin ◽  
Significant Difference ◽  
Plasma Microrna ◽  
Stage Renal Disease

Background. Diabetes mellitus is the leading cause of end-stage renal disease worldwide. Microalbuminuria is the cornerstone for the diagnosis of diabetic nephropathy. However, it is an inadequate marker for early diagnosis. MicroRNAs are not only new and promising markers for early diagnosis but also, but they may also play a role in the prevention of disease progression. Methods. This study included ninety patients with type 2 DM in addition to 30 control subjects. MicroRNA-451 expression in blood and plasma using real-time PCR was evaluated in addition to the classic diabetic nephropathy markers (serum creatinine, urinary albumin, and eGFR). Results. There was a significant difference between the studied groups versus control regarding serum creatinine, eGFR, urinary, and plasma microRNA-451 with p=0.0001. Patients with eGFR 60 ml/min/1.73 m2 showed a significantly higher plasma microRNA-451 (29.6 ± 1.6) and significantly lower urinary microRNA-451 (21 ± 0.9) in comparison to patients with eGFR >60 ml/min/1.73 m2 and p=0.0001. eGFR showed a positive correlation with urinary microRNA-451 and negative correlation with both plasma microRNA-451 and urinary albumin. Both plasma and urinary microRNA-451 are highly sensitive and specific markers for chronicity in diabetic nephropathy patients with sensitivity of 90.9% and 95.5% and specificity of 67.6% and 95.6%, respectively. Conclusion. MicroRNA-451 is a promising early biomarker for chronic kidney disease in diabetic nephropathy with high sensitivity and specificity.

scholarly journals Current Issues in Measurement and Reporting of Urinary Albumin Excretion

2009 ◽  
Vol 55 (1) ◽  
pp. 24-38 ◽  
Author(s):  
W Greg Miller ◽  
David E Bruns ◽  
Glen L Hortin ◽  
Sverre Sandberg ◽  
Kristin M Aakre ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Reference Intervals ◽  
Time Of Day ◽  
Urinary Albumin ◽  
Sample Collection ◽  
Continuous Increase ◽  
Albumin Excretion ◽  
Urine Albumin ◽  
Progression Of Kidney Disease ◽  
Patient Preparation

Abstract Background: Urinary excretion of albumin indicates kidney damage and is recognized as a risk factor for progression of kidney disease and cardiovascular disease. The role of urinary albumin measurements has focused attention on the clinical need for accurate and clearly reported results. The National Kidney Disease Education Program and the IFCC convened a conference to assess the current state of preanalytical, analytical, and postanalytical issues affecting urine albumin measurements and to identify areas needing improvement. Content: The chemistry of albumin in urine is incompletely understood. Current guidelines recommend the use of the albumin/creatinine ratio (ACR) as a surrogate for the error-prone collection of timed urine samples. Although ACR results are affected by patient preparation and time of day of sample collection, neither is standardized. Considerable intermethod differences have been reported for both albumin and creatinine measurement, but trueness is unknown because there are no reference measurement procedures for albumin and no reference materials for either analyte in urine. The recommended reference intervals for the ACR do not take into account the large intergroup differences in creatinine excretion (e.g., related to differences in age, sex, and ethnicity) nor the continuous increase in risk related to albumin excretion. Discussion: Clinical needs have been identified for standardization of (a) urine collection methods, (b) urine albumin and creatinine measurements based on a complete reference system, (c) reporting of test results, and (d) reference intervals for the ACR.

HEPATOBLASTOMA IN AN 11 YEARS OLD MALE ADOLESCENT

2021 ◽  
pp. 66-67
Author(s):  
S M Sarfaraj ◽  
Ripan Saha ◽  
Md. Maidul Islam ◽  
Malay Kumar Sinha ◽  
Chhanda Datta
Keyword(s):  
Gold Standard ◽  
Clinical Laboratory ◽  
Male Adolescent

Hepatoblastoma is the most common tumour in children under the age of 5 years. Diagnosis is made usually by combination of clinical, laboratory and radiological ndings. Biopsy is the gold standard for diagnosis. We present a case of hepatoblastoma of an 11 years old boy which is unusual in his age

Abstract 16116: Chronic Kidney Disease in HIV Population and Cardiovascular Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Bertrand Ebner ◽  
Jelani Grant ◽  
Louis Vincent ◽  
Quentin Loyd ◽  
Catherine Boulanger ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Viral Load ◽  
Kidney Disease ◽  
Clinical Laboratory ◽  
South Florida ◽  
Cvd Risk ◽  
Comparable Rate ◽  
Persons Living With Hiv ◽  
Significant Difference

Background: Chronic kidney disease (CKD) is well known to increase the risk of cardiovascular disease (CVD). However, there is limited knowledge about the association between CKD in persons living with HIV (PLWH) and CVD. We sought to investigate the prevalence and characteristics of CVD in PLWH with and without CKD at a large single center in South Florida. Methods: A retrospective chart review of 985 of PLWH from a Special Immunology clinic at a large center in South Florida between 2017-2019 was performed. Data on demographics, clinical, laboratory and diagnostic studies were obtained from electronic health records. Results: The prevalence of CKD in PLWH in our cohort was 11%. The group of CKD was older (58 vs. 51 years p<0.05), with significantly more men (66% vs. 53% p=0.012). The CKD cohort had increased rates of hypertension, coronary artery disease (CAD), heart failure, diabetes mellitus, and cerebrovascular disease (<0.05 for all). PLWH with CKD had a significantly higher HbA1C level, systolic and diastolic blood pressure, statin use, and lower LDL-C (p<0.05 for all). Subjects with HIV and CKD had a higher rate of cardiac catheterization (7.2%), with an increased rate of obstructive CAD (6.3%), when compared to PLWH without CKD (1.3% and 0.7%, respectively, p<0.05 for both). The rate of diastolic dysfunction was significantly higher in PLWH with CKD than those without CKD (p=0.004), although, no difference in ejection fraction (p=0.079) was noted. We found a significantly lower average CD4 count in individuals with HIV and CKD compared to those without CKD (483 ± 297 cells/mm 3 vs. 570 ± 342 cells/mm 3 , p=0.006). No significant difference was noted between groups in mean viral load, proportion with undetectable viral load, and use of antiretroviral medications. Prevalence of chronic hepatitis infection (B and/or C) was also higher in the CKD cohort (p<0.05). Conclusion: In this study, we found a comparable rate of CKD compared to age-matched patients from the general population. We found higher rates of traditional CVD risk factors and disease in the CKD cohort, without significant difference in HIV-related factors. This supports the importance of CVD risk factor optimization in this population.

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