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Specificity 81 100 refer to table 6 for summary table

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specificity (81-100%) (refer to Table 6 for summary).Table 6 includes a summary of thekey components of the cross sectional studies in relation to the assessment of the applicabilityof ACR.
Type 2 Diabetes Guideline35Chronic Kidney Disease, June2009Table 6:ACR – sensitivity and specificity for microalbuminuria screeningStudy IDReference method forAERReferencelevel forAERACRurinesampleACR resultSensitivity(%)Specificity(%)Bakker(1999)Immunoturbidimetry(overnight sample)20 μg/minOvernight2.5 mg/mmol(female)1.8 mg/mmol(male)94 (female)94 (male)92 (female)93 (male)Gatling et al(1985)Micro-ELISA (overnightsample)AER 30μg/minEarlymorning>3.5 mg/mmol8697Hutchison etal (1988)Radioimmunoassay(overnight sample)AER 30μg/minEarlymorning>3.0 mg/mmol9794Nathan et al(1987)Radioimmunoassay (24hr sample)44mg/24hr24 hr3.4 mg/mmol100100Parsons et al(1999)Immunoturbidimetry (24hr sample)20mg/l24 hr2.65 mg/mmol9579Poulsen &Mogensen(1998)Immunoturbidimetry(overnight sample)ACR 3.5mg/mmol(female),2.5mg/mmol(male)Not stated>3.5 mg/mmol(female)>2.5 mg/mmol(male)9198A large study of people with type 2 diabetes from the United States showed that ACR,measured on a random urine sample, in the range 3.0 – 37.8 mg/mmol was over 88%sensitive and specific for the presence of microalbuminuria (Zelmanovitz et al, 1997).However it is important to note that the microalbuminuria range for ACR is influenced byboth gender and age. There were approximately 30% false positives for ACR in people aged>65 years in a more recent study by Houlihan et al (2002c). For these reasons ACR haslimitations as a diagnostic test but remains an excellent screening test for microalbuminuria.ACR performed on overnight urine samples has been reported in a number of studies as theleast variable parameter (lowest co-efficient of variation) for measuring microalbuminuria.The coefficient of variation for the day to day variability or urinary creatinine excretion is inthe range of 8-13% (Smulders et al, 1998) and 40-50% for AER (Feldt-Rasmussen et al,1985). As discussed by others, the reasons for this variability include changes in bloodpressure, activity and fluid intake for albumin excretion, and changes in dietary protein intakefor creatinine excretion (e.g Mogensen 1995 and Flynn et al, 1992).Previous studies haveshown the intra-individual coefficient of variation for ACR to be 49% in first morning urinesamples (McHardy et al, 1991) compared with 27% in timed overnight urine collections.ACR on overnight urine collections has been found to be the least variable parameter for themeasurement of microalbuminuria (Harvey et al, 1999; Smulders et al, 1998).ACR is influenced by gender such that for a similar degree of albuminuria the ACR will belower in males.Ageing has not been widely recognized as an important predictor of ACRand current guidelines only take gender into account as indicated in the review article byMogensen et al (1995). In one study examining the inter-individual variability of urinarycreatinine excretion and influence on ACR in people with diabetes, only gender andbody

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Term
Three
Professor
professor_unknown
Tags
Nephrology, Chronic kidney disease

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