Screening for Early Diabetic Nephropathy

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Abstract
An albumin excretion rate of 30–150 μ/min is a strong predictor of future clinical diabetic nephropathy. The collection of urine samples commonly used is cumbersome and tedious for both patients and laboratory staff. We have therefore examined the usefulness of albumin:creatinine ratio measurement as a predictor of albumin excretion rates greater than 30 μg/min. Values above 3·5 for the albumin:creatinine ratio gave high sensitivity (98%) but low specificity (63%) while a value greater than 4·5 had a sensitivity of 96% and specificity of 72%. We conclude that the albumin:creatinine ratio in a first morning urine sample is useful as an initial screening test for microalbuminuria but that further analysis is required to select those with definite microalbuminuria.