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Handbook of Diagnostic Endocrinology - part 6

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Protein nước tiểu có thể được đo bằng que thăm phân tích, tuy nhiên đo lường này không phải là cụ thể cho bài tiết albumin, là với các bệnh cầu thận. Hơn nữa, phân tích que thăm sẽ không được tích cực cho đến khi nước tiểu nồng độ protein trên 250-300 mg | 170 Goldfine despite poor glycemic control only one-third to one-half of diabetic patients develop nephropathy and genetic factors appear to play a permissive or protective role. Parental hypertension or a first-degree family member affected with diabetic nephropathy are the clearest risk factors for this complication. Urine protein can be measured by dipstick analysis however this measurement is not specific for albumin excretion which is present with the glomerular disease. Furthermore dipstick analysis will not be positive until the urine protein levels are above 250-300 mg protein daily and if other causes of proteinuria have been excluded would signify significant diabetic renal disease. Normal albumin excretion ranges from 3-25 mg daily. Proteinuria is considered to exist if the urine excretion is greater than 300 mg d. The range between normal excretion and that detected by the traditional dipstick method i.e. 30 and 300 mg daily is considered to be in the microalbuminuric range. Microalbumin measurements performed by radioimmunoassay can now detect much lower levels of albumin at rates 5 pg min 29 . Microalbuminuria has been shown to predict individuals at high risk of progression to advanced diabetic renal disease 30 31 and elevated levels are now considered to represent an early stage of this complication. Microalbumin should be measured annually on a spot urine sample and is best expressed as a ratio to the urine creatinine. The test is considered abnormal when the urine microalbumin is 20 pg mg of creatinine. Poor metabolic control and hypertension can both cause small increases in urine microalbumin and may reverse with treatment. It is less clear if these transient changes identify patients at risk of progression. Furthermore the test must be interpreted cautiously as there are many other causes of increased microalbumin excretion including exercise which may impose a circadian variation to microalbumin excretion 32 urinary tract infection and a .