noelle
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1]WHAT IS THE BEST SCREENING TEST FOR DIABETIC NEPHROPATHY?
IS IT 24 PROTEIN COLLECTION OR URINE SPOT ALBUMIN AND CREATININE?? :roll:
2]MICROALBUMINURIA IS URINE PROTEIN 30-300 MG/24HR CORRECT?? AND DIPSTICK IS ABLE TO DETECT PROTEIN ONLY ABOVE 300MG/DAY??
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| mikyro
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1]WHAT IS THE BEST SCREENING TEST FOR DIABETIC NEPHROPATHY?
IS IT 24 PROTEIN COLLECTION OR URINE SPOT ALBUMIN AND CREATININE??
Noelle, diabetic nephropathy usually manifests clinically quite long after the clinical diagnosis of DM. It is sometimes possible to diagnose DM once the petient comes to you for the first time and to find unexplicable proteinuria.
That is why there are two possibilities:
1. the patient has been already diagnosed with DM. Your role as a doctor is to first inform the patient about this complication and then do your best to diagnose it in real time. As you know, the regular disptick tests do not detect microalbuminuria (<300 mg/24 hr). That is why you need to collect a 24 urine sample to detect microalbuminuria. So, in this case the best screening test is: 24 hr protein collection. Once you find microalbuminuria, you must inform the patient that his/her kidneys have been already affected and that it is imperative that he/she start treatment as soon as possible to stop/delay the decline in renal function. As you know, ACE inhibitors are the DOC in this case (unless CI).
2. the patient comes to you for the first time. You do not know he has diabetes. You can have two options now:
a. urine dipstick positive for protein; also glucose in urine - next: creatinine levels - next: start treatment immediately and check creatinine clearance to see how badly the kidneys are affected.
b. urine dipstick negative for protein (no gross proteinuria) - next: get a 24 hr urine sample and check for microalbuminuria - if present; next: creatinine clearance - next: start treatment.
2]MICROALBUMINURIA IS URINE PROTEIN 30-300 MG/24HR CORRECT?? AND DIPSTICK IS ABLE TO DETECT PROTEIN ONLY ABOVE 300MG/DAY??
YES, correct  .
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| noelle
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thanks miky!
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| ELM
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Also i remember reading about adding somestuff into the regular urine dipstick test to detect microambuminuria as a screening test, but of course it's me ....forgot what exactly was added into the urine. :| Just keep that in mind that there is some other easier way to detect microambuminia besides 24h urine collection!!! But i think the 24h collection has more specifisity though.
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| ELM
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Noelle,
I just encountered this very q on UW today and it says best screen for diabetic nephropathy is spot urine testing for albumin-creatinine ratio, according to UW less than 30 is normal, above is abnormal screen. Because 24h collection of urine is not too convienent for the patiens so this is the best test according to UW.
What you have to pick on your test is up to you. 8)
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| noelle
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i dont like when UW does this to me!!
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| ELM
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Yes, me too....there were many times i don't agree with their statements and i know that there will be more, so what we do is take everything with salt and pepper :lol: (you know, take it as what majorty of books and references say:lol: )
I like UW, but I don't like when they lie to me or trick me with old witch's trick :x .......but overall i like it though, it's fun.
Did you tell me once your average on UW is 70 something? Is that a first time or second time? Did you do them in timed? Also did you use your used qs?
I am doing it now in timed, mixed, unused mode and struggling to reach 70 as my average, it's killing me. :lol: Let me how you did??? Just curious.
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| mikyro
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best screen for diabetic nephropathy is spot urine testing for albumin-creatinine ratio, according to UW less than 30 is normal, above is abnormal screen.
Never heard of that :? . All the us docs I've been discussing with have told me that the best screening test is 24 hr urine collection. They must know why .
Because 24h collection of urine is not too convienent for the patiens so this is the best test according to UW.
Well, when a petient finds out that he/she has DM and if the patient has some knowledge of this disease / some interest in human diseases, that patient will automatically ask you about complications :wink: . And believe me, I've seen over 100 pts with DM during 2004 in my country and they all agreed to stay for 2-3 days in the ambulatory service to have some tests done - among which, 24 hr urine collection . Of course, I explained them first about the possible complications of DM and how we could diagnose / prevent them in real time and they all agreed to have all tests done . Afterall, it's easier and cheaper to prevent than to treat, right :wink: ?
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| ELM
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Oooh my whatever. :|
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