medigraphic.com
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2006, Number 3

Next >>

Rev Invest Clin 2006; 58 (3)

Utility of the Dipstick Micraltest II™ in the screening of microalbuminuria of diabetes mellitus type 2 and essential hypertension

Cortés-Sanabria L, Martínez-Ramírez HR, Hernández JL, Rojas-Campos E, Canales-Muñoz JL, Cueto-Manzano AM

Language: English
References: 35
Page: 190-197
PDF size: 80.72 Kb.


ABSTRACT

Background. In Mexico, diabetes mellitus type 2 and hypertension are leading causes of end-stage renal disease. Diagnosis of early renal damage with detection of microalbuminuria (microAlbU) is fundamental for treatment and prevention, and so avoiding the catastrophes of renal failure. For screening purposes, several simplified tests, including dipstick methods, fulfill the accuracy requirements for microAlbU detection compared with gold standards; however, no study has established the reliability of such tests in our setting. Aim. To evaluate the utility of micraltest II™ as a screening test for microAlbU compared with nephelometry in patients with diabetes mellitus type 2 and non-diabetic patients with essential hypertension. Patients and methods. Patients with diabetes mellitus type 2 as well as patients with essential hypertension of any age, sex and time of evolution, attending to three primary health-care units (UMF No. 3, 92 and 93, Guadalajara, Jalisco) were included. Patients with transitory albuminuria, secondary hypertension and serum creatinine ≥ 2 mg/dL were excluded. Micraltest II™ was performed in the first morning urine sample, and nephelometry was performed in a 24-h urine collection. Diagnostic accuracy of the dipstick test was then determined. Results. 245 patients were studied: 71 (29%) were diabetics without hypertension, 95 (39%) were diabetics with hypertension, and 79 (32%) had only essential hypertension. In diabetic patients, micraltest II™ sensitivity was 83%, specificity 96%, and positive and negative predictive values were 95% and 88%, respectively. Correlation between nephelometry and micraltest II™ results was 0.81 (p ‹ 0.001). The best cut-off point for microAlbU was 30.5 mg/L, and area under the curve (± SEM) was 0.91 ± 0.03 (confidence interval 95%: 0.85-0.96). In non-diabetic patients with essential hypertension, micraltest II™ sensitivity was 75%, specificity 95%, and positive and negative predictive values were 43% and 99%, respectively. Correlation between nephelometry and micraltest II™ results was 0.43 (p ‹ 0.001). The best cut-off point for microAlbU was 28.2 mg/L, and area under the curve was 0.85 ± 0.13 (0.60-1.10. Conclusion. Micraltest II™ dispstick is a rapid, valid and reliable method for albuminuria screening in patients with diabetes mellitus type 2 and in those nondiabetic patients with essential hypertension in our setting.


REFERENCES

  1. Mogensen CE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med 1984; 310: 356-60.

  2. Ruilope LM, Rodicio JL. The kidney and arterial hypertension. Nephrol Dial Transplant 2001; 16: 50-2.

  3. Messent JW, Elliot TG, Hill RG, Jarrett RJ, Keen H, Viberti GC. Prognostic significance of microalbuminuria in insulin-dependent diabetes mellitus: a twenty-three-year follow-up study. Kidney Int 1992; 41: 836-9.

  4. Mogensen CE. Natural history of cardiovascular and renal disease in patients with type 2 diabetes: effect of therapeutic interventions and risk modification. Am J Cardiol 1998; 82: 4R-7R.

  5. The National Kidney Foundation –K/DOQI guidelines. http://www.kidney.org

  6. Rossert JA, Wauters JP. Recommendations for the screening and management of patients with chronic kidney disease. Nephrol Dial Transplant 2002; 17(1): 19-28.

  7. Keane WF, Eknoyan G. Proteinuria, albuminuria, risk, assessment, detection, elimination (PARADE): A position paper of National Kidney Foundation. Am J Kidney Dis 1999; 33: 1004-10.

  8. Yudkin JS, Forrest RD, Jackson CA. Microalbuminuria as predictor of vascular disease in non-diabetic subjects. Lancet 1998; 2: 530-3.

  9. Ismail N, Becker B, Strzelczyk P, Ritz E. Renal disease and hypertension in non insulin-dependent diabetes mellitus. Kidney Int 1999; 55: 1-28.

  10. Kutter D, Thoma J, Kremer A, Hansen S, Carl R. Screening for oligoalbuminuria by micral-test II a new inmunological test strip. Eur J Clin Chem Clin Biochem 1995; 33: 243-5.

  11. Tiu SC, Lee SS, Cheng MW. Comparison of six commercial techniques in the measurement of microalbuminuria in diabetic patients. Diabetes Care 1993; 16: 616-20.

  12. Velazquez-Monroy O, Rosas Peralta M, Lara Esqueda A, et al. Prevalence and interrelations of noncommunicable chronic diseases and cardiovascular risk factors in México. Arch Cardiol Mex 2003; 73: 62-77.

  13. Velazquez-Monroy O, Rosas Peralta M, Lara Esqueda A, et al. Hipertensión arterial en México: Resultados de la Encuesta Nacional de Salud (ENSA) 2000. Arch Cardiol Mex 2002; 72: 71-84.

  14. United States Renal Data System: http://www.usrds.org

  15. Breien AH, García BH, García GG, Gómez NB, Hernández RI, Lomelí AM, Monteón RF, Palomeque M, Ruiz MN. Epidemiología de la Insuficiencia Renal Crónica en Jalisco. Boletín del Colegio Jalisciense de Nefrología, A.C. 2001; 5: 6-7.

  16. Martínez-Ramírez HR, Jalomo-Martínez B, Cortés-Sanabria L, Rojas-Campos E, Barragán G, Alfaro G, Cueto Manzano AM. Renal function preservation in type 2 diabetes mellitus patients with early nephropathy: A comparative prospective cohort study between primary health-care doctors and nephrologist. Am J Kidney Dis 2006 (in press).

  17. Cueto-Manzano AM, Cortés-Sanabria L, Martínez-Ramírez HR, Rojas-Campos E, Barragán G, Alfaro G, Flores J, et al. Detection of early nephropathy in Mexican type 2 diabetes mellitus patients. Kidney Int 2005; 68 (Suppl. 97): S40-S45.

  18. González VC, Stern MP, Arredondo PB, Martínez DS, Islas AS, Revilla C, González VM, Rivera MD. Nephropathy in low income diabetics: The Mexico City diabetes study. Arch Med Res 1996; 27: 367-73.

  19. American Diabetes Association: Clinical Practice Recommendations 2001. Diabetes Care 2001; 24(1): S69-S72.

  20. Chobanian AV, Barkis HL, Cushman WC, Green LA, Izzo JL, Jones DW, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42: 1206-52.

  21. Pegorado A, Singh A, Bakir A, Arruda JAL, Dunea G. Simplified screening for microalbuminuria. Ann Intern Med 1997; 127: 817-19.

  22. Gerber LM, Johnston K, Alderman HM. Assessment of a new dipstick test in screening for microalbuminuria in patients with hypertension. Am J Hypertension 1998; 11: 1321-7.

  23. Gilbert R, Akdeniz A, Jerums G. Detection of microalbuminuria in diabetic patients by urinary dipstick. Diabetes Res Clin Practice 1997; 35: 57-60.

  24. Minetti EE, Cozzi MG, Granata S, Guidi E. Accuracy of the urinary albumin tritator stick “Micral-Test” in kidney disease patients. Nephrol Dial Transplant 1997; 12: 78-80.

  25. Fernández F, Páez PJM, Hermosín BT, Vazquez GP, Ortiz CMA, Tarilonte DMA. Rapid screening test evaluation for microalbuminuria in diabetes mellitus. Acta Diabetol 1998; 35: 199-202.

  26. Pouslen PL, Mogensen CE. Evaluation of a new semiquantitative stick for microalbuminuria. Diabetes Care 1995: 18: 732-3.

  27. Mogensen CE, Viberti GC, Peheim E, Kutter D, Hasslacher C, Hofmann W, et al. Multicenter evaluation of the micraltest II test strip, an inmunologic rapid test for the detection of microalbuminuria. Diabetes Care 1997; 20: 1642-6.

  28. Calzada-León R, Altamirano-Bustamante N, Robles-Valdés C, Franco-Rodríguez A, Franco-Betancur H, Jiménez C, et al. Sensibilidad y especificidad de la determinación cuantitativa de microalbuminuria para el diagnóstico de nefropatía diabética. Bol Med Hosp Infant Mex 1994; 51: 174-8.

  29. Poulsen PL. Office tests for microalbuminuria. In: Mogensen CE (Ed.). The kidney and hypertension in diabetes mellitus. Third edition. Kluwer Academic Publishers, Norwell; 1997, pp. 127-34.

  30. Mogensen CE. Microalbuminuria as a predictor of clinical diabetic nephropathy. Kidney Int 1987; 31: 673-89.

  31. Keane WF. Proteinuria: Its clinical importance and role in progressive renal disease. Am J Kidney Dis 2000; 35(1): S97-S105.

  32. Pedrinelli R. Microalbuminuria in essential hypertension. A marker of systemic vascular damage. Nephrol Dial Transplant 1997; 12: 379-98.

  33. Weinstock BW, Keane WF. Proteinuria and cardiovascular disease. Am J Kidney Dis 2001; 38 (1): S8-S13.

  34. Hebert LA, Wilmer WA, Falkenhain ME, Ladson-Wofford SE, Nahman NS, Rovin BH. Renoprotection: One or many therapies? Kidney Int 2001; 59: 1211-26.

  35. Jungers P. Late referral: loss of chance for the patient, loss of money for society. Nephrol Dial Transplant 2002; 17: 371-5.




2020     |     www.medigraphic.com