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Re: [IP] 24 hour urine tests and other urine tests



Great going, Barbara!  I think it is critical that we also look to the clinical
guidelines.
Hope all is well with you.
Jeri

email @ redacted wrote:

> FYI: the following information is from the ADA web site, Clinical Practice
> Recommendations. After initial evaluation for microalbumin and routine urine
> test, annual visits should include:
>
> <<In the absence of previously demonstrated microalbuminuria, an annual test
> for the presence of microalbumin is necessary. Screening for microalbuminuria
> in individuals with type 1 diabetes should begin with puberty and after 5
> years' duration of the disease. Because of the difficulty in precise dating
> of the onset of type 2 diabetes, such screening should begin at the time of
> diagnosis. Screening for microalbuminuria can be performed by three methods:
>
> Measurement of the albumin-to-creatinine ratio in a random, spot collection
>
> 24-h collection with creatinine, allowing the simultaneous measurement of
> creatinine clearance
>
> Timed (e.g., 4-h or overnight) collection
>
> The first method is often found to be the easiest in an office setting and
> generally provides accurate information. First-void or other morning
> collections are preferred because of the known diurnal variation in albumin
> excretion, but if this timing cannot be used, uniformity of timing for
> different collections in the same individual should be employed.
>
> The role of annual urine protein dipstick testing and microalbuminuria
> assessment is less clear after diagnosis of microalbuminuria and institution
> of ACE inhibitor therapy and blood pressure control. Many experts recommend
> continued surveillance both to assess response to therapy and progression of
> disease. In addition to assessment of urinary albumin excretion, assessment
> of renal function is important in patients with diabetic kidney disease.>>
>
> I hope this is useful information.  There was a study a few years ago that
> reviewed medical management practices based on ADA guidelines. Many physician
> practices failed to do microalbumin screening tests to evaluate the need for
> 24 hour urine testing.  From comments by members of this list, not much has
> changed. Sad.
> Barbara B.
>
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