期刊论文详细信息
BMC Nephrology
Urinary albumin excretion in healthy adults: a cross sectional study of 24-hour versus timed overnight samples and impact of GFR and other personal characteristics
Lars Barregard1  Borje Haraldsson2  Magnus Akerstrom1  Gerd Sallsten1  Peter Fagerstrom1 
[1] Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, PO Box 414, Gothenburg S-405 30, Sweden;Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
关键词: Overnight samples;    24-hour samples;    Timed urine samples;    Urinary albumin;    Glomerular filtration rate;   
Others  :  1122061
DOI  :  10.1186/1471-2369-16-8
 received in 2014-09-24, accepted in 2015-01-13,  发布年份 2015
PDF
【 摘 要 】

Background

Urinary albumin can be measured in 24 h or spot samples. The 24 h urinary albumin excretion rate is considered the gold standard, but is cumbersome to collect. Instead, often an overnight sample is collected, and adjusted for dilution. Proxies for 24 h excretion rate have been studied in diabetics, but seldom in healthy individuals. Our aims were to compare 24 h and overnight albumin excretion, to assess the impact of personal characteristics, and to examine correlations between the 24 h excretion rate and proxies such as the albumin to creatinine ratio (ACR).

Methods

Separate 24 h and overnight urine samples were collected from 152 healthy kidney donors. Urinary creatinine, specific gravity, collection time, and sample volume determined. Differences between 24 h and overnight samples were examined, and the effects of age, sex, smoking, body mass, glomerular filtration rate, and urinary flow rate were assessed.

Results

The 24 h albumin excretion rate and ACR were both significantly higher than their overnight counterparts. Unadjusted albumin was unsurprisingly higher in the more concentrated overnight samples, while concentrations adjusted for specific gravity were similar. In multivariate analysis, the 24 h excretion rate and proxies were positively associated with glomerular filtration rate, as was ACR in overnight samples. There were positive associations between urinary albumin and body mass.

Conclusions

Proxies for the 24 h albumin excretion rate showed relatively high correlations with this gold standard, but differences due to sampling period, adjustment method, and personal characteristics were large enough to be worth considering in studies of albumin excretion in healthy individuals.

【 授权许可】

   
2015 Fagerstrom et al.; licensee BioMed Central.

【 预 览 】
附件列表
Files Size Format View
20150213021925185.pdf 317KB PDF download
Figure 4. 26KB Image download
Figure 3. 27KB Image download
Figure 2. 30KB Image download
Figure 2. 79KB Image download
【 图 表 】

Figure 2.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】
  • [1]Klausen K, Borch-Johnsen K, Feldt-Rasmussen B, Jensen G, Clausen P, Scharling H, et al.: Very low levels of microalbuminuria are associated with increased risk of coronary heart disease and death independently of renal function, hypertension, and diabetes. Circulation 2004, 110(1):32-35.
  • [2]Romundstad S, Holmen J, Kvenild K, Hallan H, Ellekjær H: Microalbuminuria and all-cause mortality in 2,089 apparently healthy individuals: a 4.4-year follow-up study. The nord-trøndelag health study (HUNT), Norway. Am J Kidn Dis 2003, 3:466-473.
  • [3]Ärnlöv J, Evans JC, Meigs JB, Wang TJ, Fox CS, Levy D, et al.: Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals: The Framingham Heart Study. Circulation 2005, 112(7):969-975.
  • [4]Damsgaard EM, Frøland A, Jørgensen OD, Mogensen CE: Microalbuminuria as predictor of increased mortality in elderly people. BMJ 1990, 300(6720):297-300.
  • [5]Verhave JC, Hillege HL, Burgerhof JGM, Navis G, de Zeeuw D, de Jong PE: Cardiovascular risk factors are differently associated with urinary albumin excretion in men and women. J Am Soc Nephrol 2003, 14(5):1330-1335.
  • [6]Gaspari F, Perico N, Remuzzi G: Timed urine collections are not needed to measure urine protein excretion in clinical practice. Am J Kidn Dis 2006, 47(1):1-7.
  • [7]Shidham G, Hebert L: Timed urine collections are not needed to measure urine protein excretion in clinical practice. Am J Kidn Dis 2006, 47(1):8-14.
  • [8]Naresh CN, Hayen A, Weening A, Craig JC, Chadban SJ: Day-to-Day variability in spot urine albumin-creatinine ratio. Am J Kidney Dis 2013, 62(6):1095-1101.
  • [9]Guy M, Borzomato JK, Newall RG, Kalra PA, Price CP: Protein and albumin-to-creatinine ratios in random urines accurately predict 24 h protein and albumin loss in patients with kidney disease. Ann Clin Biochem 2009, 46(6):468-476.
  • [10]Gansevoort RT, Brinkman J, Bakker SJL, De Jong PE, de Zeeuw D: Evaluation of measures of urinary albumin excretion. Am J Epidemiol 2006, 164(8):725-727.
  • [11]Barregard L, Fabricius-Lagging E, Lundh T, Mölne J, Wallin M, Olausson M, et al.: Cadmium, mercury, and lead in kidney cortex of living kidney donors: Impact of different exposure sources. Environ Res 2010, 110(1):47-54.
  • [12]Akerstrom M, Lundh T, Barregard L, Sallsten G: Sampling of urinary cadmium: differences between 24-h urine and overnight spot urine sampling, and impact of adjustment for dilution. Int Arch Occup Environ Health 2012, 85(2):189-196.
  • [13]Junge W, Wilke B, Halabi A, Klein G: Determination of reference intervals for serum creatinine, creatinine excretion and creatinine clearance with an enzymatic and a modified Jaffé method. Clin Chim Acta 2004, 344(1–2):137-148.
  • [14]Brändström E, Grzegorczyk A, Jacobsson L, Friberg P, Lindahl A, Aurell M: GFR measurement with iohexol and 51Cr-EDTA. A comparison of the two favoured GFR markers in Europe. Nephrol Dial Transplant 1998, 13(5):1176-1182.
  • [15]Suwazono Y, Åkesson A, Alfvén T, Järup L, Vahter M: Creatinine versus specific gravity-adjusted urinary cadmium concentrations. Biomarkers 2005, 10(2–3):117-126.
  • [16]Hornung RW, Reed LD: Estimation of average concentration in the presence of nondetectable values. Appl Occup Environ Hyg 1990, 5(1):46-51.
  • [17]Watts GF, Morris RW, Khan K, Polak A: Urinary albumin excretion in healthy adult subjects: Reference values and some factors affecting their interpretation. Clin Chim Acta 1988, 172(2–3):191-198.
  • [18]Montagna G, Buzio C, Calderini C, Quadetti P, Migone L: Relationship of proteinuria and albuminuria to posture and to urine collection period. Nephron 1983, 35:143-144.
  • [19]Robinson RR, Glenn WG: Fixed and reproducible orthostatic proteinuria. IV. Urinary albumin excretion by healthy human subjects in the recumbent and upright postures. J Lab Clin Med 1964, 34:717-723.
  • [20]Junglee NA, Lemmey AB, Burton M, Searell C, Jones D, Lawley JS, et al.: Does proteinuria-inducing physical activity increase biomarkers of acute kidney injury? Kidney Blood Press Res 2012, 36(1):278-289.
  • [21]Newman DJ, Pugia MJ, Lott JA, Wallace JF, Hiar AM: Urinary protein and albumin excretion corrected by creatinine and specific gravity. Clin Chim Acta 2000, 294(1–2):139-155.
  • [22]Koopman MG, Koomen GC, Krediet RT, de Moor EA, Hoek FJ, Arisz L: Circadian rhythm of glomerular filtration rate in normal individuals. Clin Sci (Lond) 1989, 77(1):105-111.
  • [23]Yamasaki F, Schwartz JE, Gerber LM, Warren K, Pickering TG: Impact of shift work and race/ethnicity on the diurnal rhythm of blood pressure and catecholamines. Hypertension 1998, 32(3):417-423.
  • [24]Ohlson M, Sörensson J, Lindström K, Blom AM, Fries E, Haraldsson B: Effects of filtration rate on the glomerular barrier and clearance of four differently shaped molecules. Am J Physiol Renal Physiol 2001, 281(1):F103-F113.
  • [25]Smithies O: Why the kidney glomerulus does not clog: A gel permeation/diffusion hypothesis of renal function. Proc Natl Acad Sci U S A 2003, 100(7):4108-4113.
  • [26]Cirillo M, Senigalliesi L, Laurenzi M: Microalbuminuria in nondiabetic adults: Relation of blood pressure, body mass index, plasma cholesterol levels, and smoking: the gubbio population study. Arch Intern Med 1998, 158(17):1933-1939.
  • [27]Viberti GC, Mogensen CE, Keen H, Jacobsen FK, Jarrett RJ, Christensen CK: Urinary excretion of albumin in normal man: The effect of water loading. Scand J Clin Lab Invest 1982, 42(2):147-151.
  • [28]Gosling P, Beevers DG: Urinary albumin excretion and blood pressure in the general population. Clin Sci (Lond) 1989, 76(1):39-42.
  • [29]Jensen JS, Feldt-rasmussen B, Borch-johnsen K, Jensen G: Urinary albumin excretion in a population based sample of 1011 middle aged non-diabetic subjects. Scand J Clin Lab Invest 1993, 53(8):867-872.
  • [30]Hutchison AS, O'Reilly DS, MacCuish AC: Albumin excretion rate, albumin concentration, and albumin/creatinine ratio compared for screening diabetics for slight albuminuria. Clin Chem 1988, 34(10):2019-2021.
  • [31]Derhaschnig U, Kittler H, Woisetschläger C, Bur A, Herkner H, Hirschl MM: Microalbumin measurement alone or calculation of the albumin/creatinine ratio for the screening of hypertension patients? Nephrol Dial Transplant 2002, 17(1):81-85.
  • [32]Kallner A, Estonius M: Are there advantages with U-Albumin/U-Creatinine ratios compared with U-Albumin in monitoring diabetes? Scand J Clin Lab Invest 2005, 65(6):439-445.
  • [33]Cowell C, Rogers S, Silink M: First morning urinary albumin concentration is a good predictor of 24-hour urinary albumin excretion in children with Type I (insulin-dependent) diabetes. Diabetologia 1986, 29(2):97-99.
  • [34]Howey JE, Browning MC, Fraser CG: Selecting the optimum specimen for assessing slight albuminuria, and a strategy for clinical investigation: novel uses of data on biological variation. Clin Chem 1987, 33(11):2034-2038.
  • [35]Gansevoort RT, Verhave JC, Hillege HL, Burgerhof JGM, Bakker SJL, de Zeeuw D, et al.: The validity of screening based on spot morning urine samples to detect subjects with microalbuminuria in the general population. Kidney Int 2005, 67(S94):S28-S35.
  • [36]Akerstrom M, Barregard L, Lundh T, Sallsten G: Variability of urinary cadmium excretion in spot urine samples, first morning voids, and 24[thinsp]h urine in a healthy non-smoking population: Implications for study design. J Expos Sci Environ Epidemiol 2014, 24(2):171-179.
  • [37]Cirillo M, Laurenzi M, Mancini M, Zanchetti A, De Santo NG: Low muscular mass and overestimation of microalbuminuria by urinary albumin/creatinine ratio. Hypertension 2006, 47(1):56-61.
  • [38]Mattix HJ, Hsu CY, Shaykevich S, Curhan G: Use of the albumin/creatinine ratio to detect microalbuminuria: Implications of sex and race. J Am Soc Nephrol 2002, 13(4):1034-1039.
  • [39]Xu R, Zhang L, Zhang P, Wang F, Zuo L, Zhou Y, et al.: Gender-specific reference value of urine albumin-creatinine ratio in healthy Chinese adults: Results of the Beijing CKD survey. Clin Chim Acta 2008, 398(1–2):125-129.
  • [40]Dyer AR, Greenland P, Elliott P, Daviglus ML, Claeys G, Kesteloot H, et al.: Evaluation of measures of urinary albumin excretion in epidemiologic studies. Am J Epidemiol 2004, 160(11):1122-1131.
  • [41]Bakker AJ: Detection of microalbuminuria. Receiver operating characteristic curve analysis favors albumin-to-creatinine ratio over albumin concentration. Diabetes Care 1999, 22(2):307-313.
  • [42]Lambers Heerspink HJ, Brantsma AH, De Zeeuw D, Bakker SJL, De Jong PE, Gansevoort RT: Albuminuria assessed from first-morning-void urine samples versus 24-hour urine collections as a predictor of cardiovascular morbidity and mortality. Am J Epidemiol 2008, 168(8):897-905.
  • [43]Witte EC, Heerspink HJL, De Zeeuw D, Bakker SJL, De Jong PE, Gansevoort R: First morning voids are more reliable than spot urine samples to assess microalbuminuria. J Am Soc Nephrol 2009, 20(2):436-443.
  • [44]Eshøj O, Feldt-Rasmussen B, Larsen ML, Mogensen EF: Comparison of overnight, morning and 24-hour urine collections in the assessment of diabetic microalbuminuria. Diabet Med 1987, 4(6):531-533.
  • [45]Carrieri M, Trevisan A, Bartolucci GB: Adjustment to concentration-dilution of spot urine samples: Correlation between specific gravity and creatinine. Int Arch Occup Environ Health 2001, 74(1):63-67.
  • [46]Elkins HB, Pagnotto LD, Smith HL: Concentration adjustments in urinalysis. Am Ind Hyg Assoc J 1974, 35(9):559-565.
  • [47]Walser M: Creatinine excretion as a measure of protein nutrition in adults of varying age. JPEN J Parenter Enteral Nutr 1987, 11(5 suppl):73S-78S.
  • [48]Jensen JS: Intra-individual variation of overnight urinary albumin excretion in clinically healthy middle-aged individuals. Clin Chim Acta 1995, 243(1):95-99.
  • [49]Feldt-Rasmussen B, Mathiesen ER: Variability of urinary albumin excretion in incipient diabetic nephropathy. Diabet Nephrop 1984, 3:101-103.
  • [50]Gomes MB, Gonçalves MFR: Is there a physiological variability for albumin excretion rate?: Study in patients with diabetes type1 and non-diabetic individuals. Clin Chim Acta 2001, 304(1–2):117-123.
  文献评价指标  
  下载次数:17次 浏览次数:45次