Application of urine albumin for the diagnosis and treatment of kidney disorders in adults

doi:10.3969/j.issn.1673-8640.2016.09.021

Abstract

Abstract:

The determination of urine albumin （Alb） is common in the diagnosis and treatment of kidney disorders. However,until now,its uncertainties and controversies regarding the diagnosis and treatment of acute and chronic kidney disorders still exist. The reference ranges for urine Alb have changed recently. This article reviews the latest clinical guidelines and summarizes the application of urine Alb determination in the diagnosis and treatment of acute kidney injury,acute and chronic kidney disorders in adults. The international organization Kidney Disease：Improving Global Outcomes（KDIGO） attempted to resolve these controversies by updating original consensus,staging systems and proper laboratory evaluation for acute and chronic kidney disorders. KDIGO also provided recommendations for the screening and confirmation test of these diseases.

Key words: Albumin, Kidney injury, Glomerular filtration rate, Kidney function, Kidney disorders

CLC Number:

R446.1

CHEN Yanwen, HU Yao. Application of urine albumin for the diagnosis and treatment of kidney disorders in adults[J]. Laboratory Medicine, 2016, 31(9): 830-834.

Figures/Tables 3

References 21

1	MANN JF,GERSTEIN HC,YI QL,et al.Development of renal disease in people at high cardiovascular risk:results of the HOPE randomized study[J]. J Am Soc Nephrol,2003,14(3):641-647.
2	GERSTEIN HC,MANN JF,YI Q,et al.Albuminuria and risk of cardiovascular events,death,and heart failure in diabetic and nondiabetic individuals[J]. JAMA,2001,286(4):421-426.
3	Kidney Disease:Improving Global Outcomes (KDIGO). KDIGO clinical practice guideline for acute kidney injury[EB/OL]. (2013-03-30)[2015-07-11]. .
4	Kidney Disease:Improving Global Outcomes (KDIGO). KDIGO clinical practice guideline for the evaluation and management of chronic kidney disease[EB/OL]. (2013-03-30)[2015-07-11]. .
5	LEVEY AS,INKER LA. Definition and staging of chronic kidney disease in adults[EB/OL]. (2014-03-26)[2015-07-11]. .
6	LEVEY AS,CORESH J.Chronic kidney disease[J]. Lancet,2012,379(9811):165-180.
7	BELLOMO R,KELLUM JA,RONCO C.Acute kidney injury[J]. Lancet,2012,380(9843):756-766.
8	MCFARLANE PA.Testing for albuminuria in 2014[J]. Can J Diabetes,2014,38(5):372-375.
9	ROEST M,BANGA JD,JANSSEN WM,et al.Excessive urinary albumin levels are associated with future cardiovascular mortality in postmenopausal women[J]. Circulation,2001,103(25):3057-3061.
10	BORCH-JOHNSEN K,FELDT-RASMUSSEN B,STRANDGAARD S,et al.Urinary albumin excretion. An independent predictor of ischemic heart disease[J]. Arterioscler Thromb Vasc Biol,1999,19(8):1992-1997.
11	MORRIS RK,RILEY RD,DOUG M,et al.Diagnostic accuracy of spot urinary protein and albumin to creatinine ratios for detection of significant proteinuria or adverse pregnancy outcome in patients with suspected pre-eclampsia:systematic review and meta-analysis[J]. BMJ,2012,345:e4342.
12	PEDERSEN LM,TERSLEV L,SLRENSEN PG,et al.Urinary albumin excretion and transcapillary escape rate of albumin in malignancies[J]. Med Oncol,2000,17(2):117-122.
13	LEVEY AS,STEVENS LA,SCHMID CH,et al.A new equation to estimate glomerular filtration rate[J]. Ann Intern Med,2009,150(9):604-612.
14	WU MT,LAM KK,LEE WC,et al.Albuminuria,proteinuria,and urinary albumin to protein ratio in chronic kidney disease[J]. J Clin Lab Anal,2012,26(2):82-92.
15	FISHER H,HSU CY,VITTINGHOFF E,et al.Comparison of associations of urine protein-creatinine ratio versus albumin-creatinine ratio with complications of CKD:a cross-sectional analysis[J]. Am J Kidney Dis,2013,62(6):1102-1108.
16	GUH JY.Proteinuria versus albuminuria in chronic kidney disease[J]. Nephrology(Carlton),2010,15(Suppl 2):53-56.
17	National Kidney Foundation.K/DOQI clinical practice guidelines for chronic kidney disease:evaluation,classification,and stratification[J]. Am J Kidney Dis,2002,39(2 Suppl 1):S1-S266.
18	MCLNTYRE NJ,TAAL MW.How to measure proteinuria?[J]. Curr Opin Nephrol Hypertens,2008, 17(6):600-603.
19	MILLER WG,BRUNS DE,HORTIN GL,et al.Current issues in measurement and reporting of urinary albumin excretion[J]. Clin Chem,2009,55(1):24-38.
20	LEVEY AS,CATTRAN D,FRIEDMAN A,et al.Proteinuria as a surrogate outcome in CKD: report of a scientific workshop sponsored by the National Kidney Foundation and the US Food and Drug Administration[J]. Am J Kidney Dis,2009,54(2):205-226.
21	RUGGENENTI P,REMUZZI G.Time to abandon microalbuminuria?[J]. Kidney Int,2006, 70(7):1214-1222.

项目	ACR	PCR
实验室检测成本	高	低
实验室检测标准化	有	无
实验室检测分析性能	高	低
早期糖尿病肾病监测	敏感	不敏感
肾病综合征GFR监测	不敏感	敏感

项目	ACR	PCR
实验室检测成本	高	低
实验室检测标准化	有	无
实验室检测分析性能	高	低
早期糖尿病肾病监测	敏感	不敏感
肾病综合征GFR监测	不敏感	敏感

项目	ACR	eGFR_Cr	eGFR_{Cys C}
应用	肾损伤初筛	GFR评估初筛	GFR评估确认
结果解释的局限
对于急性肾损伤	ACR会高估AER	eGFR的改变滞后于mGFR	eGFR的改变滞后于mGFR
个体代谢影响	降低：肌肉含量高升高：肌肉含量低	降低：肌肉含量高、摄入过多蛋白、肌酸升高：截肢、肌肉损耗性疾病	降低：甲亢、糖皮质激素过多、肥胖、吸烟、感染升高：甲状腺功能减退
肾外排泄影响		随透析治疗细胞外液的大量流失（胸腔引流、腹水）而升高, 因抗菌药物抑制Cr酶而降低	随细胞外液的大量流失而升高（胸腔引流、腹水）
检测范围	ACR越低越不精确	GFR越高越不精确	GFR越高越不精确
分析干扰	前带效应（高浓度尿Alb）	广谱干扰（胆红素、药物）,化学干扰（糖、酮体）

项目	ACR	eGFR_Cr	eGFR_{Cys C}
应用	肾损伤初筛	GFR评估初筛	GFR评估确认
结果解释的局限
对于急性肾损伤	ACR会高估AER	eGFR的改变滞后于mGFR	eGFR的改变滞后于mGFR
个体代谢影响	降低：肌肉含量高升高：肌肉含量低	降低：肌肉含量高、摄入过多蛋白、肌酸升高：截肢、肌肉损耗性疾病	降低：甲亢、糖皮质激素过多、肥胖、吸烟、感染升高：甲状腺功能减退
肾外排泄影响		随透析治疗细胞外液的大量流失（胸腔引流、腹水）而升高, 因抗菌药物抑制Cr酶而降低	随细胞外液的大量流失而升高（胸腔引流、腹水）
检测范围	ACR越低越不精确	GFR越高越不精确	GFR越高越不精确
分析干扰	前带效应（高浓度尿Alb）	广谱干扰（胆红素、药物）,化学干扰（糖、酮体）

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