Current Issues in Measurement and Reporting of Urinary Albumin Excretion
W. Greg Miller,David E. Bruns,Glen L. Hortin,Sverre Sandberg,Kristin M. Aakre,Matthew J. McQueen,Yoshihisa Itoh,John C. Lieske,David W. Seccombe,Graham R D Jones,David M. Bunk,Gary C. Curhan,Andrew S. Narva +12 more
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TLDR
Clinical needs have been identified for standardization of urine collection methods, urine albumin and creatinine measurements based on a complete reference system, reporting of test results, and reference intervals for the ACR.Abstract:
Background: Urinary excretion of albumin indicates kidney damage and is recognized as a risk factor for progression of kidney disease and cardiovascular disease. The role of urinary albumin measurements has focused attention on the clinical need for accurate and clearly reported results. The National Kidney Disease Education Program and the IFCC convened a conference to assess the current state of preanalytical, analytical, and postanalytical issues affecting urine albumin measurements and to identify areas needing improvement.
Content: The chemistry of albumin in urine is incompletely understood. Current guidelines recommend the use of the albumin/creatinine ratio (ACR) as a surrogate for the error-prone collection of timed urine samples. Although ACR results are affected by patient preparation and time of day of sample collection, neither is standardized. Considerable intermethod differences have been reported for both albumin and creatinine measurement, but trueness is unknown because there are no reference measurement procedures for albumin and no reference materials for either analyte in urine. The recommended reference intervals for the ACR do not take into account the large intergroup differences in creatinine excretion (e.g., related to differences in age, sex, and ethnicity) nor the continuous increase in risk related to albumin excretion.
Discussion: Clinical needs have been identified for standardization of ( a ) urine collection methods, ( b ) urine albumin and creatinine measurements based on a complete reference system, ( c ) reporting of test results, and ( d ) reference intervals for the ACR.read more
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Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis.
Kunihiro Matsushita,Marije van der Velde,Brad C. Astor,Mark Woodward,Andrew S. Levey,Paul E. de Jong,Josef Coresh,Ron T. Gansevoort,Meguid El-Nahas,Kai-Uwe Eckardt,Bertram L. Kasiske,Marcello Tonelli,Brenda R. Hemmelgarn,Yaping Wang,Robert C. Atkins,Kevan R. Polkinghorne,Steven J. Chadban,Anoop Shankar,Ronald Klein,Barbara E.K. Klein,Haiyan Wang,Fang Wang,Luxia Zhang,Lisheng Liu,Michael G. Shlipak,Mark J. Sarnak,Ronit Katz,Linda Fried,Tazeen H. Jafar,M. Mazharul Islam,Juanita Hatcher,Neil R Poulter,Nish Chaturvedi,Dietrich Rothenbacher,Hermann Brenner,Elke Raum,Wolfgang Koenig,Caroline S. Fox,Shih-Jen Hwang,James B. Meigs,Massimo Cirillo,Stein Hallan,Stian Lydersen,Jostein Holmen,Paul Roderick,Dorothea Nitsch,Astrid E. Fletcher,Christopher J. Bulpitt,Takayoshi Ohkubo,Hirohito Metoki,Masaaki Nakayama,Masahiro Kikuya,Yutaka Imai,Simerjot K. Jassal,Elizabeth Barrett-Connor,Jaclyn Bergstrom,David G. Warnock,Paul Muntner,Suzanne E. Judd,William M. McClellan,Mary Cushman,George Howard,Leslie A. McClure,Sun Ha Jee,Heejin Kimm,Ji Eun Yun,Chi Pang Wen,Sung Feng Wen,Chwen Keng Tsao,Min Kuang Tsai,Johan Ärnlöv,Priscilla Auguste,Kasper Veldhuis,Laura Camarata,Beverly Thomas,Tom Manley +75 more
TL;DR: In this article, a meta-analysis of general population cohorts was conducted to assess the independent and combined associations of estimated glomerular filtration rate (eGFR) and albuminuria with mortality.
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Andrew S. Levey,Paul E. de Jong,Josef Coresh,Meguid El Nahas,Brad C. Astor,Kunihiro Matsushita,Ron T. Gansevoort,Bertram L. Kasiske,Kai-Uwe Eckardt +8 more
TL;DR: KDIGO has convened a workgroup to develop a global clinical practice guideline for the definition, classification, and prognosis of chronic kidney disease.
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Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis
Caroline S. Fox,Kunihiro Matsushita,Mark Woodward,Mark Woodward,Henk J. G. Bilo,John Chalmers,Hiddo J.L. Heerspink,Brian J Lee,Robert M. Perkins,Peter Rossing,Peter Rossing,Toshimi Sairenchi,Marcello Tonelli,Joseph A. Vassalotti,Kazumasa Yamagishi,Josef Coresh,Paul E. de Jong,Chi Pang Wen,Chi Pang Wen,Robert G. Nelson +19 more
TL;DR: Despite higher risks for mortality and ESRD in diabetes, the relative risks of these outcomes by eGFR and ACR are much the same irrespective of the presence or absence of diabetes, emphasising the importance of kidney disease as a predictor of clinical outcomes.
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Evolving importance of kidney disease: from subspecialty to global health burden
Kai-Uwe Eckardt,Josef Coresh,Olivier Devuyst,Richard J. Johnson,Anna Köttgen,Andrew S. Levey,Adeera Levin +6 more
TL;DR: Strong, graded, and consistent associations exist between clinical prognosis and two hallmarks of chronic kidney disease: reduced glomerular filtration rate and increased urinary albumin excretion.
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Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality.: A collaborative meta-analysis of high-risk population cohorts
Marije van der Velde,Kunihiro Matsushita,Josef Coresh,Brad C. Astor,Mark Woodward,Andrew S. Levey,Paul E. de Jong,Ron T. Gansevoort +7 more
TL;DR: Lower eGFR and higher albuminuria are risk factors for all-cause and cardiovascular mortality in high-risk populations, independent of each other and of cardiovascular risk factors.
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