Quantitative Micro-albuminuria Assessment from 'Random Voided Urinary Albumin: Creatinine Ratio' Versus '24 hours Urinary Albumin Concentration' for Screening of Diabetic Nephropathy.

AIMS This study aims at assessing the predictive value of random urine A:C ratio as a screening method for Micro-albuminuria assessment in DM patients as compared to 24 hours urine albumin. SETTINGS AND DESIGN A cross sectional observational study was conducted at a tertiary care centre. One hundred ninty three patients diagnosed with DM were enrolled in the study but 14 participants didn't turn up with 24 hours urine sample. Thus, 179 people actually participated in the study. MATERIAL AND METHODS All DM patients who attended Out Patient Departments (OPDs) and In Patient Departments (IPDs) of Medicine, Surgery and Orthopaedics, were enrolled. Proper history about development and duration of DM was taken from the patients. Examination in the form of height and weight measurement to know Body Mass Index (BMI), the Waist: Hip Ratio (W:H ratio) calculated from waist and hip circumference and blood pressure measurement was done. Fasting blood sugar was measured in the study group. [Urine analysis was done for urinary albumin and urinary creatinine]. Two urine samples were collected from each participant; one, 24 hours sample and the other random urine sample. 24 hours urine samples were used to measure urinary albumin concentration while urinary albumin to creatinine ratio was measured from random urine sample. STATISTICAL ANALYSIS USED SPSS 17. RESULTS Twenty four hours RUA:C ratio has very good sensitivity and specificity of Sensitivity and specificity of 84.9% and 95.8% respectively,which makes it a better alternative to 24 hours UAC. Negative and positive predictive values of RUA:C ratio method are 0.93 and 0.090 respectively with false negative and false positive rates, 15.1% and 4.2 % respectively. CONCLUSION Twenty four hours UAC is considered gold standard for screening of Micro-albuminuria but is cumbersome to collect 24 hours urine sample especially in OPD setup and in female patients. This leads to loss of compliance thereby preventing early diagnosis of diabetic nephropathy. This problem is more impracticable in hilly regions of India. By using random urine sample for screening of Micro-albuminuria in the form of RUA: C in random urine sample that correlates well with 24 hours UAC in 24 hours urine sample,is easier and more practical in Indian scenario especially in diabetics residing in hills.