Ann Lab Med.  2017 Jan;37(1):28-33. 10.3343/alm.2017.37.1.28.

Comparison of Urine Albumin-to-Creatinine Ratio (ACR) Between ACR Strip Test and Quantitative Test in Prediabetes and Diabetes

• Nah EH
• Cho S
• Kim S
• Cho HI

• KMID: 2373610
• DOI: http://doi.org/10.3343/alm.2017.37.1.28

Abstract

BACKGROUND
Albuminuria is generally known as a sensitive marker of renal and cardiovascular dysfunction. It can be used to help predict the occurrence of nephropathy and cardiovascular disorders in diabetes. Individuals with prediabetes have a tendency to develop macrovascular and microvascular pathology, resulting in an increased risk of retinopathy, cardiovascular diseases, and chronic renal diseases. We evaluated the clinical value of a strip test for measuring the urinary albumin-to-creatinine ratio (ACR) in prediabetes and diabetes.
METHODS
Spot urine samples were obtained from 226 prediabetic and 275 diabetic subjects during regular health checkups. Urinary ACR was measured by using strip and laboratory quantitative tests.
RESULTS
The positive rates of albuminuria measured by using the ACR strip test were 15.5% (microalbuminuria, 14.6%; macroalbuminuria, 0.9%) and 30.5% (microalbuminuria, 25.1%; macroalbuminuria, 5.5%) in prediabetes and diabetes, respectively. In the prediabetic population, the sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the ACR strip method were 92.0%, 94.0%, 65.7%, 99.0%, and 93.8%, respectively; the corresponding values in the diabetic population were 80.0%, 91.6%, 81.0%, 91.1%, and 88.0%, respectively. The median [interquartile range] ACR values in the strip tests for measurement ranges of <30, 30-300, and >300 mg/g were 9.4 [6.3-15.4], 46.9 [26.5-87.7], and 368.8 [296.2-575.2] mg/g, respectively, using the laboratory method.
CONCLUSIONS
The ACR strip test showed high sensitivity, specificity, and negative predictive value, suggesting that the test can be used to screen for albuminuria in cases of prediabetes and diabetes.

Keyword

Albuminuria; Albumin-to-creatinine ratio; Prediabetes; Diabetes; Strip test

MeSH Terms

Adult
Aged
Aged, 80 and over
Albumins/*analysis
Creatinine/*urine
Diabetes Mellitus, Type 2/pathology/urine
Female
Humans
*Immunoassay
Male
Middle Aged
Prediabetic State/pathology/urine
Reagent Strips/chemistry
Albumins
Creatinine
Reagent Strips

Figure

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  Fig. 1 Samples misclassified as false negatives and false positives according to the cut-off of 30 mg/g in prediabetes and diabetes. Abbreviation: ACR, albumin-creatinine ratio.

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  Fig. 2 Laboratory quantitative test versus strip test for albumin-to-creatinine ratio (ACR). Samples that were misclassified by the strip test as negative and positive are boxed and labelled as False Negatives and False Positives, respectively.

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