How is the diagnosis of diabetic nephropathy made

Quantitative determination of albumin in the urine can be expressed in three ways:

1. with measurement of the albumin to creatinine ratio in a random or morning urine sample (normal values < 30mg/g creatinine or

< 3.5 mg/mmol creatinine in women and < 2.5 mg/mmol creatinine in men);

2. with a 4-hour or 8-hour urine collection (overnight urine collection, normal values < 20 mg/min);

3. with a 24-hour urine collection, with simultaneous determination of creatinine clearance (normal values < 30 mg/24 h).

Owing to the well known variation of urine albumin excretion over a 24-hour period, a first morning urine sample or overnight collection is preferred. Determination of albumin in the urine is performed with a radioimmunoassay (RIA, the most reliable method), with ELISA (enzyme linked immunoassay), nephelometry, etc. Qualitative determination of albumin in the urine can also be performed using a special dipstick (microalbumin test, micral II), but the specificity is lower than that of RIA.

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