We offer a microalbumin/creatinine ratio from a random specimen of urine as
part of the annual review of diabetic patients. However, one of our local
GPs, who does a diabetic clinic at another hospital, is recommending that we
adopt the following practice:-
Once a year, random urine specimens should be obtained on three consecutive
days and assayed for microalbumin/creatinine ratio.
If two or three are positive, this should be followed up by a 24 hour
specimen for microalbumin to provide a quantitative level for a baseline
prior to the patient being stated on an ACE Inhibitor. The patients on ACE
inhibitors should be monitored by annual 24 hour collections. If the
quantitative microalbumin is found to be rising after a year, despite what
appears to be adequate blood pressure control, an ACE Receptor Blocker
should be added and early referral made to the Renal Unit, if appropriate.
If only one of the three random urine specimens is positive and if clinical
suspicion is low, the patient should not be started on an ACE Inhibitor but
should be re-evaluated in a year's time.
We would be interested to here how others monitor their diabetic patients
with respect to microalbumin and whether their protocol(s) are evidence
based.
Elliott Simpson
Clinical Director
Labs & Pharmacy
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