Rajiv Agarwal, MD
What is the accuracy of screening with urine dipsticks for detecting albuminuria in community populations? Does accuracy differ in at-risk subgroups?
Blinded comparison of urine dipstick readings with albumin–creatinine ratio (ACR).
Representative population cohort in Australia.
10 944 adults ≥ 25 years of age (mean age 52 y, 55% women) who participated in the baseline biomedical examination of the Australian Diabetes, Obesity, and Lifestyle Study and had complete urinalysis data.
Dipstick (Bayer Multistix, Siemens) urinalysis using an automated analyzer on random spot urine samples obtained from fasted participants. Positive readings were defined as ≥ 1+ (urine protein level ≥ 0.3 g/L) or ≥ trace (urine protein level ≥ 0.1 g/L).
ACR ≥ 30 mg/g (albuminuria) and ≥ 300 mg/g (macroalbuminuria).
Included sensitivity, specificity, and likelihood ratios (calculated from data in article).
6.6% of participants had albuminuria, and 0.8% had macroalbuminuria. Sensitivity and specificity of urine dipsticks for detecting albuminuria and macroalbuminuria are shown in the Table. Diagnostic accuracy of dipsticks for detecting albuminuria was lower in women than in men (reading ≥ 1+, relative diagnostic odds ratio [RDOR] 0.67, 95% CI 0.47 to 0.95; reading ≥ trace, RDOR 0.68, CI 0.48 to 0.97) and for participants with vs those without a history of cardiovascular disease (reading ≥ trace, RDOR 0.57, CI 0.38 to 0.87); diagnostic accuracy did not differ in other risk groups (age ≥ 50 years, presence of diabetes or hypertension, or estimated glomerular filtration rate < 60 mL/min/1.73 m2).
Urine dipstick readings ≥ 1+ had limited sensitivity but high specificity for detecting albuminuria in adults; sensitivity and specificity were high for detecting macroalbuminuria.
*Diagnostic terms defined in Glossary. LRs calculated from data in article.
†Albuminuria = albumin–creatinine ratio ≥ 30 mg/g; macroalbuminuria = albumin–creatinine ratio ≥ 300 mg/g.
Agarwal R. Urine dipstick readings ≥ 1+ had limited sensitivity but high specificity for detecting albuminuria in adults. Ann Intern Med. 2011;155:JC4–10. doi: 10.7326/0003-4819-155-8-201110180-02010
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Published: Ann Intern Med. 2011;155(8):JC4-10.
Nephrology, Urological Disorders.
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