Carl Erik Mogensen, MD
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Mogensen CE. Practice Guidelines for Chronic Kidney Disease. Ann Intern Med. 2004;140:933-934. doi: 10.7326/0003-4819-140-11-200406010-00024
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Published: Ann Intern Med. 2004;140(11):933-934.
TO THE EDITOR:
Screening for microalbuminuria is clearly recommended, especially for diabetes, by the American Diabetes Association, the new guidelines from the Seventh Joint National Commission on Health Care, and the European Society of Hypertension (1). Levey and colleagues (2) reported the National Kidney Foundation guidelines for chronic kidney disease. The problem with these guidelines regarding microalbuminuria is the initial step where an albumin-specific stick is proposed; this may be ill-defined. We propose the following, which is very much in line with the guidelines from the European Society of Hypertension and from the American Diabetes Association (Figure). Clinicians should start with a more specific test for measuring albumin–creatinine ratio, preferably in the early-morning urine. Several laboratory tests are available, as is the DCA 2000, which is quite reliable in clinical practice (3). With the presence of microalbuminuria, shown by an albumin–creatinine ratio between 30 and 300 mg/g, clinicians should take further steps toward diagnosis, particularly confirming the abnormal test result and offering the patient explanation and intervention.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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