Andrew S. Levey, MD; Kidney Disease Outcomes Quality Initiatives Work Group on Chronic Kidney Disease
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Levey A., ; Practice Guidelines for Chronic Kidney Disease. Ann Intern Med. 2004;140:934-935. doi: 10.7326/0003-4819-140-11-200406010-00026
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Published: Ann Intern Med. 2004;140(11):934-935.
Many of the points raised by Drs. Mogensen and Korosi are discussed in the full version of the guidelines (1). Page numbers cited below refer to pages in that publication.
Dr. Mogensen agrees with the recommendation to test patients at increased risk for chronic kidney disease for “microalbuminuria” in a spot urine sample. However, he suggests measuring the albumin-to-creatinine ratio rather than an albumin-specific dipstick, as depicted in Figure 2 of our article in Annals. We agree that that testing could begin with measurement of albumin-to-creatinine ratio (page S215), as discussed in a more recent consensus conference sponsored by the National Kidney Foundation and the National Institute of Diabetes and Digestive and Kidney Diseases (2). The gold standard method for detection of microalbuminuria is based on immunoassay in a timed urine collection. Sensitivity of detection of microalbuminuria using an albumin-specific dipstick or an albumin-to-creatinine ratio in spot urine samples is 80% to 90% (pages S97–S98). The guidelines also recommend periodic reevaluation of patients with negative test results using either method.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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