The range of albumin concentrations in the single-void first morning urine of 1090 healthy young children

Screening school children for albuminuria, proteinuria and occult blood with dipsticks

Beginning in 1974, the Japanese Ministry of Health Welfare directed the screening of schoolchildren for proteinuria. We studied their procedure and methods in 6197 school children and also evaluated a new urine dipstick that measures albumin concentrations down to about 10 mg/l and creatinine down to about 300 mg/l. We used specimens from adult in- and outpatients to test the accuracy of the dipsticks. Based on the quantitative results, we set as cutoffs < 150 mg/l for protein and < 30 mg/l for albumin as the concentrations representing "low risk." The quantitative values were assumed to be correct, and the dipstick results were judged accordingly, i.e., a dipstick protein of > or = "150" mg/l or an albumin of I "30" mg/l indicated increased risk of developing or having a genitourinary disorder. The sensitivity/specificity of the protein dipstick was 95.1%/95.5%, and the same for the albumin dipstick was 83.8%/93.8%. The cut-off for the albumin dipsticks probably should be set somewhat lower to reduce the number of false negatives and increase the sensitivity of the dipstick. When we compared the quantitative albumin to the protein dipsticks with the above cut-offs, we found the sensitivity/specificity to be 79.3%/94.4%, i.e., much like the albumin dipstick results. The many reports on the association of albuminuria and risk of renal disease recommend that screening should be done for albumin rather than protein. Based on the data from the school children, we estimate that a dipstick albumin of "30" mg/l is borderline increased risk, and that a protein dipstick of "150" mg/l is the same. If we call the dipstick "10" mg/l albumin, "30" mg/l albumin and the "150" mg/l protein results "low risk," then we estimate the prevalence of albuminuria in the school children to be about 2.1% and proteinuria to be about 4.3%. Children with these values should have a quantitative test for albumin and protein. We also tested a dipstick for creatinine and found increasing values with increasing age in both genders; the older boys had significantly higher creatinine values than the older girls and younger boys. For the albumin/creatinine ratio, we found 6028 children with a ratio of < 30 mg/g indicating low risk and 159 children with a ratio of > or = 30 mg/g indicating increased risk. The ratio may be more useful owing to the likely reduction of the number of false negatives and false positives.

Changes in the urinary excretion of creatinine, albumin and N-acetyl-beta-D-glucosaminidase with increasing age and maturity in healthy schoolchildren

Raised urinary levels of albumin and N-acetyl-beta-D-glucosaminidase (NAG) are predictive of abnormal renal function and excretion of these substances is often expressed as a creatinine ratio. However, it is important to establish normal reference limits of albumin and NAG excretion for comparison of values from patients. For this reason, overnight excretion rates of creatinine, albumin and NAG were determined in timed overnight urine samples from 528 healthy schoolchildren (260 boys, 268 girls; 4-16 years) of normal size. There was a significant correlation with age and puberty for all substances in both sexes (P < 0.01). Peak creatinine excretion occurred at 16 years in boys, at 15 years in girls and at pubertal stage 5 in both sexes. Maximum albumin excretion was seen at 15 years and genital stage 5 in boys and at 16 years and breast stage 4 in girls. Peak NAG excretion occurred earlier, at 14 years and genital stage 4 in boys and at 13 years and breast stage 3 in girls. Boys excreted significantly more creatinine compared with girls before and during puberty (reflecting greater muscle mass) (P < 0.001) while excretion rates for albumin and NAG were similar in both sexes. Height and weight combined accounted for 58% and 29% of the variation in creatinine and NAG excretion respectively, while height alone predicted 20% of variation in albumin excretion.

CONCLUSION

Age and puberty influence the urinary excretion of albumin and NAG while sex has an additional effect on creatinine excretion. The urinary excretion of albumin and NAG in children with renal disorders should be compared with age-related normal ranges while creatinine excretion could be used as a marker of muscle growth.

Changes of albumin concentrations in the first morning urine according to age and sex in 2990 healthy children and adults

This study was performed to clarify the changes in urinary albumin excretion according to age and sex in healthy subjects, for the appropriate judgment of microalbuminuria in insulin-dependent diabetes mellitus (IDDM). Concentrations of albumin in the first morning urine from 2990 healthy individuals (1713 males, 1277 females) aged from 6 to 39 years were measured by turbidimetry immunoassay. Reference values of the concentrations for each age group were obtained from the 95% confidence limits from the distribution simulated by the chi 2-test (k = 1). Reference values were 1.3-2.2 mg/dl in children aged 6-11 years. Values for females increased significantly from 22 mg/dl at age 11 years to 3.9 mg/dl at age 12 years (P < 0.0001) and those of males increased gradually from 1.7 mg/dl at age 11 years to 3.9 mg/dl at age 16 years. There were significant differences between males and females at the ages of 12 (P < 0.0001), 13 (P < 0.0001), and 14 (P < 0.0007). After 17 years, the values decreased from 3.9 mg/dl to 3.3 mg/dl in females, and to 2.9 mg/dl in males. We conclude that reference values of urinary albumin excretion change according to age and sex, which should be taken into consideration in the assessment of diabetic nephropathy in IDDM.