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Sahare T, Sahoo BN, Jaiswal S, Rana S, Joshi A. An account of the current status of point-of-care lateral flow tests for kidney biomarker detection. Analyst 2024. [PMID: 39221602 DOI: 10.1039/d4an00806e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Globally, the primary causes of mortality and morbidity related to kidney ailments can be classified as Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD). Biomarker detection can have great potential to improve survival, lower mortality, and reduce the cost of treatment of kidney diseases. Considering the chronic nature of CKD, non-invasive identification and monitoring have proven to be useful. Biosensors and more specifically lateral flow test strips (LFTs) are regarded as the most desirable point-of-care instruments which have shown promise in elevating the healthcare industry to a new level. The major aspects of an ideal point-of-care (POC) lateral flow test include its cost effectiveness, high sensitivity and specificity, ease of use, quick result delivery, and quality control. This review provides a detailed account of recent developments, challenges, and opportunities in renal biomarker detection using LFTs including various approaches for sensitivity enhancement along with potential future advancements in POC and LFT kits.
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Affiliation(s)
- Tileshwar Sahare
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology, Indore, Khandwa Road, Simrol, Indore - 453552, Madhya Pradesh, India.
| | - Badri Narayana Sahoo
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology, Indore, Khandwa Road, Simrol, Indore - 453552, Madhya Pradesh, India.
| | - Surbhi Jaiswal
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology, Indore, Khandwa Road, Simrol, Indore - 453552, Madhya Pradesh, India.
| | - Simran Rana
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology, Indore, Khandwa Road, Simrol, Indore - 453552, Madhya Pradesh, India.
| | - Abhijeet Joshi
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology, Indore, Khandwa Road, Simrol, Indore - 453552, Madhya Pradesh, India.
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Jahanban-Esfahlan A, Amarowicz R. Molecularly imprinted polymers for sensing/depleting human serum albumin (HSA): A critical review of recent advances and current challenges. Int J Biol Macromol 2024; 266:131132. [PMID: 38531529 DOI: 10.1016/j.ijbiomac.2024.131132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 03/28/2024]
Abstract
Human serum albumin (HSA) is an essential biomacromolecule in the blood circulatory system because it carries numerous molecules, including fatty acids (FAs), bilirubin, metal ions, hormones, and different pharmaceuticals, and plays a significant role in regulating blood osmotic pressure. Fluctuations in HSA levels in human biofluids, particularly urine and serum, are associated with several disorders, such as elevated blood pressure, diabetes mellitus (DM), liver dysfunction, and a wide range of renal diseases. Thus, the ability to quickly and accurately measure HSA levels is important for the rapid identification of these disorders in human populations. Molecularly imprinted polymers (MIPs), well known as artificial antibodies (Abs), have been extensively used for the quantitative detection of small molecules and macromolecules, especially HSA, in recent decades. This review highlights major challenges and recent developments in the application of MIPs to detect HSA in artificial and real samples. The fabrication and application of various MIPs for the depletion of HSA are also discussed, as well as different MIP preparation approaches and strategies for overcoming obstacles that hinder the development of MIPs with high efficiency and recognition capability for HSA determination/depletion.
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Affiliation(s)
- Ali Jahanban-Esfahlan
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz 5165665813, Iran.
| | - Ryszard Amarowicz
- Division of Food Sciences, Institute of Animal Reproduction and Food Research of the Polish Academy of Sciences, Street Tuwima 10, 10-748 Olsztyn, Poland.
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Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, Herrington WG, Hill G, Inker LA, Kazancıoğlu R, Lamb E, Lin P, Madero M, McIntyre N, Morrow K, Roberts G, Sabanayagam D, Schaeffner E, Shlipak M, Shroff R, Tangri N, Thanachayanont T, Ulasi I, Wong G, Yang CW, Zhang L, Levin A. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int 2024; 105:S117-S314. [PMID: 38490803 DOI: 10.1016/j.kint.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 03/17/2024]
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Zhang Q, Wang G, Zong X, Sun J. Performance evaluation of Hipee S2 point-of-care testing urine dipstick analyser: a cross-sectional study. BMJ Open 2022; 12:e063781. [PMID: 36302575 PMCID: PMC9621178 DOI: 10.1136/bmjopen-2022-063781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE With advances in mobile technology, smartphone-based point-of-care testing (POCT) urinalysis hold great potential for disease screening and health management for clinicians and individual users. The purpose of this study is to evaluate the analytical performance of Hipee S2 POCT urine dipstick analyser. DESIGN A multicentre, hospital-based, cross-sectional study. SETTING Analytical performance of the POCT analyser was conducted at a clinical laboratory, and method comparison was performed at three clinical laboratories in China. PARTICIPANTS Urine samples were collected from 1603 outpatients and inpatients at three hospitals, and 5 health check-up population at one of the hospitals. OUTCOME MEASURES All tests were performed by clinical laboratory technicians. Precision, drift, carry-over, interference and method comparison of Hipee S2 were evaluated. Diagnostic accuracy of semiquantitative albumin-to-creatinine ratio (ACR) for albuminuria was carried out using quantitative ACR as the standard. RESULTS The precision for each parameter, assessed by control materials, was acceptable. No sample carry-over or drift was observed. Ascorbate solution with 1 g/L had an inhibitory effect for the haemoglobin test. Agreement for specific gravity (SG) varied between moderate to substantial (κ values 0.496-0.687), for pH was moderate (κ values 0.423-0.569) and for other parameters varied between substantial to excellent (κ values 0.669-0.991), on comparing the Hipee S2 with laboratory analysers. The semiquantitative microalbumin and creatinine were highly correlated with the quantitative results. The sensitivity of semiquantitative ACR to detect albuminuria was 87.2%-90.7%, specificity was 70.7%-78.4%, negative predictive value was 85.3%-87.9% and positive predictive value was 73.9%-83%. CONCLUSIONS Hipee S2 POCT urine analyser showed acceptable analytical performance as a semiquantitative method. It serves as a convenient alternate device for clinicians and individual users for urinalysis and health management. In addition, the POCT semiquantitative ACR would be useful in screening for albuminuria.
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Affiliation(s)
- Qiang Zhang
- Clinical Laboratory, Branch of Tianjin Third Central Hospital, Tianjin, China
| | - Guoqing Wang
- Clinical Laboratory, Tianjin Stomatological Hospital, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
| | - Xiaolong Zong
- Clinical Laboratory, Tianjin Medical University Second Hospital, Tianjin, China
| | - Jinghua Sun
- Medical Laboratory Center, Chinese PLA General Hospital, Beijing, China
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Mejia JR, Fernandez-Chinguel JE, Dolores-Maldonado G, Becerra-Chauca N, Goicochea-Lugo S, Herrera-Añazco P, Zafra-Tanaka JH, Taype-Rondan A. Diagnostic accuracy of urine dipstick testing for albumin-to-creatinine ratio and albuminuria: A systematic review and meta-analysis. Heliyon 2021; 7:e08253. [PMID: 34765776 PMCID: PMC8571083 DOI: 10.1016/j.heliyon.2021.e08253] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/05/2021] [Accepted: 10/21/2021] [Indexed: 12/03/2022] Open
Abstract
Background The accuracy of urine dipsticks to detect increased albuminuria is uncertain. We aimed to assess the diagnostic accuracy of urine dipsticks for detecting albuminuria. Methods A systematic review of studies that assessed the diagnostic accuracy of urine dipstick testing for detecting albuminuria has been conducted (using as reference standard the albuminuria in a 24-hour sample or the albumin-to-creatinine ratio) in Scopus, PubMed, and Google Scholar. The risk of bias of the included studies has been assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Whenever possible, we performed meta-analyses for sensitivity and specificity. The certainty of the evidence has also been assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Results A total of 14 studies have been included in this review, having assessed all albumin-to-creatinine ratio (ACR) as assessed standard. Each study used different dipstick types. The resulting pooled sensitivity and specificity for each cutoff point were as follows: for ACR >30 mg/g (13 studies): 0.82 (95% confidence interval: 0.76–0.87) and 0.88 (0.83–0.91); for ACR 30–300 mg/g (7 studies): 0.72 (0.68–0.77) and 0.82 (0.76–0.89); and for ACR >300 mg/g (7 studies): 0.84 (0.71–0.90) and 0.97 (0.95–0.99), respectively. An overall high risk of bias, an important heterogeneity in all pooled analysis, and a very low certainty of the evidence have been found. Conclusions Pooled sensitivity and specificity of urine dipsticks have been calculated for different ACR cutoff points. However, the dipstick types differed across studies, and the certainty of the evidence was very low. Thus, further well-designed studies are needed to reach more confident estimates and to assess accuracy differences across dipstick types. Registration PROSPERO (CRD42019124637).
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Affiliation(s)
- Jhonatan R. Mejia
- Universidad Nacional del Centro del Perú, Sociedad Científica de Estudiantes de Medicina del Centro, Huancayo, Peru
| | | | | | | | | | - Percy Herrera-Añazco
- Instituto de Evaluación de Tecnologías en Salud e Investigación-IETSI, Lima, Peru
- Universidad Privada San Juan Bautista, Lima, Peru
| | | | - Alvaro Taype-Rondan
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
- Corresponding author.
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Diagnostic accuracy of semiquantitative point of care urine albumin to creatinine ratio and urine dipstick analysis in a primary care resource limited setting in South Africa. BMC Nephrol 2021; 22:103. [PMID: 33743616 PMCID: PMC7981803 DOI: 10.1186/s12882-021-02290-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/02/2021] [Indexed: 11/21/2022] Open
Abstract
Background The prevalence of chronic kidney disease (CKD) is predicted to rise over the next few decades. In resource-limited settings access to central laboratory services is limited. Point-of-care (POC) urine dipstick testing offers the potential to detect markers of kidney damage (albuminuria) as well as markers of other disease processes. We evaluated the diagnostic accuracy of the semi-quantitative albumin-creatinine ratio (ACR) Sysmex UC-1000 POC urine dipstick system as well as the extent of other abnormal dipstick findings in urine. Methods 700 participants from a rural area in South Africa were screened for albuminuria. A spot urine sample was used to measure POC and central laboratory ACR. We determined the sensitivity, specificity, positive predictive value and negative predictive value of the POC ACR, and recorded dipstick parameters. Results The prevalence of albuminuria was 11.6% (95%CI; 9.3–14.2). Those with albuminuria had higher mean diastolic (82 vs 79 mmHg, p = 0.019) and systolic (133 vs 128 mmHg, p = 0.002) blood pressures and a higher proportion of diabetes mellitus (17.6 vs 4.9%, p < 0.001). The sensitivity of the POC ACR system was 0.79, specificity 0.84, positive predictive value 0.39 and negative predictive value 0.97. The sensitivity improved to 0.80, 0.85, 0.85 and 0.89 in those with elevated blood pressure, diabetes mellitus, HIV positive status, and those 65 years and older, respectively. Abnormalities other than albuminuria were detected in 240 (34.3%) of the samples; 88 (12.6%) were positive for haematuria, 113 (16.1%) for leucocytes, 66 (9.4%) for nitrites and 27 (3.9%) for glycosuria. Conclusion Our study shows that POC ACR has good negative predictive value and could be used to rule out albuminuria when screening for CKD. Additionally, a high proportion of participants had other urine abnormalities detected with dipsticks which may reflect kidney disease or co-morbid untreated genitourinary pathology such as urinary tract infections or endemic schistosomiasis with important implications for CKD. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02290-5.
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Al-Awaida WJ, Hameed WS, Al Hassany HJ, Al-Dabet MM, Al-Bawareed O, Hadi NR. Evaluation of the Genetic Association and Expressions of Notch-2 /Jagged-1 in Patients with Type 2 Diabetes Mellitus. Med Arch 2021; 75:101-108. [PMID: 34219868 PMCID: PMC8228649 DOI: 10.5455/medarh.2021.75.101-108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Diabetes mellitus (DM) is the world's most common cause of chronic kidney diseases (CKD), with approximately 1 in 4 adults with DM having CKD and 1 out of 10 to 20% of DM patients die from CKD. Objective The current study aims to investigate the correlation between Notch-2 and Jag-1expressions and specific inflammation biomarkers IL-1β and IL-6 with different stages of diabetic nephropathy. Methods From August 2018 to January 2019, three hundred subjects were recruited for this study. One hundred and fifty subjects were healthy and age-matched to the diabetic group and selected as a control group. Another 150 patients with an established diagnosis of type 2 diabetes (T2DM) according to the criteria of the American Diabetes Association (ADA) were also recruited. Blood specimens were eventually used to identify the expressions Notch-2 and Jagged-1 and the levels of inflammatory biomarkers IL-1β and IL-6. Result The current study shows a significant increase in gene expression and inflammatory biomarkers in patients with moderate and severe diabetic nephropathy compared to the control group. However, there was no significant difference between healthy control and mild diabetic nephropathy patients. This study shows a close association between the increase in the levels of inflammatory biomarkers IL-1β and IL-6 as well as the gene expressions levels of both Notch-2 and Jag-1 with human diabetic nephropathy. Conclusion According to our findings, we emphasize the use of Notch-2 and Jag-1 expressions and IL-1β and IL-6 levels as potential biomarkers for different stages of diabetic nephropathy.
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Affiliation(s)
- Wajdy J Al-Awaida
- Department of Biology and Biotechnology, American University of Madaba, Madaba, Jordan
| | - Wasan S Hameed
- Department of Microbiology, Faculty of Medicine, University of Kufa, Kufa, Iraq
| | - Haider J Al Hassany
- Department of Microbiology, Faculty of Medicine, University of Kufa, Kufa, Iraq
| | | | - Omar Al-Bawareed
- Department of normal physiology, RUDN University, Moscow, Russia
| | - Najah R Hadi
- Department of Pharmacology and Therapeutics,Faculty of Medicine, University of Kufa, Kufa, Iraq
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Sumida K, Nadkarni GN, Grams ME, Sang Y, Ballew SH, Coresh J, Matsushita K, Surapaneni A, Brunskill N, Chadban SJ, Chang AR, Cirillo M, Daratha KB, Gansevoort RT, Garg AX, Iacoviello L, Kayama T, Konta T, Kovesdy CP, Lash J, Lee BJ, Major RW, Metzger M, Miura K, Naimark DMJ, Nelson RG, Sawhney S, Stempniewicz N, Tang M, Townsend RR, Traynor JP, Valdivielso JM, Wetzels J, Polkinghorne KR, Heerspink HJL. Conversion of Urine Protein-Creatinine Ratio or Urine Dipstick Protein to Urine Albumin-Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis : An Individual Participant-Based Meta-analysis. Ann Intern Med 2020; 173:426-435. [PMID: 32658569 PMCID: PMC7780415 DOI: 10.7326/m20-0529] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), total urine protein or dipstick protein is often measured instead. OBJECTIVE To develop equations for converting urine protein-creatinine ratio (PCR) and dipstick protein to urine albumin-creatinine ratio (ACR) and to test their diagnostic accuracy in CKD screening and staging. DESIGN Individual participant-based meta-analysis. SETTING 12 research and 21 clinical cohorts. PARTICIPANTS 919 383 adults with same-day measures of ACR and PCR or dipstick protein. MEASUREMENTS Equations to convert urine PCR and dipstick protein to ACR were developed and tested for purposes of CKD screening (ACR ≥30 mg/g) and staging (stage A2: ACR of 30 to 299 mg/g; stage A3: ACR ≥300 mg/g). RESULTS Median ACR was 14 mg/g (25th to 75th percentile of cohorts, 5 to 25 mg/g). The association between PCR and ACR was inconsistent for PCR values less than 50 mg/g. For higher PCR values, the PCR conversion equations demonstrated moderate sensitivity (91%, 75%, and 87%) and specificity (87%, 89%, and 98%) for screening (ACR >30 mg/g) and classification into stages A2 and A3, respectively. Urine dipstick categories of trace or greater, trace to +, and ++ for screening for ACR values greater than 30 mg/g and classification into stages A2 and A3, respectively, had moderate sensitivity (62%, 36%, and 78%) and high specificity (88%, 88%, and 98%). For individual risk prediction, the estimated 2-year 4-variable kidney failure risk equation using predicted ACR from PCR had discrimination similar to that of using observed ACR. LIMITATION Diverse methods of ACR and PCR quantification were used; measurements were not always performed in the same urine sample. CONCLUSION Urine ACR is the preferred measure of albuminuria; however, if ACR is not available, predicted ACR from PCR or urine dipstick protein may help in CKD screening, staging, and prognosis. PRIMARY FUNDING SOURCE National Institute of Diabetes and Digestive and Kidney Diseases and National Kidney Foundation.
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Affiliation(s)
- Keiichi Sumida
- University of Tennessee Health Science Center, Memphis, Tennessee (K.S.)
| | - Girish N Nadkarni
- Icahn School of Medicine at Mount Sinai, New York, New York (G.N.N.)
| | - Morgan E Grams
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G., Y.S., S.H.B., J.C., K.M., A.S.)
| | - Yingying Sang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G., Y.S., S.H.B., J.C., K.M., A.S.)
| | - Shoshana H Ballew
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G., Y.S., S.H.B., J.C., K.M., A.S.)
| | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G., Y.S., S.H.B., J.C., K.M., A.S.)
| | - Kunihiro Matsushita
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G., Y.S., S.H.B., J.C., K.M., A.S.)
| | - Aditya Surapaneni
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.E.G., Y.S., S.H.B., J.C., K.M., A.S.)
| | - Nigel Brunskill
- Leicester General Hospital, University Hospitals of Leicester NHS Trust, and University of Leicester, Leicester, United Kingdom (N.B., R.W.M.)
| | - Steve J Chadban
- Royal Prince Alfred Hospital and Kidney Node, University of Sydney, Sydney, New South Wales, Australia (S.J.C.)
| | - Alex R Chang
- Geisinger Health, Danville, Pennsylvania (A.R.C.)
| | | | - Kenn B Daratha
- Providence Sacred Heart Medical Center and Gonzaga University School of Anesthesia, Spokane, Washington (K.B.D.)
| | - Ron T Gansevoort
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (R.T.G.)
| | - Amit X Garg
- ICES and Western University, London, Ontario, Canada (A.X.G.)
| | - Licia Iacoviello
- IRCCS Neuromed, Pozzilli, Italy, and University of Insubria, Varese, Italy (L.I.)
| | | | - Tsuneo Konta
- Yamagata University, Yamagata, Japan (T.K., T.K.)
| | - Csaba P Kovesdy
- Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis, Tennessee (C.P.K.)
| | - James Lash
- University of Illinois at Chicago, Chicago, Illinois (J.L.)
| | - Brian J Lee
- Kaiser Permanente, Hawaii Region, and Moanalua Medical Center, Honolulu, Hawaii (B.J.L.)
| | - Rupert W Major
- Leicester General Hospital, University Hospitals of Leicester NHS Trust, and University of Leicester, Leicester, United Kingdom (N.B., R.W.M.)
| | - Marie Metzger
- Paris Saclay University, Paris-Sud University, UVSQ, CESP, INSERM U1018, Villejuif, France (M.M.)
| | - Katsuyuki Miura
- Shiga University of Medical Science Seta-Tsukinowa-cho, Shiga, Japan (K.M.)
| | - David M J Naimark
- Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada (D.M.N.)
| | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona (R.G.N.)
| | | | | | - Mila Tang
- University of British Columbia, Vancouver, British Columbia, Canada (M.T.)
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (R.R.T.)
| | - Jamie P Traynor
- Queen Elizabeth University Hospital, Glasgow, Scotland (J.P.T.)
| | - José M Valdivielso
- Institute of Biomedical Research of Lleida and Spanish Research Network for Renal Diseases, Lleida, Spain (J.M.V.)
| | - Jack Wetzels
- Radboud University Medical Center, Nijmegen, the Netherlands (J.W.)
| | | | - Hiddo J L Heerspink
- University of Groningen, University Medical Center, Groningen, the Netherlands, and The George Institute for Global Health, Sydney, New South Wales, Australia (H.J.H.)
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Résimont G, Piéroni L, Bigot-Corbel E, Cavalier E, Delanaye P. Urinary strips for protein assays: easy to do but difficult to interpret! J Nephrol 2020; 34:411-432. [PMID: 32328900 DOI: 10.1007/s40620-020-00735-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/03/2020] [Indexed: 11/29/2022]
Abstract
Urine samples can be readily obtained from patients in everyday clinical practice. Therefore, the availability of urine allows physicians to obtain relevant clinical information in a timely manner. Since the measurement of urinary protein levels is essential in diagnosing and treating a host of diseases, the potential detection of urinary proteins by urinary strips in an easy, quick, and cheap way is very attractive. However, to ensure optimal use of urinary strips, one needs to be aware of their characteristics and their limitations. In this review, we discuss the characteristics of the urinary strips available for testing urinary protein levels and for detecting urinary albumin. We then consider their analytical performances in their most widely used clinical applications (e.g., in pregnancy, chronic kidney disease, diabetes, and screening of the general population).
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Affiliation(s)
- Guillaume Résimont
- Service de Néphrologie-Dialyse-Transplantation, University of Liège, CHU Sart Tilman (CHU ULg), 4000, Liège, Belgium.
| | - Laurence Piéroni
- Département de Biochimie-Hormonologie, Pôle de Biologie-Pathologie, CHU Montpellier, Montpellier, France
| | - Edith Bigot-Corbel
- Laboratoire de Biochimie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liege, CHU de Liège, Liège, Belgium
| | - Pierre Delanaye
- Service de Néphrologie-Dialyse-Transplantation, University of Liège, CHU Sart Tilman (CHU ULg), 4000, Liège, Belgium.,Department of Nephrology-Dialysis-Apheresis, Hopital Universitaire Caremeau, Nimes, France
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Kim Y, Park S, Kim MH, Song SH, Lee WM, Kim HS, Jin K, Han S, Kim YC, Han SS, Lee H, Lee JP, Joo KW, Lim CS, Kim YS, Kim DK. Can a semi-quantitative method replace the current quantitative method for the annual screening of microalbuminuria in patients with diabetes? Diagnostic accuracy and cost-saving analysis considering the potential health burden. PLoS One 2020; 15:e0227694. [PMID: 31961894 PMCID: PMC6974274 DOI: 10.1371/journal.pone.0227694] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 12/25/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Diabetes is a global epidemic, and the high cost of annually and quantitatively measuring urine albumin excretion using the turbidimetric immunoassay is challenging. We aimed to determine whether a semi-quantitative urinary albumin-creatinine ratio test could be used as a screening tool for microalbuminuria in diabetic patients. METHODS We assessed the diagnostic accuracy of the semi-quantitative method. The costs of false results in the semi-quantitative method were calculated based on the annual probability of disease progression analyzed through a systematic literature review and meta-analysis. The pooled long-term cost-saving effect of the semi-quantitative method compared with the quantitative test was assessed using a Markov model simulating a long-term clinical setting. Diagnostic accuracy and the cost-saving effect were also validated in an independent external cohort. RESULTS Compared with the quantitative test, the semi-quantitative method had sensitivities of 93.5% and 81.3% and specificities of 61.4% and 63.1% in the overall sample of diabetic patients (n = 1,881) and in diabetic patients with eGFR ≥60 ml/min/1.73 m2 and a negative dipstick test (n = 1,110), respectively. After adjusting for direct and indirect medical costs, including the risk of disease progression, which was adjusted by the meta-analyzed hazard ratio for clinical outcomes, it was determined that using the semi-quantitative method could save 439.4 USD per person for 10 years. Even after adjusting the result to the external validation cohort, 339.6 USD could be saved for one diabetic patient for 10 years. CONCLUSIONS The semi-quantitative method could be an appropriate screening tool for albuminuria in diabetic patients. Moreover, it can minimize the testing time and inconvenience and significantly reduce national health costs.
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Affiliation(s)
- Yaerim Kim
- Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seokwoo Park
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-Hee Kim
- Department of Dental Hygiene, College of Health Science, Eulji University, Gyeonggi-do, Korea
| | - Sang Hoon Song
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Won Mok Lee
- Department of Laboratory Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hye Soon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Kyubok Jin
- Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Seungyeup Han
- Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Yong Chul Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung Seok Han
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hajeong Lee
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Division of Nephrology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwon Wook Joo
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Soo Lim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Division of Nephrology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yon Su Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ki Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
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11
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Suzuki I, Ogawa M, Seino K, Nogawa M, Naito H, Yamakoshi KI, Tanaka S. NIR spectroscopic determination of urine components in spot urine: preliminary investigation towards optical point-of-care test. Med Biol Eng Comput 2019; 58:67-74. [PMID: 31745837 DOI: 10.1007/s11517-019-02063-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/02/2019] [Indexed: 02/06/2023]
Abstract
Presently, there is no convenient method to measure 24-h urinary Na excretion, which is an important index of daily Na intake, and 24-h urine collection involves a complex process. However, the Na-to-creatinine ratio (NCR) in spot urine has the potential to evaluate 24-h Na excretion and is useful for point-of-care testing. Thus, this study aimed to realize a near-infrared spectroscopic system to assess NCR in spot urine: (1) We attempted to estimate Na concentration using fewer than 10 wavelengths; (2) we calculated NCR using creatinine concentrations from our previous report and verified the NCR predictability. A calibration model was created using multi-linear regression analysis using 10 selected wavelengths in the range of Fourier-transform infrared spectrometer. Spot urine samples were obtained from healthy adults, and glucose powder was added to them to simulate diabetic samples. NCR was calculated using only six wavelengths, and the results confirmed the high accuracy of the estimated Na concentration even though inorganic components do not absorb near-infrared light. Our method enables to optically estimate NCR in spot urine, and it will be useful for point-of-care testing. Graphical abstract.
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Affiliation(s)
- Ikuto Suzuki
- Graduate School of Natural Science & Technology, Kanazawa University, Kanazawa, 920-1192, Japan.
| | - Mitsuhiro Ogawa
- Department of Information and Electronic Engineering, Faculty of Science and Engineering, Teikyo University, Utsunomiya, 320-8551, Japan
| | - Kimihiro Seino
- Graduate School of Natural Science & Technology, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Masamichi Nogawa
- Department of Clinical Engineering, Faculty of Health Sciences, Komatsu University, Komatsu, 923-0961, Japan
| | - Hisashi Naito
- Faculty of Frontier Engineering, Institute of Science & Engineering, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Ken-Ichi Yamakoshi
- Graduate School of Natural Science & Technology, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Shinobu Tanaka
- Faculty of Frontier Engineering, Institute of Science & Engineering, Kanazawa University, Kanazawa, 920-1192, Japan
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12
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Hayashi Y. Detection of Lower Albuminuria Levels and Early Development of Diabetic Kidney Disease Using an Artificial Intelligence-Based Rule Extraction Approach. Diagnostics (Basel) 2019; 9:E133. [PMID: 31569548 PMCID: PMC6963949 DOI: 10.3390/diagnostics9040133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/21/2019] [Accepted: 09/27/2019] [Indexed: 12/22/2022] Open
Abstract
The aim of the present study was to determine the lowest cut-off value for albuminuria levels, which can be used to detect diabetic kidney disease (DKD) using the urinary albumin-to-creatinine ratio (UACR). National Health and Nutrition Examination Survey (NHANES) data for US adults were used, and participants were classified as having diabetes or prediabetes based on a self-report and physiological measures. The study dataset comprised 942 diabetes and 524 prediabetes samples. This study clarified the significance of the lower albuminuria (UACR) levels, which can detect DKD, using an artificial intelligence-based rule extraction approach. The diagnostic rules (15 concrete rules) for both samples were extracted using a recursive-rule eXtraction (Re-RX) algorithm with continuous attributes (continuous Re-RX) to discriminate between prediabetes and diabetes datasets. Continuous Re-RX showed high test accuracy (77.56%) and a large area under the receiver operating characteristics curve (75%), which derived the two cut-off values (6.1 mg/g Cr and 71.00 mg/g Cr) for the lower albuminuria level in the UACR to detect early development of DKD. The early cut-off values for normoalbuminuria (NA) and microalbuminuria (MA) will be determined to help detect CKD and DKD, and to detect diabetes before MA develop and to prevent diabetic complications.
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Affiliation(s)
- Yoichi Hayashi
- Department of Computer Science, Meiji University, 1-1-1 Higashimita, Tama-ku, Kawasaki 214-8571, Japan.
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13
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Shore J, Green M, Hardy A, Livesey D. The compliance and cost-effectiveness of smartphone urinalysis albumin screening for people with diabetes in England. Expert Rev Pharmacoecon Outcomes Res 2019; 20:387-395. [PMID: 31354065 DOI: 10.1080/14737167.2019.1650024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND People with diabetes are at increased risk of developing chronic kidney disease (CKD) and should undergo annual screening, but adherence is poor. A home urinalysis self-test has been developed to improve compliance with screening. The objective of this paper is to report on a clinical evaluation and economic analysis of home urinalysis self-testing. RESEARCH DESIGN AND METHODS People with diabetes who had not undergone screening within the previous 18 months were recruited to a single-arm clinical evaluation to assess the uptake and compliance of home urinalysis self-testing. An economic evaluation assessed the likely cost-consequences of the use of home urinalysis self-testing over a lifetime time horizon. RESULTS A total of 2,196 people with diabetes were contacted as part of the clinical evaluation. Of these, 695 people agreed to be sent a home urinalysis self-testing kit and 499 people completed and returned the test. Cost savings of £2,008 per person were estimated over a lifetime due to increased CKD diagnosis and reduced progression to end stage renal disease. CONCLUSIONS Home urinalysis self-testing of ACR in people with diabetes is estimated to be a cost-effective use of NHS resources in England in people who would otherwise not comply with standard care.
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Affiliation(s)
- Judith Shore
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York , York, UK
| | - Michelle Green
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York , York, UK
| | - Andrew Hardy
- Diadem Medical Practice, Modality Partnership, NHS , Hull, UK
| | - Deborah Livesey
- Fisher Medical Practice, Modality Partnership, NHS , Skipton, UK
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14
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Memic A, Colombani T, Eggermont LJ, Rezaeeyazdi M, Steingold J, Rogers ZJ, Navare KJ, Mohammed HS, Bencherif SA. Latest Advances in Cryogel Technology for Biomedical Applications. ADVANCED THERAPEUTICS 2019. [DOI: 10.1002/adtp.201800114] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Adnan Memic
- Center of NanotechnologyKing Abdulaziz University Jeddah 21589 Saudi Arabia
- Center for Biomedical EngineeringDepartment of MedicineBrigham and Women's HospitalHarvard Medical School Cambridge MA 02139 USA
- Department of Chemical EngineeringNortheastern University Boston MA 02115 USA
| | - Thibault Colombani
- Department of Chemical EngineeringNortheastern University Boston MA 02115 USA
| | - Loek J. Eggermont
- Department of Chemical EngineeringNortheastern University Boston MA 02115 USA
- Department of Tumor ImmunologyOncode Institute, Radboud Institute for Molecular Life SciencesRadboud University Medical Center Nijmegen 6500 The Netherlands
| | | | - Joseph Steingold
- Department of Pharmaceutical SciencesNortheastern University Boston MA 02115 USA
| | - Zach J. Rogers
- Department of Chemical EngineeringNortheastern University Boston MA 02115 USA
| | | | | | - Sidi A. Bencherif
- Department of Chemical EngineeringNortheastern University Boston MA 02115 USA
- Department of BioengineeringNortheastern University Boston MA 02115 USA
- Harvard John A. Paulson School of Engineering and Applied SciencesHarvard University Cambridge MA 02138 USA
- Sorbonne UniversityUTC CNRS UMR 7338Biomechanics and Bioengineering (BMBI)University of Technology of Compiègne Compiègne 60159 France
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15
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Troxerutin Protects Kidney Tissue against BDE-47-Induced Inflammatory Damage through CXCR4-TXNIP/NLRP3 Signaling. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:9865495. [PMID: 29849929 PMCID: PMC5932985 DOI: 10.1155/2018/9865495] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/07/2017] [Indexed: 12/11/2022]
Abstract
2,2′,4,4′-Tetrabromodiphenyl ether (BDE-47) induces oxidative stress in kidney cells, but the underlying mechanism remains poorly understood. Troxerutin, a natural flavonoid, has potential antioxidant and anti-inflammatory efficacy. In this study, we assessed the effect of troxerutin on kidney damage caused by BDE-47 and investigated the underlying mechanism. The results showed troxerutin reduced reactive oxygen species (ROS) level and urine albumin-to-creatinine ratio (ACR), decreased the activities of inflammatory factors including cyclooxygenase-2 (COX-2), induced nitric oxide synthase (iNOS) and nuclear factor kappa B (NF-κB) in the kidney tissues of BDE-47-treated mice. Furthermore, troxerutin significantly weakened the expression of kidney NLRP3 inflammasome containing NLRP3, ASC, and caspase-1, contributing to the decline of IL-1β. Additionally, troxerutin inhibited the increased protein level of stromal-derived factor-1(SDF-1), C-X-C chemokine ligand 12 receptor 4 (CXCR4), and thioredoxin interaction protein (TXNIP) caused by BDE-47. Specifically, the immunoprecipitation assay indicated that there was a direct interaction between CXCR4 and TXNIP. CXCR4 siRNA and TXNIP siRNA also decreased the inflammatory damage, which was similar to the action of troxerutin. Our data demonstrated that troxerutin regulated the inflammatory lesions via CXCR4-TXNIP/NLRP3 inflammasome in the kidney of mice induced by BDE-47.
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16
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Lim S, Yu H, Lee S, Park H, Kwon M, Woo H. Evaluation of the URiSCAN 2 ACR Strip to estimate the urine albumin/creatinine ratios. J Clin Lab Anal 2018; 32:e22289. [PMID: 28649724 PMCID: PMC6816874 DOI: 10.1002/jcla.22289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/01/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The urine albumin/creatinine ratio (ACR) test is used to screen patients with chronic diseases, such as diabetes, hypertension and cardiovascular diseases that put them at an increased risk of developing kidney disease. Here, we evaluated the performance of the URiSCAN 2 ACR Strip (URiSCAN; YD diagnostics, Yongin, Korea), a semiquantitative point-of-care testing (POCT) assay, and we compared to an existing POCT assay and a quantitative assay. MATERIALS AND METHODS A total of 1,020 random urine specimens were analyzed using the semiquantitative URiSCAN 2 ACR Strip and semiquantitative CLINITEK Microalbumin 2 Strip (CLINITEK; Siemens, New York, USA). We evaluated the precision of the URiSCAN 2 ACR Strip and compared the results of the ACR obtained from URiSCAN to those of CLINITEK with the quantitative results of a quantitative assay as a reference. RESULTS The precision evaluation of the URiSCAN revealed a range between the cutoff (C50 )-20% and C50 +20% bounds, the C5 -C95 interval, with 85.8% confidence. URiSCAN and CLINITEK showed sensitivity and specificity of 87.7% and 72.2%, and 90.2% and 83.0%, respectively. The concordance rates of URiSCAN with CLINITEK and the quantitative assay were 75.6% and 79.1%, respectively. The concordance rate in the abnormal range (≥30 mg/g) between URiSCAN and the quantitative assay were higher than that between CLINITEK and the quantitative assay (78.8% vs 75.4%). CONCLUSIONS URiSCAN showed good precision and comparable sensitivity with lower specificity than those of CLINITEK.
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Affiliation(s)
- Sangeun Lim
- Department of Laboratory MedicineKangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulKorea
| | - Hui‐Jin Yu
- Department of Laboratory MedicineKangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulKorea
| | - Seungjun Lee
- Department of Laboratory MedicineKangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulKorea
| | - Hyosoon Park
- Department of Laboratory MedicineKangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulKorea
| | - Min‐Jung Kwon
- Department of Laboratory MedicineKangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulKorea
| | - Hee‐Yeon Woo
- Department of Laboratory MedicineKangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulKorea
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17
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Nah EH, Cho S, Kim S, Cho HI. Comparison of Urine Albumin-to-Creatinine Ratio (ACR) Between ACR Strip Test and Quantitative Test in Prediabetes and Diabetes. Ann Lab Med 2017; 37:28-33. [PMID: 27834062 PMCID: PMC5107614 DOI: 10.3343/alm.2017.37.1.28] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 07/19/2016] [Accepted: 10/05/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Albuminuria is generally known as a sensitive marker of renal and cardiovascular dysfunction. It can be used to help predict the occurrence of nephropathy and cardiovascular disorders in diabetes. Individuals with prediabetes have a tendency to develop macrovascular and microvascular pathology, resulting in an increased risk of retinopathy, cardiovascular diseases, and chronic renal diseases. We evaluated the clinical value of a strip test for measuring the urinary albumin-to-creatinine ratio (ACR) in prediabetes and diabetes. METHODS Spot urine samples were obtained from 226 prediabetic and 275 diabetic subjects during regular health checkups. Urinary ACR was measured by using strip and laboratory quantitative tests. RESULTS The positive rates of albuminuria measured by using the ACR strip test were 15.5% (microalbuminuria, 14.6%; macroalbuminuria, 0.9%) and 30.5% (microalbuminuria, 25.1%; macroalbuminuria, 5.5%) in prediabetes and diabetes, respectively. In the prediabetic population, the sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the ACR strip method were 92.0%, 94.0%, 65.7%, 99.0%, and 93.8%, respectively; the corresponding values in the diabetic population were 80.0%, 91.6%, 81.0%, 91.1%, and 88.0%, respectively. The median [interquartile range] ACR values in the strip tests for measurement ranges of <30, 30-300, and >300 mg/g were 9.4 [6.3-15.4], 46.9 [26.5-87.7], and 368.8 [296.2-575.2] mg/g, respectively, using the laboratory method. CONCLUSIONS The ACR strip test showed high sensitivity, specificity, and negative predictive value, suggesting that the test can be used to screen for albuminuria in cases of prediabetes and diabetes.
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Affiliation(s)
- Eun Hee Nah
- Department of Laboratory Medicine and Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea.
| | - Seon Cho
- Department of Laboratory Medicine and Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea
| | - Suyoung Kim
- Department of Laboratory Medicine and Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea
| | - Han Ik Cho
- MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, Korea
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19
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Akbari A, Clase CM, Acott P, Battistella M, Bello A, Feltmate P, Grill A, Karsanji M, Komenda P, Madore F, Manns BJ, Mahdavi S, Mustafa RA, Smyth A, Welcher ES. Canadian Society of Nephrology Commentary on the KDIGO Clinical Practice Guideline for CKD Evaluation and Management. Am J Kidney Dis 2015; 65:177-205. [DOI: 10.1053/j.ajkd.2014.10.013] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 10/31/2014] [Indexed: 12/24/2022]
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20
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Fatoni A, Numnuam A, Kanatharana P, Limbut W, Thavarungkul P. A novel molecularly imprinted chitosan–acrylamide, graphene, ferrocene composite cryogel biosensor used to detect microalbumin. Analyst 2014; 139:6160-7. [DOI: 10.1039/c4an01000k] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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21
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McTaggart MP, Stevens PE, Price CP, Newall RG, Pinnock RG, Lamb EJ. Investigation of apparent non-albuminuric proteinuria in a primary care population. Clin Chem Lab Med 2014; 51:1961-9. [PMID: 23729629 DOI: 10.1515/cclm-2013-0225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 04/30/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is debate as to whether using the urinary albumin- or protein-to-creatinine ratio (ACR or PCR) should be the primary test for proteinuria. Whilst albuminuria (increased ACR) in the absence of proteinuria (increased PCR) may be expected in some patients, the converse (i.e., proteinuria in the absence of albuminuria) is more unusual and its cause and significance are unclear. We investigated the nature of such apparent non-albuminuric proteinuria in a primary care population of patients. METHODS ACR and PCR were measured in 569 urine samples from patients who either had chronic kidney disease or were at increased risk of the condition. Samples with apparent proteinuria (PCR ≥23 mg/mmol/≥200 mg/g) but no albuminuria (ACR <3.4 mg/mmol/<30 mg/g) were classified as 'discrepant' (37% of proteinuric samples, 6% of all samples); 27 of these samples were available for further analyses. The further analyses included electrophoresis, repeat measurement, immunoassays for markers of tubular proteinuria and use of alternative albumin and total protein methods. RESULTS Electrophoresis did not identify significant proteinuria in the discrepant samples. The only evidence of tubular proteinuria following measurement of three urinary markers of the condition was a mildly increased α1-microglobulin-to-creatinine ratio in 10 of the 27 discrepant samples analysed, four of which also had a raised β-trace protein-to-creatinine ratio. Use of an alternative urinary total protein method resulted in significantly lower PCRs and 17 of the 27 samples were no longer classified as proteinuric. CONCLUSIONS We were unable to confirm the cause of a raised PCR without albuminuria in these patients and suspect that in most cases it is artefactual.
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Komenda P, Ferguson TW, Macdonald K, Rigatto C, Koolage C, Sood MM, Tangri N. Cost-effectiveness of primary screening for CKD: a systematic review. Am J Kidney Dis 2014; 63:789-97. [PMID: 24529536 DOI: 10.1053/j.ajkd.2013.12.012] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 12/29/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a major health problem with an increasing incidence worldwide. Data on the cost-effectiveness of CKD screening in the general population have been conflicting. STUDY DESIGN Systematic review. SETTING & POPULATION General, hypertensive, and diabetic populations. No restriction on setting. SELECTION CRITERIA FOR STUDIES Studies that evaluated the cost-effectiveness of screening for CKD. INTERVENTION Screening for CKD by proteinuria or estimated glomerular filtration rate (eGFR). OUTCOMES Incremental cost-effectiveness ratio of screening by proteinuria or eGFR compared with either no screening or usual care. RESULTS 9 studies met criteria for inclusion. 8 studies evaluated the cost-effectiveness of proteinuria screening and 2 evaluated screening with eGFR. For proteinuria screening, incremental cost-effectiveness ratios ranged from $14,063-$160,018/quality-adjusted life-year (QALY) in the general population, $5,298-$54,943/QALY in the diabetic population, and $23,028-$73,939/QALY in the hypertensive population. For eGFR screening, one study reported a cost of $23,680/QALY in the diabetic population and the range across the 2 studies was $100,253-$109,912/QALY in the general population. The incidence of CKD, rate of progression, and effectiveness of drug therapy were major drivers of cost-effectiveness. LIMITATIONS Few studies evaluated screening by eGFR. Performance of a quantitative meta-analysis on influential assumptions was not conducted because of few available studies and heterogeneity in model designs. CONCLUSIONS Screening for CKD is suggested to be cost-effective in patients with diabetes and hypertension. CKD screening may be cost-effective in populations with higher incidences of CKD, rapid rates of progression, and more effective drug therapy.
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Affiliation(s)
- Paul Komenda
- Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Seven Oaks General Hospital Renal Program, Winnipeg, Canada.
| | - Thomas W Ferguson
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Seven Oaks General Hospital Renal Program, Winnipeg, Canada
| | - Kerry Macdonald
- Department of Library Services, University of Manitoba, Winnipeg, Canada
| | - Claudio Rigatto
- Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Seven Oaks General Hospital Renal Program, Winnipeg, Canada
| | - Chris Koolage
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Seven Oaks General Hospital Renal Program, Winnipeg, Canada
| | - Manish M Sood
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Navdeep Tangri
- Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Seven Oaks General Hospital Renal Program, Winnipeg, Canada
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