The investigators conducted their analysis in 701 patients with type 2 diabetes and kidney disease who were participating in the Reduction in Endpoints in Non Insulin Dependent Diabetes Mellitus with the Angiotensin-II Antagonist Losartan (RENAAL) trial. They defined worsening kidney function as the development of end-stage renal disease or a doubling of blood levels of creatinine (a breakdown product of muscle creatine). Kidney dysfunction diminishes the ability to filter creatinine, resulting in a rise in blood creatinine levels.

Dr. Lambers Heerspink and his team found that measuring the albumin:creatinine ratio in a first morning urine sample was the superior method to predict kidney problems in patients with type 2 diabetes and kidney disease. "From a clinical point of view, these results are very important, because they imply that collection of first morning voids, which is clearly more convenient than collecting a 24-hour urine, can be used for assessment of proteinuria," Dr. Lambers Heerspink said. The authors noted that standardizing proteinuria measures will improve methods for detecting and monitoring kidney disease.

In an accompanying editorial, Bryan Kestenbaum, MD and Ian de Boer, MD (University of Washington, Seattle) stated that "given data from this study and the considerable patient effort required for a 24-hour urine collection, we agree with the authors that the first morning albumin:creatinine ratio is in general the logical choice for quantifying proteinuria in clinical practice."

Source : Journal of the American Society Nephrology