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Year : 2003  |  Volume : 3  |  Issue : 2  |  Page : 21-23

First Voided Spot Urine Albumin Creatinine Ratio as a Screening Test For Microalbuminuria in Hypertensive Nephropathy

1 Department of Clinical Pathology, College of Medicine, University of Lagos
2 Department of Internal Medicine, College of Medicine, University of Lagos
3 Nigeria Institute of Medical Research, Lagos

Correspondence Address:
I O Oluwatowoju
Department of Clinical Pathology, College of Medicine, University of Lagos

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Source of Support: None, Conflict of Interest: None

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Abstract: Kidney plays a very important role in the control of blood pressure and it is one of the vital organs frequently damaged when there is hypertension. There is increase urinary albumin and creatinine excretion in hypertensive nephropathy. This increase may be explained by factors such as renal haemodynamic changes, selectivity changes of the glomerular filters and structural arteriolar and glomerular changes due to nephrosclerosis. This research aimed at assessing the suitability of first voided spot urine albumin creatinine ratio as screening test of microalbuminuria in hypertensive Nigerians. Method: Forty (40) normal subjects were enrolled as controls, the control population was make-up of 23 healthy male and 17 females aged between 20-70 years. Based on the effect of treatment on blood pressure of subject, 30 well controlled BP <140/100mmHg and 30 poorly controlled BP > 140/100mmHg benign essential hypertensive patients were recruited and studied. They were also of the same age range as the control subjects. Urinary albumin was measure by ELISA( Enzyme Linked Immunosorbent Assay) method from 2 types of patient's urine samples (a) an 8-hours overnight urine sample and (b) an early morning first voided spot urine. Albumin excretion rates (AER) was calculated from urinary albumin concentration, urine volume and the collection time. Urinary creatinine was also measured on early morning (first voided) spot urine by modified Jaffe method. The AER of 8-hours overnight urine sample was compared with the albumin creatinine ratio of first voided early morning urine. Statistical analysis was by EPI info programme, Harvard graphic and Spearman's rank correlation coefficient programme. Results: The results showed significant positive correlation between AER and Albumin creatinine ratio (ACR). Among the control subject 12.5% has AER > 20μg/min and 10% has ACR > 3.0mg/mmol. Among well-controlled patients, 40% has AER > 20μg/min while 33% has ACR > 3.0mg/mmol. Among poorly controlled patients 56.7% has AER > 20μg/min and 50% has ACR > 3.0mg/mmol. The correlation between AER and ACR increased significantly with severity of hypertension. In control, r = 0.84 p < 0.05, in well control r = 0.86 P < 0.05 and in poorly controlled r = 0.99, p < 0.05 Conclusion: Assessment of first voided spot urine albumin creatinine ratio from early morning (first voided) spot urine is a good alternative to precisely times and conducted overnight albumin excretion rate.

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