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February 1990

Identifying Patients With Incipient Diabetic Nephropathy: Should 24-Hour Urine Collections Be Used?

Author Affiliations

From the Department of Internal Medicine (Drs Stehouwer, Fischer, and den Ottolander) and Endocrinological Laboratory (Dr Hackeng), Bergweg Municipal Hospital, Rotterdam, the Netherlands. Dr Stehouwer is now with Free University Hospital, Amsterdam, the Netherlands.

Arch Intern Med. 1990;150(2):373-375. doi:10.1001/archinte.1990.00390140091020

• It is not clear whether 24-hour or overnight urine collections should be used to identify patients with incipient diabetic nephropathy (defined as persistent urinary albumin excretion rate [AER] of 20 to 200 μg/min). We therefore studied diurnal variations in AER in type I diabetics with normal AER (n = 16) and incipient (n=12) and clinical (defined as persistent AER 200 μg/min) nephropathy (n = 12), and in healthy controls (n = 24). In all groups AER was lowest at night. In some patients of all groups, marked diurnal variations were observed. Twenty-fourhour urine collections classified all patients correctly. Overnight urine collections, however, misclassified patients with incipient nephropathy as having normal AER in 4 of 12, 7 of 12, or 3 of 7 cases, depending on which cutoff level was used. We conclude that 24-hour urine collections are more sensitive than overnight samples in identifying patients with incipient diabetic nephropathy.

(Arch Intern Med. 1990;150:373-375)

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