Study On The Screening Value Of Urinary Albuminuria/creatinine Ratio For Early Diabetic Nephropathy

In today’s society, along with the rapid development of economy and the acceleration of the industrialization process, the threat of non-communicable diseases to human health is increasing. Diabetes is no longer a "specialty" of developed countries. The situation is more severe in China because of the huge population. The incidence of type2diabetes (type2diabetes mellitus, T2DM) on a global scale is increasing year by year, especially in developing countries and some developed countries.The major hazard even life-threatening of diabetes is a variety of acute and chronic complications. Diabetic nephropathy(DN) is a common chronic complication of diabetes, which has being a major cause of end-stage renal failure. In this study, we compared the screening value of ACR, UAER and GFR to observe the screening value of ACR in patients with early diabetic nephropathy.Objective To investigate the screening value of ACR for early diabetic nephropathy.Method220cases with T2DM (diagnosed by The First Affiliated Hospital of Soochow University from March,2012to October,2012) were categorized:excluding patients suffering from acute or chronic kidney diseases of other causes. ACR, UAER, Cr-S, UA, UREA, ALB, GLU, HbAlc and the general data of these patients were collected. The eGFR was assessed using simplified MDRD formula. The BMI was also carried out in the patients. According to different levels of eGFR, they were divided into four groups:eGFR≥90ml/min/1.73m2,60ml/min/1.73m2≤eGFR<90ml/min/1.73m2,30ml/min/1.73m2≤eGFR<60ml/min/1.73m2, eGFR<30ml/min/1.73m2。Result1. The prevalence rate of eGFR≥90ml/min/1.73m2,60ml/min/1.73m2<eGFR <90ml/min/1.73m2,30ml/min/1.73m2<eGFR<60ml/min/1.73m2,eGFR <30ml/min/1.73m2were68.18%,22.27%,8.18%,1.36%respectively.2. The differences between groups were meaningful using chi-squared analysis (ACR:x2=25.992, P<0.05,UAER:x2=8.105, P<0.05). The sensitivity and specificity in evaluating renal function by ACR were45.71%and74.67%, while they were94.29%and16.00%by UAER when compared with eGFR3. In the group which eGFR≥90ml/min/1.73m2, there were about25.33%patients suffering from abnormal ACR. And in the group which eGFR between60～90ml/min/1.73m2(meaning that patients of this group had early kidney damage), there were only about30.61%patients suffering from abnormal ACR.4. The ACR was positively correlated with course, Cr-S, UA, UREA and HbA1c (r=0.209,0.334,0.202,0.196,0.409, P<0.05). And it was negatively correlated with eGFR(r=-0.221, P<0.05).Conclusions1. The ACR has great sensitivity and specificity, which is quickly and convenient in evaluating the renal function and early diagnosis of DN. 2. The increase of ACR was associated with poor glucose control.3. Combination of detecting ACR and eGFR might evaluate the renal function better which was important in selecting of antidiabetic medicine and adjusting the dose of medicine excretion through renal.