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DP Initiatives Project

DP Initiatives Project. Urine Albumin Creatinine Ratio (UACR) Testing Practical Issues. What is UACR?. UACR measures Albumin excretion in: mg albumin/g creatinine Run on a spot urine sample; timed samples not necessary. This test accounts for variation in urine concentration

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DP Initiatives Project

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  1. DP Initiatives Project Urine Albumin Creatinine Ratio (UACR) Testing Practical Issues

  2. What is UACR? • UACR measures Albumin excretion in: mg albumin/g creatinine • Run on a spot urine sample; timed samples not necessary. • This test accounts for variation in urine concentration • Good at assessing any level of proteinuria • Values can be used for screening, diagnosing, and monitoring interventions, for guiding therapy From: www.ihs.gov

  3. Why is UACR Measured in the DP Initiatives Project? • Typically recommended test for individuals diagnosed with diabetes to follow renal function. • However, studies have shown that there may be a correlation between elevated urine albumin (> 30mg/g of creatinine) and an increased CVD risk in individuals without diabetes. • The Funding Opportunity Agreement (FOA) Section II B, Award Recipient Responsibilities indicates it is one of the required elements of the DP Initiatives Project. • DDTP is interested in determining if this reported correlation holds true in the population of patients served by IHS.

  4. How is the UACR test performed? • Should be a random urine sample, preferably first morning void. • Quantitative testing must be done – typically run as a Moderately Complex CLIA test. • There are some CLIA-waived UACR tests available, but it is important that a quantitative result be given on the sample. • Serial testing not recommended for the purposes of the DP Initiative project, BUT any individual found to have an elevated UACR (> 30mg/g creatinine) should be referred to their health care provider for further evaluation. From: www.ihs.gov

  5. Practical UACR Collection Issues • Do not screen if symptoms of UTI or a UA that is more than TRACE positive for leukocytes, nitrite, or RBC. • For results > TRACE positive for the above tests more than 3 times, refer the individual to their health care provider to address these issues first, then repeat the UACR once resolved. • It is possible that certain individuals will have persistent urine samples that have > TRACE positive results for leukocytes, nitrite and RBCs even after thorough evaluation and/or treatment. • There may be some participants that you will never be able to get a usable urine sample for UACR during the course of their participation.

  6. When NOT to collect a sample for UACR • Strenuous exercise within 24 hours • Infection • Fever • Congestive Heart Failure (CHF) • Marked hyperglycemia • Pregnancy • Marked hypertension • UTI • Gross hematuria All of these circumstances may cause a FALSE POSITIVE result for the UACR From: www.ihs.gov

  7. DP Participant #1 UACR testing • A 35 year old man who is diagnosed with prediabetes is enrolled in your DP program. • He comes in for his Baseline Assessment labs and provides a first morning urine sample for his UACR. • The results come back and are: “uACR = 35mg/g creatinine” • What should you do next? • What would you do if the results came back: “uACR Unable to calculate value due to one or more components used in calculation is out of instrument linearity” ?

  8. DP Participant #2UACR Testing • A 60 year old woman is screened, meets eligibility requirements for your DP program and enthusiastically agrees to participate. • Her Baseline Assessment labs are completed and a urine sample is obtained. At the lab, the urine is noted to have 1+ leukocytes, 1+ protein and 2+ blood. It is rejected for UACR testing. • What is your next step? • What if the urine sample showed 1+ protein only? • What can you tell the lab about running the test?

  9. Helpful Articles and References • “Microalbuminuria: An increasingly recognized risk factor for CVD”, Fran Lowry. www.TheHeart.org • “Even very low-grade albuminuria is risk factor for CVD”, Alison Palkhivala. www.medscape.com • “A Longitudinal Study of Hypertension Risk Factors and Their Relation to Cardiovascular Disease. The Strong Heart Study”, Wenyu Wang, Elisa T. Lee, Richard R. Fabsitz, Richard Devereux, Lyle Best, Thomas K. Welty, Barbara V. Howard. • http://www.ihs.gov/medicalprojects/diabetes/HomeDocs/Resources/DiabetesTopics/Treatment/DM_screen_Tx_algorithms.pdf

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