Determination of the Diagnostic Accuracy of Albumin to Creatinine Ratio in the Diagnosis of Diabetic Nephropathy, Taking Microalbuminuriaas the Gold Standard
Rabia Saeed, Kanwal Naeem
Keywords: Diabetic nephropathy, type 2 diabetes mellitus, albumin-to-creatinine ratio, microalbuminuria, renal function assessment.
ABSTRACT
Introduction: Diabetic nephropathy is a leading complication of type 2 diabetes mellitus (T2DM) and is primarily detected through microalbuminuria assessment. The urine albumin-to-creatinine ratio (ACR) has been proposed as a convenient alternative to 24-hour urine albumin estimation. This study evaluates the diagnostic accuracy of ACR in detecting diabetic nephropathy, using microalbuminuria as the gold standard.
Objective: To determine the sensitivity, specificity, and predictive values of the urine ACR in diagnosing diabetic nephropathy in patients with T2DM.
Methods: A cross-sectional study was conducted at the Pathology Department of CMH Institute of Medical Sciences, Bahawalpur, from February 2023 to August 2023. A total of 117 patients with T2DM aged 30-60 years were enrolled through non-probability consecutive sampling. Patients with renal failure, chronic liver disease, cardiac disease, or protein-losing enteropathies were excluded. Urine samples were analyzed for ACR and 24- hour microalbuminuria. Diagnostic performance was assessed using sensitivity, specificity, and predictive values.
Results: The mean patient age was 47.53 ± 8.64 years, with 69 males (58.97%) and 48 females (41.03%). The ACR test yielded a sensitivity of 92.31%, specificity of 80.77%, positive predictive value of 85.71%, negative predictive value of 89.36%, and overall diagnostic accuracy of 87.18%.
Conclusion: The ACR is a reliable and convenient screening tool for diabetic nephropathy, demonstrating high sensitivity and specificity. It offers a practical alternative to 24-hour urine collection for early detection and routine monitoring in clinical practice.
Keywords: Diabetic nephropathy, type 2 diabetes mellitus, albumin-to-creatinine ratio, microalbuminuria, renal function assessment.