Microalbumin Screening for Diabetic Nephropathy
DESCRIPTION
Microalbuminuria is the appearance of low but abnormal levels of albumin in the urine. It represents the earliest clinical evidence of nephropathy in diabetics. Diabetes has become the single most common cause of end-stage renal disease (ESRD) in the United States.
Microalbumin screening in individuals with type I diabetes should begin at puberty or after 5 years of disease duration. Individuals with type II diabetes should begin microalbumin screening at the time of diagnosis. A test for the presence of microalbumin should be performed annually on all individuals with type I or type II diabetes.
Microalbumin screening can be performed by three methods. The methods include: 1) random spot collection measurement of the albumin-to-creatinine ratio; 2) 24-hour collection with creatinine; and 3) timed collection (e.g., 4-hour or overnight collection.) Microalbuminuria is present if urinary albumin excretion rate is equal to or greater than 30 mg/ 24 hour for the 24 hour collection sample, equivalent to 20 µg/ min on a timed specimen or 30 mg/ g creatinine on a random sample.
POLICY
Microalbumin screening as an early diagnostic tool for the detection of diabetic nephropathy in type I and type II diabetics is considered medically necessary.
Any device utilized for this procedure must have FDA approval specific to the indication, otherwise it will be considered investigational.
IMPORTANT REMINDER
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SOURCES
American Diabetes Association. (2004). Nephropathy in diabetes. Diabetes Care, 27 (1), S79 - S83. Retrieved March 15, 2006 from http://care.diabetesjournals.org/cgi/content/full/27/suppl_1/s79.
American Diabetes Association. (2006). Summary of revisions for the 2006 clinical practice recommendations. Diabetes Care, 29 (1), S3. Retrieved March 18, 2009 from http://care.diabetesjournals.org/cgi/content/full/29/suppl_1/s3.
American Diabetes Association. (2008) Standards of Medical Care in Diabetes – 2008, Diabetes Care, 31(Supplement 1), S12 – S54. Retrieved March 19, 2009 from http://care.diabetesjournals.org/cgi/content/full/31/Supplement_1/S12.
American Academy of Family Physicians. (2005). Diabetic nephropathy: Common questions. American Family Physician, 72 (1), 96-99. Retrieved March 18, 2009 from http://www.aafp.org/afp/20050701/96.html.
Comper, W., Osicka, T., Clark, M., MacIsaac, R., & Jerums, G. (2004). Earlier detection of microalbuminuria in diabetic patients using a new urinary albumin assay. Kidney International, 65 (5), 1850 - 1855. (Level 4 Evidence)
Gilbert, R. E., Akdeniz, A., & Jerums, G. (1997). Detection of microalbuminuria in diabetic patients by urinary dipstick. Diabetes Research and Clinical Practice, 35 (1), 57 - 60. (Level 4 Evidence)
Gross, J., de Azevedo, M., Silveiro, S., Canani, L., Caramori, M., & Zelmanovitz, T. (2005) Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care, 28 (1), 164 - 176. (Level 5 Evidence)
Hale, W. A., & Wilson, S. A. (2003). Does screening for microalbuminuria in diabetes prevent complications? The Journal of Family Practice, 52 (3), 229 - 231. (Level 5 Evidence)
Johnson, S., Tierney, E., Onyemere, K., Tseng, C., Safford, M., & Karter, A. (2006). Who is tested for diabetic kidney disease and who initiates treatment? The Translating Research Into Action for Diabetes (TRIAD) Study. Diabetes Care, 29 (8), 1733 - 1738. (Level 5 Evidence)
Leong, S. O., Lui, K. F., Ng, W.Y., & Thai, A. C. (1998). The use of semi-quantitative urine test-strip (Micral Test) for microalbuminuria screening in patients with diabetes mellitus. Singapore Medical Journal, 39 (3), 101 - 103. (Level 4 Evidence)
National Guideline Clearinghouse. Institute for Clinical Systems Improvement. (2008 March). Diagnosis and management of type 2 diabetes mellitus in adults. Retrieved March 18, 2009 from http://www.guideline.gov/summary/summary.aspx?doc_id=12693&nbr=6581.
Thorn, L., Forsblom, C., Fagerudd, J., Thomas, M., Pettersson-Fernholm, K., Saraheimo, M., et al. (2005). Metabolic syndrome in type 1 diabetes: association with diabetic nephropathy and glycemic control (the FinnDiane study). Diabetes Care, 28 (8), 2019 - 2024. (Level 4 Evidence)
ORIGINAL EFFECTIVE DATE: 10/24/97
MOST RECENT REVIEW DATE: 5/14/2009
ID_BT
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