Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (1079 page)

   Recommended by the American Diabetes Association to screen for microalbuminuria.

   Medications that act on the renin–angiotensin system may delay onset of renal and cardiovascular disease, making screening for microalbumin important in the care of diabetic patients.

   Interpretation

   Increased excretion of albumin (microalbuminuria) is a predictor of future development of clinical renal disease in patients with hypertension or DM.

   Limitations

   Microalbuminuria may be seen transiently during pregnancy, after exercise, and with protein loading, hyperglycemia, fever, and urinary tract infections. There is also day-to-day, as well as diurnal, variation in albumin excretion. Hence, it is important to base treatment on the results of several tests.

   Vigorous exercise can cause a transient increase in albumin excretion. Patients should refrain from vigorous exercise in the 24 hours prior to the test.

   The optimal time to measure the urine albumin-to-creatinine ratio is not clearly defined. The first-morning void specimen is preferred.

   The accuracy of the urine albumin-to-creatinine ratio will be diminished if creatinine excretion is substantially different from the expected value; this is particularly important in patients with borderline values. Albumin excretion will be underestimated in a muscular man with a high rate of creatinine excretion and overestimated in a cachectic patient in whom muscle mass and creatinine excretion are markedly reduced.

Suggested Reading

American Diabetes Association. Standards of medical care in diabetes.
Diabetes Care.
2004;27(Suppl 1):S79.

MÜLLERIAN INHIBITING SUBSTANCE

   Definition

   The primary function of müllerian inhibiting substance (MIS) is to initiate regression of müllerian structures in males as a part of normal sexual development. Secreted by the Sertoli cells of the testes during embryogenesis of the male fetus. It is also expressed by granulose cells of the ovary during reproductive years and controls the primary follicles by inhibiting the excessive follicular development by FSH. Other names: anti-müllerian hormone, müllerian inhibiting hormone.

   
Normal range:
see Table 16.57.