Effect Of Urine Volume On Determination Of Urine Protein In Patients With Type 2 Diabetes

Objective: Microalbuminuria(MAU)is a main screening method for diabetic kidney disease(DKD),and its results are affected by many aspects.In clinical observations,it is found that the 24-hour urine volume collected by patients varies greatly,especially when the same patient is repeatedly tested.The urine volume is very different,often due to the difference of water intake in 24 hours.And the MAU test results vary with urine output,therefore the accuracy of detecting MAU is very important for clinical diagnosis of DKD.The research studied the effect of urine output on urine protein determination by measuring the urine protein related indexes of24-hour urine in patients with type 2 diabetes under non-sufficient drinking water and adequate drinking water.Methods: This research was conducted in Hebei General Hospital from October,2018 to January,2019 and enrolled 53 hospitalized patients with type 2 diabetes,whose 24-hour urine output was ?1.5L under non-sufficient drinking water.In the same period,30 healthy volunteers with matching age and gender were recruited as controls,and all the subjects signed written informed consent.The inpatients collected another24-hour urine in 4 days,and had a daily liquid intake(including food intake)of 2.5L.Healthy volunteers daily liquid intake was controlled at ?1.5L when collected 24-hour urine output under non-sufficient drinking water,then collected another 24-hour urine used same way with inpatients.Two24-hour urine specimens were taken,and 24 h microalbuminuria quantification,24-hour urine protein quantitation,urine creatinine,and the urinary albumin/creatinine ratio(UACR)were detected.two methods for measuring microalbuminuria were compared(immunoturbidimetry,immunofluorescence dry quantification).Before taking the urine,fasting vein blood was taken to detect blood sugar,blood lipids,liver and renal function and other biochemical indicators.The statistical results of the experiment were analyzed by SPSS21.0 software.Result:1 General clinical data of two groupsThe general indicators of the two groups were analyzed.The results showed that there was no significant difference in gender,age and BMI between the diabetic group and the healthy group(P>0.05).Fasting blood glucose,glycosylated hemoglobin,triglyceride,total cholesterol,creatinine and blood urea nitrogen in the diabetic group were higher than those in the healthy group,and the difference was statistically significant(P<0.05);And total protein,albumin in the diabetic group were lower than those in the healthy group,and the difference was statistically significant(P<0.05);There was no significant difference in alanine aminotransferase,aspartate aminotransferase and uric acid between the two groups(P>0.05).2 Comparison of two times urine protein related indexes in each groupIn the healthy group,compared with the 24h-urine(adequate drinking water),the levels of urine volume was significantly lower in the24h-urine(non-sufficient drinking water);the levels of the urine creatinine and 24 h microalbuminuria quantification measured by the two methods were significantly higher in the 24h-urine(non-sufficient drinking water)(P<0.05).There was no statistical difference in 24 h urine protein quantitation,UACR and 24 h microalbuminuria quantification measured by the two methods.In the diabetic group: compared with the 24h-urine(adequate drinking water),the level of urine volume was obviously significantly lower in the 24h-urine(non-sufficient drinking water);the levels of the urine creatinine and 24 h microalbuminuria quantification measured by the two methods were obviously significantly higher in the24h-urine(non-sufficient drinking water)(P<0.01).There was no statisticaldifference in 24 h urine protein quantitation,UACR and 24 h microalbuminuria quantification measured by the two methods.The value difference of each urine protein index in the healthy group was lower than that in the diabetic group.There was no significantly difference in urine volume,24 h urine protein quantitation and urine creatinine between two groups(P>0.05).There was significantly difference in value differences of24 h microalbuminuria quantification measured by the two methods and UACR between two groups(P<0.05).There was significantly difference in microalbuminuria concentration measured by the two methods between two groups(P<0.05).There was significantly difference between two groups in microalbuminuria concentration measured by the two methods(P<0.05).3 Comparison of positive rates of two times urine protein related indexes in each groupIn the healthy group,both of 24 h urine protein quantitation and 24 h microalbuminuria quantification(immunofluorescence)were negative,and one(not same)of two times 24 h microalbuminuria quantification(immunoturbidimetry)was positive,there were 2 positive cases in 24 h microalbuminuria quantification(immunoturbidimetry)in the 24h-urine(non-sufficient drinking water).The positive rate was low and not statistically significant(P>0.05).The paired four-grid table was used to show the number of positive urine protein indicators in the diabetic group.The microalbuminuria concentration and 24 h microalbuminuria quantification positive rates measured by immunoturbidimetry were statistically significant(P<0.05).Conclusion:1 When diagnosing early diabetic kidney disease,whether it is fluorescein or immunoturbidimetric measurement of urine MAU,insufficient drinking water can cause an increase in the positive rateof MAU.2 Compared with normal people,MAU of diabetic patients is susceptible by drinking water.3 UACR is a reliable indicator,and urine volume has less effect on it.