64. Define the term 'microalbumin', explain why it is important to test for microalbuminuria in diabetics, and correlate microalbumin results with
other renal function test results.
 When a healthy adult excretes between 30 and 300 mg of albumin per day into the urine
 Or 20 to 200 picograms per minute
 May be indicative of diabetic nephropathy
 It cannot be detected by urinalysis since they need 300 mg/dL to detect the albumin
 If detected before the 300 mg/day mark, the effects of diabetes can be delayed or reversed with dietary restrictions and careful blood pressure
control
 
 Can be analyzed using a 24 hour urine
o Must refrain from strenuous exercise
o No chemical preservatives
o Refrigerate container during collection
o Use immunochemical assay todetect microalbuminuria
 Can also be analyzed using a random urine given the albumin/creatinine excretion ratio
  

 
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Glucos  From Fasting Type of Specimen 1. Reducing Potential Analysis
e carbohydrate Normal  Serum Glucose  Enol anion intermediate
 metabolism 70-100 mg/dL   of glucose is a source of reducing
 Upta   70-100 mg/dL fasting potential
ke into tissue is Pre-diabetes    Clinitest
regulated by 110-125 mg/dL  Plasma glucose is o Enol anion
insulin   3% lower reduces Cu+2 to Cu+1 resulting in
 From Diabetes Anticoagulant in tube a color change
gluconeogenesis 126 mg/dL causes osmotic shift o Used to screen
in liver and   of water from RBCs urine or feces
kidneys Random to the plasma
 Store > 200 = diabetes  Whole blood is
d as and released 10-15% lower
through glycogen Less water inside RBCs  
metabolism in for glucose to 1. Hexokinase (reference method)
liver and muscle dissolve in Hemolysis FN
 Com Difference increases with Lipemia & ictuerus FP
pletely increasing hematocrit 1.
reabsorbed by  
the kidneys Site of Collection
 Arterial and
capillary blood is
higher in glucose
than venous blood
 <5 mg/dL
difference fasting
or low insulin but  
as much as 1. Glucose Oxidase
70mg/dL post-  Spectrophotometric=
prandial or high TRINDER METHOD
insulin o A lot of
  interference w/ peroxide
In Vitro Glycolysis  Bilirubin,
 Cells continue to ascorbic acid, hemoglobin,
take up glucose uric acid, tetracyclines
after blood is
drawn
 Decreases at 5-
 10/hr at room
temp
 Separate within
60 min
o Stable for
hours at
room temp
or 72 hrs
refrigerated 1. Electrochemical
 Draw grey  Measure oxygen
stoppered tue if consumption= fewer
can't be separated interferences than Trinder
promptly o Measure using
o Fluoride polarographic electrode
inhibits sensitive to PO2 in reaction
enolase and mixture. O2 is proportional
glycolysis to glucose in the specimen.
o Maybe affected by
patient O2 levels and
hematocrit
 
1. Measure peroxidase reduction
 Electrode maintained at
high enough voltage to
oxidize peroxide, creating a
flow ofelectrons (current)
which is proportional to
glucose in specimen
 
1. Glucose Dehydrogenase
 Used in POC meters (accu-check)
False Positives
Galactose > 15 mg/dL
Asorbic acid > 3mg/dL
Lipemia (triglycerides)>1800 mg/dL
HgbA1c  Resul 3-6% of all hemoglobin A in non-  Fasting is 1. Standard Ion-exchange
ts from diabetics NOT required chromatography/HPLC
spontaneous    Collect  Reference method but no
glycation of Controlled = as close to 6% as purple top EDTA tube longer routinely performed
hemoglobin A possible and  Stable for  Labor intensive w/ long
 <7% several hours at analysis time
glycated   room temp, few days  Sensitive to changes in
hemoglobi at 4C temp, pH, ionic strength
n  Lyse  Requires pre-treatment
 whole blood to avoid interference from labile
stable and immediately prior to fraction Schiff base
persists analysis  A hollow tube filled with
 %Hgb   silica particles that have been
A1c in blood is  Patients modified to have certain particles on
proportional to with hemolytic its surface
the average episodes or recent  A weak acid has been
blood glucose transfusion invalidate added to the particles used in this
concentration   results method, giving an overall negative
over the  Patients charge
previous 6-8 with hemoglobin  Hemoglobin molecules
weeks assuming variants can be with more positive charge will stick to
normal RBC monitored only the column more readily
survival time against their own  Buffer is pumped through
 baseline the column, filtering out the
measure  Fr hemoglobin with more negative
long-term uctosamine can charge
control of be used instead  Absorbance is taken over
blood  Pl time
glucose in asma proteins, 2. HPLC for HgbA1c
diabetics mainly albumin  New reference method
since blood which are  Same principle as ion
samples glycated by the exchange chromatography but
collected at same instrumentation is automated so it
the time of mechanism as allows for strict control of temp, pH,
visit only hemoglobin ionic strength
reflect the  Re  Shorter analysis
past few flects average  Directly measures
hours blood glucose %HgbA1c
concentration 3. Immunoassay
over past 2  Abs specific to HgbA1c
weeks  For automated analyzers
and POC analyzers
o Must also
measure total Hgb
 Highest cost per test
4. Affinity chromatography
 Uses phenyl boronic acid
immobilized by resin which reacts
with HgbA1c, binding it
 Not affected by minor
fluctuations in temp, pH, or ionic
strength
 Not affected by
hemoglobin variants
 Measures total glycated
HgbA1c w/ correction factors used to
convert to HgbA1c