Endocrine Abstracts

Introduction: Microalbuminuria is the first of sign of incipient nephropathy and other micro vascular complications in the diabetic population. Up to 30% of the paediatric diabetic population are at risk of developing microalbuminuria by the age of 20. NICE 2006 recommends microalbuminuria screening from 12 years of age in children with type 1 diabetes however there is no guidance on specimen collection, test methodology or treatment regime. The definition of microalbuminuria varies with type of specimen and test offered resulting in different screening practice in different hospitals in the UK.

Method: A postal questionnaire was sent to 100 paediatric diabetic services in the United Kingdom. The questionnaire asked the age of commencing microalbuminuria screening, the collection procedure, specimen numbers, methodology of microalbuminuria test and criteria for repeating the specimen and initiation of treatment for abnormal results.

Results: The response rate was 61 with 90% of hospitals screening for microalbuminuria annually, 33% units screening 5 years after diagnosis. Of 70% of hospitals commenced screening before 12 years of age. Of 65% undertook microalbumnuria screening on early morning urine and 94% used the albumin cretatinine ratio and there is wide variation in repeating the specimen for abnormal results. Nephrology referral occurred for persistent microalbuminuria for more than 6months in 31% units and more than 12 months in 57% units. Of 50% hospitals would consider starting ACE inhibitors.

Conclusion: The majority of respondents undertook microalbuminuria screening but only 30% follow nice guidance. There is wide variation in screening practice on method, type of specimen, repeating test on abnormal results and also seeking advice from Nephrologists. Detailed studies are required to ensure a National consensus on microalbuminuria screening, methodology and ongoing management for the paediatric diabetic patients.