Screening of diabetic patients for microalbuminuria in primary care - The PROSIT-Project

The PROSIT (Proteinuria Screening and Intervention) Project started in 1993 in order to obtain data on the prevalence of micro- and macroalbuminuria i n diabetic patients treated in primary care, to establish an easy screening programme for microalbuminuria, in which also diabetic patients can partic ipate in self-responsibility, and to implement a specific intervention prog ramme for incipient nephropathy. In 58 representative doctor's offices 647 diabetic patients were included, who performed at home self-tests for micro albuminuria on three days within one week using the early morning urine and a newly developed qualitative immunologic test-strip for microalbuminuria. After storage they returned the same urine samples to their doctors' offic es for semiquantitative retesting with the immunologic test-strip Micral-Te st(R) II. In case of positive results the proteinuria dipstick Combur-9-Tes t(R) was applied in order to exclude other causes of positive microalbuminu ria (e.g, urinary tract infection). Data of 569 patients (6% Type 1, 88% Ty pe 2 and 6% secondary diabetes) could be analysed. Both qualitative self-te sting for microalbuminuria at home and semiquantitative retesting in doctor s' offices were found to be feasible. Based on semiquantitative retesting t he prevalences of microalbuminuria (macroalbuminuria) were 19.6% (0%) in Ty pe 1 diabetes, 17.2% (10.8%) in Type 3 diabetes and 11.7% (7.8%) in seconda ry diabetes. Type 2 diabetic patients showed a dear correlation between alb uminuria and diabetes duration, HbA1(c), serum creatinine triglycerides as well as micro- and macrovascular complications. 227 patients with micro- or macroalbuminuria were included into the ongoing PROSIT intervention progra mme.