Received March 14, 2008
Accepted on October 1, 2008

CLINICAL RESEARCH

First Morning Voids Are More Reliable Than Spot Urine Samples to Assess Microalbuminuria

Elsbeth C. Witte ^*, Hiddo J. Lambers Heerspink ¹, Dick de Zeeuw , Stephan J.L. Bakker ^*, Paul E. de Jong ^*, and Ronald Gansevoort

*Division of Nephrology and Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands

¹ To whom correspondence should be addressed. E-mail: h.j.lambers.heerspink{at}med.umcg.nl.

	Abstract

Measurement of urinary albumin excretion (UAE) in a 24-h collection is the gold standard method to determine the presence of microalbuminuria. We sought to compare more practical alternatives—measurement of urinary albumin concentration (UAC) or albumin:creatinine ratio (ACR)—in a first morning void or in a spot urine sample with this gold standard. We asked 241 participants of a prospective cohort study to make three 24-h urine collections, a first morning void, and a spot urine sample. Regression analysis showed that the ACR in a first morning void best agreed with 24-h UAE. The prevalence of microalbuminuria determined by data from a first morning void (7.5%, whether by UAC or ACR) nearly equaled the prevalence of microalbuminuria determined by 24-h UAE (10.0%), whereas the prevalence was higher when determined by spot urine samples (25.4% for UAC and 22.4% for ACR; both P < 0.001 versus 24-h UAE). The intraindividual coefficients of variation of the ACR in a first morning void and 24-h UAE were similar (19%). Intraindividual coefficients of variations of all other measurements of albuminuria were significantly greater. In conclusion, measurement of albuminuria in a first morning void, preferably as the ACR, is more reliable than a spot urine sample to diagnose and monitor microalbuminuria.