Sunday, August 31, 2008

week 10!

Subject title: Clinical Chemistry
Name of test: Urine Microalbumin Qualitative Test


Yay! 10 more weeks to go =)


Principle:

  • Urine Microalbumin Qualitative Test is a screening test to determine the presence of albumin and creatinine in urine. An albumin-to-creatinine ratio is also determined since the amount of albumin in the urine and the concentration of urine varies throughout the day, hence if we were to take the albumin results, it would not be very accurate. Creatinine on the other hand is excreted out on a consistent basis and its level is relatively stable in the urine. This test can be considered semi-quantitative, however it is not a confirmatory test.

  • This test involves plastic strips which contain two reagent areas that test for albumin and creatinine. The strips are then read instrumentally using CLINITEK STATUS®

  • Normally, albumin is present in urine at concentrations of less than 20mg/L. Measurements of 20-200mg/L indicates microalbuminuria whereas results of >200mg/L indicate clinical albuminuria. It is abnormal to have protein in your urine as the glomerular basement membrane is actually poorly permeable to it. Microalbuminuria can be an indication of glomerular damage.

  • Test principle for albumin: It is based on dye binding using a high affinity sulfonephthalein dye. If albumin is present, the colour of the reagent area that test for albumin will change to blue. The colour ranges from pale green to aqua blue.

  • Test principle for creatinine: It is based on the peroxidase-like activity of a copper creatinine complex that catalyzes the reaction of diisopropyl-benzene dihydroperoxide and 3,3,'5,5'-tetramethylbenzidine. The colour ranges from orange through green to blue.





Materials:


  1. Patients' urine

  2. CLINITEK® Microalbumin Reagent Strips





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3. CLINITEK® STATUS analyser







Retrieved 31 August, 2008, from http://diagnostics.siemens.com/webapp/wcs/stores/servlet/ProductDisplay?productId=172991&storeId=10001&langId=-111&catalogId=-111&catTree=100001,1015867

Method:

1. Check labels on the urine container to ensure the name of the patient tally

2. Key in the patient's lab no in the analyser

3. Dip a reagent strip into the sample making sure both reagent areas are wet

4. Remove the strip and drag the edge of the strip against the rim of the urine container to remove excess urine

5. Place the reagent strip with the reagent areas facing up, onto the analyser test table. Press START and the table will be automatically pulled into the analyser where the strip will be read.

6. Record the results displayed on the analyser

Results:

  • The results are determined by the Albumin-to-Creatinine Ratio (A:C) which is calculated automatically by the analyser
  • The results are recorded as NEGATIVE when the A:C displayed is <30mg/g>
  • The results are recorded as ABNORMAL when the A:C displayed is 30-300mg/g
  • The results are recorded as HIGHLY ABNORMAL when the A:C displayed is >300mg/g



Note:

  • Both ABNORMAL and HIGHLY ABNORMAL samples will be confirmed with the quantitative test which can be carried out in the machines COBAS or MODULAR P used in our lab
Nur Farhana Binte Ramlan
0604834B




10 comments:

De Incredibles said...

hihi.

just curious, how come u need additional test to confirm that the samples are abnormal? Isn't the CLINITEK® STATUS analyser's results accurate enough?

Thanks
Zhenling
TG02

hellomedtech said...

Hi there,

usually we'll carry out the quantitative test for the abnormal samples as to get the EXACT measurement...coz the analyser would not give the exact measurement..the results displayed are only 30-300mg/g and >300mg/g for abnormal and highly abnormal samples respectively...

hope ive cleared ur doubts, thanks for the qn =)

Nur Farhana
0604834B

tg01 group 2 said...
This comment has been removed by the author.
tg01 group 2 said...

Hi Nur Farhana

I've enjoyed reading your post and i have only 1 question to ask you. CLINITEK STATUS® is a machine to read the strips right? What are the controls or calibrations that need to be done to ensure it is in working conditions?

Thanks!!

Benjamin Ma
TG01

tg01 group 2 said...

Hi Farhana,

I have some questions here,

1)Why is 'Urine Microalbumin Qualitative test' known as a screening test but not a qualitative test? Also why called a qualitative test in the first place?

2)Why does the concentration of albumin varies while creatinine concentration remains relatively stable?

3)Why is this test considered a semi-quantitative test?

4)What is the mechanism by which sulfonephthalein dye binds to albumin?

5)Can you explain more on the following reaction: "peroxidase-like activity of a copper creatinine complex that catalyzes the reaction of diisopropyl-benzene dihydroperoxide and 3,3,'5,5'-tetramethylbenzidine." ?

Thankz!

Han Yang
TG01

hellomedtech said...

Hello Benjamin,

Yes we run controls every morning before we test our 1st sample of the day...we use commercially-available positive and negative controls..thanks for the qn =)

Nur Farhana
0604834B

hellomedtech said...

Hello Han Yang

1. Err i believe it is a screening test as it only tells whether a patient A:C is normal or abnormal..to confirm it we need to do quantitative..qualitative tests usually tell u whether a condition is present or absent (positive/negative/normal/abnormal)whereas quantitative tests usually give you the exact values for eg antibody titre..referring to your 3rd qn, this test can be considered semi-quantitative as it gives u the values RANGE for eg for abnormal samples ur A:C is usually 30-300mg/g but it does not tell you the EXACT value. thus,maybe u can say,it is a semi-quantitative, screening test for microalbuminuria. but our lab calls it qualitative btw =)

2. I think albumin level can be affected by diet ie high/low protein diet..whereas creatinine is a by product of muscle metabolism hence it is very much consistent..Hydration also can affect the concentration of the urine..creatinine is thus the best indicator for renal function..to get a very accurate reading of albumin, it is advised to use 24hr urine..however for this test, we just use random urine since we are looking at A:C.

4.Sulfonephthalein dye is sensitive to very low amt of albumin,as low as 2mg/dL. The reagent area for albumin contains this dye..if albumin is present in the urine, it will bind to the dye to give a colour change.

5.The reagent area for creatinine contains copper. Creatinine will react with copper to form a complex which exhibits peroxidase-like activity. This complex catalyzes the reaction between the 2 compounds mentioned to give a colour change.

hope ive cleared ur doubts..thanks

Nur Farhana
0604834B

~immortals~ said...

hey farhana

juat a teeny weeny question here. how long does it take for the analyser to produce the results?

that's all, thx
=)
Mayafirhana
TG02

hellomedtech said...

Hi Maya,

it only takes one minute to produce the results =)

thanks for the qn!

Nur Farhana
0604834B

Ms_chew said...

Just to clarify the issue about the urine albumin. It should not be present in the urine at all. Whereas creatinine should be present as it was only excreted through the kidenys. Thus, the test is used as a screening tool for dieases relating to the kidneys (more precise to the glomerulus). Please revise your basic HPI and HAP notes to see the functions of kidneys and how albumin and creatinine are excreted or not excreted.