Contributed by Kim Zuber, PA-C, who oversees patients in seven dialysis centers for Metropolitan Nephrology Associates, Clinton, Md.

Referrals to our nephrology office often come with a 24-hour urine result. Since 2002, as outlined in both the U.S. national kidney guidelines (Kidney Disease Outcomes Quality Initiative) and the international kidney guidelines (Kidney Disease: Improving Global Outcomes), the urine test of choice is a urine albumin-to-creatinine ratio (UACR), which is a spot urine test.

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Last week, a 68-year-old diabetic woman who uses a walker and has impaired vision presented to the office with her laboratory results showing an elevated serum creatinine level. The primary care office also had her collect a 24-hour urine sample for our evaluation. I can guarantee you that this patient could not have collected that urine correctly.

A 24-hour urine collection requires that you save all urine (for women, this is quite hard to do) for 24 hours, that you keep it on ice, and that you do not have a bladder accident. How can a patient with a walker carry a urine jug to the refrigerator? How can a vision-impaired patient with diabetes see if she is pouring the collection into the jug? Because the spot UACR is considered more reliable than the 24-hour urine collection, we had her urinate into a cup in our office for a quick observation.

The National Kidney Disease Education Program at the NIH has a free UACR information sheet for professionals, along with patient education handouts on kidney disease. For more information, visit: (198-5)

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