ANTECEDENTES: A excreção urinária de albumina indica lesão nos rins e é reconhecida como fator de risco para a progressão das doenças renal e cardiovascular. A dosagem da albumina urinária chama a atenção sobre a necessidade clínica de relatos de resultados precisos e claramente descritos. O National Kidney Disease Education Program e a Federação Internacional de Química Clínica e Medicina Laboratorial (IFCC) reuniram-se para avaliar o estado atual das questões pré-analíticas, analíticas e pós-analíticas que afetam as dosagens da albumina na urina e para identificar as áreas que necessitam de melhorias. CONTEÚDO: A química da albumina na urina não é completamente compreendida. Diretrizes atuais recomendam a utilização da relação albumina/creatinina (RAC) como substituta para a coleta de amostras cronometradas de urina, frequentemente inadequadas. Os resultados da RAC são afetados pela preparação do paciente, pela hora do dia da coleta das amostras e não é padronizada. Foram relatadas consideráveis diferenças intermétodos para a dosagem tanto de albumina quanto de creatinina, mas a verdade é desconhecida, porque não existem procedimentos de referência para a dosagem de albumina e não há materiais de referência para qualquer um desses analitos na urina. Os intervalos de referência recomendados para a RAC não consideram as grandes diferenças intergrupos na excreção da creatinina (por exemplo, relacionadas com diferenças em idade, sexo e etnia), nem o aumento contínuo no risco relacionado com a excreção de albumina. DISCUSSÃO: Necessidades clínicas foram identificadas para a padronização de (a) métodos de coleta da urina, (b) dosagens de albumina e de creatinina na urina com base em um sistema de referência completo, (c) relatórios dos resultados dos testes e (d) intervalos de referência para a RAC.

BACKGROUND: Urinary excretion of albumin indicates kidney damage and is recognized as a risk factor for progression of kidney disease and cardiovascular disease. The role of urinary albumin measurements has focused attention on the clinical need for accurate and clearly reported results. The National Kidney Disease Education Program and the IFCC convened a conference to assess the current state of preanalytical, analytical, and postanalytical issues affecting urine albumin measurements and to identify areas needing improvement. CONTENT: The chemistry of albumin in urine is incompletely understood. Current guidelines recommend the use of the albumin/creatinine ratio (ACR) as a surrogate for the error-prone collection of timed urine samples. Although ACR results are affected by patient preparation and time of day of sample collection, neither is standardized. Considerable intermethod differences have been reported for both albumin and creatinine measurement, but trueness is unknown because there are no reference measurement procedures for albumin and no reference materials for either analyte in urine. The recommended reference intervals for the ACR do not take into account the large intergroup differences in creatinine excretion (e.g., related to differences in age, sex, and ethnicity) nor the continuous increase in risk related to albumin excretion. DISCUSSION: Clinical needs have been identified for standardization of (a) urine collection methods, (b) urine albumin and creatinine measurements based on a complete reference system, (c) reporting of test results, and (d) reference intervals for the ACR.

Objective: To evaluate diabetes patients´ self-monitoring of blood glucose using a community pharmacy-based quality assurance procedure, to investigate whether the procedure improved the quality of the patient performance of self monitoring of blood glucose, and to examine the opinions of the patients taking part in the study. Methods: The results of patient blood glucose measurements were compared to the results obtained with HemoCue Glucose 201+ by pharmacy employees in 16 Norwegian community pharmacies. Patient performance was monitored using an eight item checklist. Patients whose blood glucose measurements differed from pharmacy measurements by more than 20% were instructed in the correct use of their glucometer. The patients then re-measured their blood glucose. If the results were still outside the set limits, the control procedure was repeated with a new lot of glucometer strips, and then with a new glucometer. The patients returned for a follow-up visit after three months. Results: During the first visit, 5% of the 338 patients had measurements that deviated from pharmacy blood glucose values by more than 20% and user errors were observed for 50% of the patients. At the second visit, there was no significant change in the analytical quality of patient measurements, but the percentage of patients who made user errors had decreased to 29% (p < 0.001). Eighty-five percent of the patients reported that they used their blood glucose results to adjust medication, exercise or meals. Fifty-one percent of the patients reported a greater trust in their measurements after the second visit. Eighty percent of patients wished to have their measurements assessed yearly. Of these patients, 83% preferred to have the assessment done at the community pharmacy. Conclusion: A community pharmacy-based quality assessment procedure of patients´ self monitoring of blood glucose significantly reduced the number of user errors. The analytical quality of the patients´ measurements was good and did not improve further during the study. The high analytical quality might be explained by a selection bias of participating patients. Patients also reported increased confidence in their blood glucose measurements after their measurements had been assessed at the pharmacy.

Objetivo: Evaluar la auto-monitorización de la glucemia de pacientes diabéticos que utilizan un procedimiento de aseguramiento de la calidad en farmacia comunitaria, investigar si el procedimiento mejoró la calidad de la ejecución de la monitorización del paciente, y examinar las opiniones de los pacientes que tomaron parte en el estudio. Métodos: Los resultados de las medidas de glucemia de los pacientes se compararon con los resultados obtenidos con un HemoCue Glucose 201+ por los empleados de la farmacia en 16 farmacias comunitarias noruegas. Se monitorizó la actuación del paciente utilizando un check-list de 8 puntos. Se educó en el uso del glucómetro a los pacientes cuyos valores de glicemia diferían en más de un 20% de los medidos en la farmacia. Después los pacientes volvieron a medir su glucemia. Si los resultados estaban aún fuera de los límites se repetía el procedimiento con un nuevo paquete de tiras de glucómetro, y después con un nuevo glucómetro. Los pacientes volvieron para una visita de seguimiento tres meses después. Resultados: Durante la primera visita, el 5% de los 338 pacientes tuvieron mediciones malas que se desviaron de las de la farmacia en valores superiores al 20% y se observaron errores en el 50% de los pacientes. En la segunda visita, no hubo cambios significativos en la calidad analítica de las medias de los pacientes, pero el porcentaje de usuarios con errores disminuyó al 29% (p<0,001). El 85% de los pacientes informó que utilizaban los resultados de su glucemia para ajustar la medicación, ejercicio o comidas. El 51% de los pacientes informó que tenían una mayor confianza en su medición después de la segunda visita. El 80% de los pacientes deseaba que se le evaluasen sus mediciones de glicemia anualmente. De estos pacientes, el 83% prefería que la evaluación se hiciese en la farmacia comunitaria. Conclusión: Un procedimiento de evaluación de la calidad de la auto-monitorización de glucemia realizado en farmacia comunitaria redujo significativamente el número de errores de los usuarios. La calidad analítica de las medidas de los pacientes fue buena y no mejoró durante el estudio. La alta calidad analítica podría explicarse por un sesgo de selección de los pacientes participantes. Los pacientes también informaron e un aumento de confianza en sus medidas de glucemia después de que sus mediciones fueses evaluadas en la farmacia.