依照國外Guideline...
DM患者應該3~6個月驗一次MAU...
但因為健Ｘ局的關係，國內醫師未免被核刪，多為1年驗一次...
另外一個問題由下面文章衍生出來...
http://forum.doctorvoice.org/viewtopic.php?f=17&t=33592
問題==>糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
請問各位站上各位前輩們...
對於這類患者，是否還需要驗有明確數值的MAU呢??
糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
版主: 版主013
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
如果我是審查委員
若發現proteinuria 1+~2+還驗microalbuminuria，殺無赦 (勾拳一記)
可是我不是審查委員喔
若發現proteinuria 1+~2+還驗microalbuminuria，殺無赦 (勾拳一記)
可是我不是審查委員喔
1984：
當記憶已經靠不住，書面記錄也經過偽造，
到這個時候，
黨宣稱他們改善了人們的生活條件，人們也只能相信了。
當記憶已經靠不住，書面記錄也經過偽造，
到這個時候，
黨宣稱他們改善了人們的生活條件，人們也只能相信了。
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
--------------------------草帽小子 寫:如果我是審查委員
若發現proteinuria 1+~2+還驗microalbuminuria，殺無赦 (勾拳一記)
可是我不是審查委員喔
+1
-
poki
- V4
- 文章: 4516
- 註冊時間: 週一 11月 13, 2006 5:24 am
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
對啊! 已經有proteinuria就趕快治療了,草帽小子 寫:如果我是審查委員
若發現proteinuria 1+~2+還驗microalbuminuria，殺無赦 (勾拳一記)
可是我不是審查委員喔
驗再多也沒用吧!
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
言之差矣！何以見得proteinuria 1+~2+ 一定是albuminuria ？草帽小子 寫:如果我是審查委員
若發現proteinuria 1+~2+還驗proteinuria 1+~2+ ，殺無赦 (勾拳一記)
可是我不是審查委員喔
如何區別尿液中的protein是albumin 而不是myoglobulin ?
你知道什麼叫做Bence Jones protein 嗎？
我們常常看到proteinuria 1+~2+ ，事實上測microalbumin卻是正常的！
Rhabdomyolysis時，尿液也會出現proteinuria，請問他是albuminuria嗎？當然不是
因為尿液中的protein無法分辨出到底是albumin OR myoglobulin，所以可以加測microalbumin！
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
申覆無效虎克 寫:言之差矣！何以見得proteinuria 1+~2+ 一定是albuminuria ？草帽小子 寫:如果我是審查委員
若發現proteinuria 1+~2+還驗proteinuria 1+~2+ ，殺無赦 (勾拳一記)
可是我不是審查委員喔
如何區別尿液中的protein是albumin 而不是myoglobulin ?
你知道什麼叫做Bence Jones protein 嗎？
我們常常看到proteinuria 1+~2+ ，事實上測microalbumin卻是正常的！
Rhabdomyolysis時，尿液也會出現proteinuria，請問他是albuminuria嗎？當然不是
因為尿液中的protein無法分辨出到底是albumin OR myoglobulin，所以可以加測microalbumin！
rhabdomyolysis 診斷沒有理由需要驗microalbumin
用urine routine來偵測Bence Jones protein, sensitivity 低
urine routine negative, 而懷疑MM 時，可加驗bence Jones protein
1984：
當記憶已經靠不住，書面記錄也經過偽造，
到這個時候，
黨宣稱他們改善了人們的生活條件，人們也只能相信了。
當記憶已經靠不住，書面記錄也經過偽造，
到這個時候，
黨宣稱他們改善了人們的生活條件，人們也只能相信了。
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
From: UpToDate
1.Urinalysis in the diagnosis of renal disease
http://www.utdol.com/online/content/top ... nldis/2332
＊＊Protein —
The urine dipstick primarily detects albumin but not other proteins, such as immunoglobulin light chains. This test is highly specific, but not very sensitive for the detection of proteinuria; it becomes positive only when protein excretion exceeds 300 to 500 mg/day.
Thus, the regular urine dipstick is an insensitive method to detect microalbuminuria, which is the earliest clinical manifestation of diabetic nephropathy and is associated with increased cardiovascular risk in patient with and without diabetes. In type 1 diabetes, the development of a positive dipstick for albumin is a relatively late event, occurring at a time when there is already substantial structural injury. There are also a variety of dipsticks that can be used to test for microalbuminuria, such as Clinitek Microalbumin Dipsticks and Micral-Test II test strips. (See "Microalbuminuria in type 1 diabetes mellitus", section on Detection and see "Microalbuminuria in type 2 diabetes mellitus", section on Detection, and see "Microalbuminuria and cardiovascular disease").
The semiquantitative categories on the dipsticks should be used with cautionand only as a rough guide since, at a given of albumin excretion, the albumin concentration will vary with the urine volume. A dilute urine, for example, will underestimate the degree of proteinuria, while a highly concentrated urine may have a 3+ response on the regular dipstick but not be indicative of heavy proteinuria.
False-positive results are common with many iodinated radiocontrast agents [14]. Thus, the urine should not be tested for protein with the dipstick for at least 24 hours after a contrast study.
1.Urinalysis in the diagnosis of renal disease
http://www.utdol.com/online/content/top ... nldis/2332
＊＊Protein —
The urine dipstick primarily detects albumin but not other proteins, such as immunoglobulin light chains. This test is highly specific, but not very sensitive for the detection of proteinuria; it becomes positive only when protein excretion exceeds 300 to 500 mg/day.
Thus, the regular urine dipstick is an insensitive method to detect microalbuminuria, which is the earliest clinical manifestation of diabetic nephropathy and is associated with increased cardiovascular risk in patient with and without diabetes. In type 1 diabetes, the development of a positive dipstick for albumin is a relatively late event, occurring at a time when there is already substantial structural injury. There are also a variety of dipsticks that can be used to test for microalbuminuria, such as Clinitek Microalbumin Dipsticks and Micral-Test II test strips. (See "Microalbuminuria in type 1 diabetes mellitus", section on Detection and see "Microalbuminuria in type 2 diabetes mellitus", section on Detection, and see "Microalbuminuria and cardiovascular disease").
The semiquantitative categories on the dipsticks should be used with cautionand only as a rough guide since, at a given of albumin excretion, the albumin concentration will vary with the urine volume. A dilute urine, for example, will underestimate the degree of proteinuria, while a highly concentrated urine may have a 3+ response on the regular dipstick but not be indicative of heavy proteinuria.
False-positive results are common with many iodinated radiocontrast agents [14]. Thus, the urine should not be tested for protein with the dipstick for at least 24 hours after a contrast study.
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
From: UpToDate
2.Overview of medical care in adults with diabetes mellitus
http://www.utdol.com/online/content/top ... view=print#
Screening for microalbuminuria —
Increased urinary protein excretion is the earliest clinical finding of diabetic nephropathy. The routine urine dipstick, however, is a relatively insensitive marker for proteinuria, not detecting protein until excretion exceeds 300 to 500 mg/day. (See "Treatment of diabetic nephropathy" and see "Microalbuminuria in type 1 diabetes mellitus" and see "Microalbuminuria in type 2 diabetes mellitus").
The normal rate of albumin excretion is less than 20 mg/day (15 mcg/min); persistent values between 30 and 300 mg/day (20 to 200 mcg/min) in a patient with diabetes is called microalbuminuria and is usually indicative of diabetic nephropathy (unless there is some coexistent renal disease) [11]. Values above 300 mg/day (200 mcg/min) are considered to represent overt proteinuria [12].
Microalbumin may be tested by screening with either a specifically sensitive dipstick or a laboratory assay on a spot urine sample, to determine an albumin-to-creatinine ratio. Abnormal results should be repeated at least two or three times over a three- to six-month period because of the large number of false positives that can occur [13]. Establishing the diagnosis of microalbuminuria requires the demonstration of a persistent (at least two abnormal tests) elevation in albumin excretion. Fever, exercise, heart failure, and poor glycemic control are among the factors that can cause transient microalbuminuria [13].
2.Overview of medical care in adults with diabetes mellitus
http://www.utdol.com/online/content/top ... view=print#
Screening for microalbuminuria —
Increased urinary protein excretion is the earliest clinical finding of diabetic nephropathy. The routine urine dipstick, however, is a relatively insensitive marker for proteinuria, not detecting protein until excretion exceeds 300 to 500 mg/day. (See "Treatment of diabetic nephropathy" and see "Microalbuminuria in type 1 diabetes mellitus" and see "Microalbuminuria in type 2 diabetes mellitus").
The normal rate of albumin excretion is less than 20 mg/day (15 mcg/min); persistent values between 30 and 300 mg/day (20 to 200 mcg/min) in a patient with diabetes is called microalbuminuria and is usually indicative of diabetic nephropathy (unless there is some coexistent renal disease) [11]. Values above 300 mg/day (200 mcg/min) are considered to represent overt proteinuria [12].
Microalbumin may be tested by screening with either a specifically sensitive dipstick or a laboratory assay on a spot urine sample, to determine an albumin-to-creatinine ratio. Abnormal results should be repeated at least two or three times over a three- to six-month period because of the large number of false positives that can occur [13]. Establishing the diagnosis of microalbuminuria requires the demonstration of a persistent (at least two abnormal tests) elevation in albumin excretion. Fever, exercise, heart failure, and poor glycemic control are among the factors that can cause transient microalbuminuria [13].
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
From UpToDate
3.Microalbuminuria in type 1 diabetes mellitus
http://www.utdol.com/online/content/top ... view=print
=====================================
4.Microalbuminuria in type 2 diabetes mellitus
http://www.utdol.com/online/content/top ... view=print
3.Microalbuminuria in type 1 diabetes mellitus
http://www.utdol.com/online/content/top ... view=print
=====================================
4.Microalbuminuria in type 2 diabetes mellitus
http://www.utdol.com/online/content/top ... view=print
最後由 MK 於 週六 8月 01, 2009 11:47 pm 編輯，總共編輯了 1 次。
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
From: UpToDate
5.Evaluation of isolated proteinuria in adults
http://www.utdol.com/online/content/top ... view=print
＊＊TYPES OF PROTEINURIA —
There are three basic types of proteinuria — glomerular, tubular, and overflow (show table 1) [2]. Only glomerular proteinuria (ie, albuminuria) is identified on a urine dipstick. Almost all cases of persistent proteinuria are due to glomerular proteinuria.
＊＊Glomerular proteinuria —
Glomerular proteinuria is due to increased filtration of macromolecules (such as albumin) across the glomerular capillary wall. The proteinuria associated with diabetic nephropathy and other glomerular diseases, as well as more benign causes such as orthostatic or exercise-induced proteinuria fall into this category. Most patients with benign causes of isolated proteinuria excrete less than 1 to 2 g/day. (See "Differential diagnosis of glomerular disease").
＊＊Tubular proteinuria —
Low molecular weight proteins — such as s2-microglobulin, immunoglobulin light chains, retinol-binding protein, and amino acids — have a molecular weight that is generally under 25,000 in comparison to the 69,000 molecular weight of albumin. These smaller proteins can be filtered across the glomerulus and are then almost completely reabsorbed in the proximal tubule. Interference with proximal tubular reabsorption, due to a variety of tubulointerstitial diseases or even some primary glomerular diseases, can lead to increased excretion of these smaller proteins [3-5].
Tubular proteinuria is often not diagnosed clinically since the dipstick for protein does not detect proteins other than albumin and the quantity excreted is relatively small. The increased excretion of immunoglobulin light chains (or Bence Jones proteins) in tubular proteinuria is mild, polyclonal (both kappa and lambda), and not injurious to the kidney. This is in contrast to the monoclonal and potentially nephrotoxic nature of the light chains in the overflow proteinuria seen in multiple myeloma.
＊＊Standard urine dipstick —
The standard urine dipstick primarily detects albumin via a colorimetric reaction between albumin and tetrabromophenol blue producing different shades of green according to the concentration of albumin in the sample. The dipstick is insensitive to the presence of non-albumin proteins. Thus a positive dipstick usually reflects glomerular proteinuria. Pure tubular or overflow proteinuria will not be diagnosed unless a 24-hour urine is collected for some other reason, or the urine is tested with sulfosalicylic acid which detects all proteins. (See "Sulfosalicylic acid test" below).
Proteinuria on the urine dipstick is graded from 1+ to 4+, which reflects progressive increases in the urine albumin concentration:
* Negative
* Trace — between 15 and 30 mg/dL
* 1+ — between 30 and 100 mg/dL
* 2+ — between 100 and 300 mg/dL
* 3+ — between 300 and 1000 mg/dL
* 4+ — >1000 mg/dL
The semiquantitative nature of this grading should only be used as a rough guide to the degree of proteinuria, since it strongly influenced by the urine volume. A high urine flow rate due to increased water intake or intravenous saline will lower the urine protein concentration by dilution but will not affect total protein excretion.
The urine dipstick is highly specific, but not very sensitive for the detection of mild proteinuria; it becomes positive only when protein excretion exceeds 300 to 500 mg/day. Thus, the standard urine dipstick is an insensitive methodto detect initial increases in protein excretion above the upper limit of normal of 150 mg/day as occurs in patients with microalbuminuria, which is the earliest clinical manifestation of diabetic nephropathy and, in patients with and without diabetes, is a marker of increased cardiovascular risk. (See "Microalbuminuria" below).
False-positive urine dipstick results are common with many iodinated radiocontrast agents [7]. Thus, the urine should not be tested for protein with the standard dipstick for at least 24 hours after a contrast study.
＊＊Microalbuminuria —
As noted above, the urine dipstick is highly specific, becomes positive only when protein excretion exceeds 300 to 500 mg/day but not very sensitive for the detection of initial increases in protein excretion above the upper limit of normal of 150 mg/day. Thus, the standard urine dipstick is an insensitive method to detect microalbuminuria, which is the earliest clinical manifestation of diabetic nephropathy and, in patients without diabetes, is a marker of increased cardiovascular risk.
The normal rate of albumin excretion is less than 20 mg/day (15 μg/min); microalbuminuria is defined as persistent albumin excretion between 30 and 300 mg/day (20 to 200 μg/min). Dipsticks are available that detect the urine albumin concentration in this range, but the preferred test for diagnosis and monitoring is the urine albumin-to-creatinine ratio, which is the similar in concept to the urine protein-to-creatinine ratio described in the preceding section.
These issues are discussed in detail elsewhere. (See "Microalbuminuria in type 1 diabetes mellitus" and see "Microalbuminuria in type 2 diabetes mellitus" and see "Microalbuminuria and cardiovascular disease").
SUMMARY
* Urinary protein excretion greater than 150 mg/day that persists beyond a single measurement should be evaluated. Proteinuria may be benign or suggestive of glomerular disease. Heavy proteinuria (>3 g/day), lipiduria, and edema are indicative of glomerular disease.
* There are three types of proteinuria: glomerular, tubular, and overflow proteinuria. Glomerular proteinuria accounts for virtually all cases of persistent proteinuria and is the only kind that is identified by urine dipstick. (See "Types of proteinuria" above).
* Qualitative tests for proteinuria include urine dipsticks and the sulfosalicylic acid test. These tests provide only rough estimates of the degree of proteinuria since they are influenced by the urine volume. (See "Measurement of urinary protein" above).
* The standard urine dipstick detects only albumin and is not sensitive enough to detect microalbuminuria. Sulfosalicylic acid (SSA) detects all proteins in the urine. (See "Measurement of urinary protein" above)
* Quantitative determination of the degree of proteinuria is provided by a 24-hour urine measurement. Such testing is cumbersome and an alternative, particularly for serial monitoring, is estimation of the total protein-to-creatinine ratio, which correlates with daily protein excretion. (See "Measurement of quantitative protein excretion" above)
* The optimal approach to the patient with proteinuria includes a thorough history, physical examination, and urinalysis. Transient and orthostatic proteinuria should be excluded. Persistent proteinuria warrants a thorough evaluation even when accompanied by a normal urine sediment. The evaluation should include measurement of serum creatinine and an ultrasound examination to rule out structural causes. (See "Approach to the patient with proteinuria" above)
* Patients with persistent proteinuria should be referred to a nephrologist for decisions regarding further management including renal biopsy. A renal biopsy may be performed in the setting of nephrotic syndrome, increasing protein excretion, or an elevation in the plasma creatinine concentration. (See "Approach to the patient with proteinuria" above)
* The renal prognosis of patients with glomerular proteinuria relates to the quantity of protein excreted. Non-nephrotic proteinuria (less than 3 g/day) is associated with a much lower risk of progressive chronic kidney disease than nephrotic range proteinuria. (See "Prognosis" above)
5.Evaluation of isolated proteinuria in adults
http://www.utdol.com/online/content/top ... view=print
＊＊TYPES OF PROTEINURIA —
There are three basic types of proteinuria — glomerular, tubular, and overflow (show table 1) [2]. Only glomerular proteinuria (ie, albuminuria) is identified on a urine dipstick. Almost all cases of persistent proteinuria are due to glomerular proteinuria.
＊＊Glomerular proteinuria —
Glomerular proteinuria is due to increased filtration of macromolecules (such as albumin) across the glomerular capillary wall. The proteinuria associated with diabetic nephropathy and other glomerular diseases, as well as more benign causes such as orthostatic or exercise-induced proteinuria fall into this category. Most patients with benign causes of isolated proteinuria excrete less than 1 to 2 g/day. (See "Differential diagnosis of glomerular disease").
＊＊Tubular proteinuria —
Low molecular weight proteins — such as s2-microglobulin, immunoglobulin light chains, retinol-binding protein, and amino acids — have a molecular weight that is generally under 25,000 in comparison to the 69,000 molecular weight of albumin. These smaller proteins can be filtered across the glomerulus and are then almost completely reabsorbed in the proximal tubule. Interference with proximal tubular reabsorption, due to a variety of tubulointerstitial diseases or even some primary glomerular diseases, can lead to increased excretion of these smaller proteins [3-5].
Tubular proteinuria is often not diagnosed clinically since the dipstick for protein does not detect proteins other than albumin and the quantity excreted is relatively small. The increased excretion of immunoglobulin light chains (or Bence Jones proteins) in tubular proteinuria is mild, polyclonal (both kappa and lambda), and not injurious to the kidney. This is in contrast to the monoclonal and potentially nephrotoxic nature of the light chains in the overflow proteinuria seen in multiple myeloma.
＊＊Standard urine dipstick —
The standard urine dipstick primarily detects albumin via a colorimetric reaction between albumin and tetrabromophenol blue producing different shades of green according to the concentration of albumin in the sample. The dipstick is insensitive to the presence of non-albumin proteins. Thus a positive dipstick usually reflects glomerular proteinuria. Pure tubular or overflow proteinuria will not be diagnosed unless a 24-hour urine is collected for some other reason, or the urine is tested with sulfosalicylic acid which detects all proteins. (See "Sulfosalicylic acid test" below).
Proteinuria on the urine dipstick is graded from 1+ to 4+, which reflects progressive increases in the urine albumin concentration:
* Negative
* Trace — between 15 and 30 mg/dL
* 1+ — between 30 and 100 mg/dL
* 2+ — between 100 and 300 mg/dL
* 3+ — between 300 and 1000 mg/dL
* 4+ — >1000 mg/dL
The semiquantitative nature of this grading should only be used as a rough guide to the degree of proteinuria, since it strongly influenced by the urine volume. A high urine flow rate due to increased water intake or intravenous saline will lower the urine protein concentration by dilution but will not affect total protein excretion.
The urine dipstick is highly specific, but not very sensitive for the detection of mild proteinuria; it becomes positive only when protein excretion exceeds 300 to 500 mg/day. Thus, the standard urine dipstick is an insensitive methodto detect initial increases in protein excretion above the upper limit of normal of 150 mg/day as occurs in patients with microalbuminuria, which is the earliest clinical manifestation of diabetic nephropathy and, in patients with and without diabetes, is a marker of increased cardiovascular risk. (See "Microalbuminuria" below).
False-positive urine dipstick results are common with many iodinated radiocontrast agents [7]. Thus, the urine should not be tested for protein with the standard dipstick for at least 24 hours after a contrast study.
＊＊Microalbuminuria —
As noted above, the urine dipstick is highly specific, becomes positive only when protein excretion exceeds 300 to 500 mg/day but not very sensitive for the detection of initial increases in protein excretion above the upper limit of normal of 150 mg/day. Thus, the standard urine dipstick is an insensitive method to detect microalbuminuria, which is the earliest clinical manifestation of diabetic nephropathy and, in patients without diabetes, is a marker of increased cardiovascular risk.
The normal rate of albumin excretion is less than 20 mg/day (15 μg/min); microalbuminuria is defined as persistent albumin excretion between 30 and 300 mg/day (20 to 200 μg/min). Dipsticks are available that detect the urine albumin concentration in this range, but the preferred test for diagnosis and monitoring is the urine albumin-to-creatinine ratio, which is the similar in concept to the urine protein-to-creatinine ratio described in the preceding section.
These issues are discussed in detail elsewhere. (See "Microalbuminuria in type 1 diabetes mellitus" and see "Microalbuminuria in type 2 diabetes mellitus" and see "Microalbuminuria and cardiovascular disease").
SUMMARY
* Urinary protein excretion greater than 150 mg/day that persists beyond a single measurement should be evaluated. Proteinuria may be benign or suggestive of glomerular disease. Heavy proteinuria (>3 g/day), lipiduria, and edema are indicative of glomerular disease.
* There are three types of proteinuria: glomerular, tubular, and overflow proteinuria. Glomerular proteinuria accounts for virtually all cases of persistent proteinuria and is the only kind that is identified by urine dipstick. (See "Types of proteinuria" above).
* Qualitative tests for proteinuria include urine dipsticks and the sulfosalicylic acid test. These tests provide only rough estimates of the degree of proteinuria since they are influenced by the urine volume. (See "Measurement of urinary protein" above).
* The standard urine dipstick detects only albumin and is not sensitive enough to detect microalbuminuria. Sulfosalicylic acid (SSA) detects all proteins in the urine. (See "Measurement of urinary protein" above)
* Quantitative determination of the degree of proteinuria is provided by a 24-hour urine measurement. Such testing is cumbersome and an alternative, particularly for serial monitoring, is estimation of the total protein-to-creatinine ratio, which correlates with daily protein excretion. (See "Measurement of quantitative protein excretion" above)
* The optimal approach to the patient with proteinuria includes a thorough history, physical examination, and urinalysis. Transient and orthostatic proteinuria should be excluded. Persistent proteinuria warrants a thorough evaluation even when accompanied by a normal urine sediment. The evaluation should include measurement of serum creatinine and an ultrasound examination to rule out structural causes. (See "Approach to the patient with proteinuria" above)
* Patients with persistent proteinuria should be referred to a nephrologist for decisions regarding further management including renal biopsy. A renal biopsy may be performed in the setting of nephrotic syndrome, increasing protein excretion, or an elevation in the plasma creatinine concentration. (See "Approach to the patient with proteinuria" above)
* The renal prognosis of patients with glomerular proteinuria relates to the quantity of protein excreted. Non-nephrotic proteinuria (less than 3 g/day) is associated with a much lower risk of progressive chronic kidney disease than nephrotic range proteinuria. (See "Prognosis" above)
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
From UpToDate
6.Evaluation of proteinuria in children
http://www.utdol.com/online/content/top ... view=print#
6.Evaluation of proteinuria in children
http://www.utdol.com/online/content/top ... view=print#
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
From:UpToDate
7.Measurement of urinary protein excretion
http://www.utdol.com/online/content/top ... view=print
SUMMARY AND RECOMMENDATIONS
* Daily urinary protein excretion is normally less than 150 mg, of which approximately 10 mg is albumin. Persistent albumin excretion between 30 and 300 mg/day is called microalbuminuria. Values of albumin excretion above 300 mg/day are considered to represent overt proteinuria or macroalbuminuria. At these levels, proteinuria consists primarily of albumin. (See "Amounts of proteinuria" above).
* We recommend NOT using the semiquantitative regular and albuminuria dipsticks to accurately quantify proteinuria. Limitations include significant error due to variations in urine concentrations and the decreased ability to detect non-albumin proteins, particularly immunoglobulin light chains. (See "Screening and semiquantitative measurements" above)
* We recommend obtaining a first morning specimen to quantify proteinuria, but a random specimen is acceptable if a first morning specimen is not available.
- We recommend that initial quantification of urinary proteinuria be performed using the urinary albumin-to-creatinine ratio on a random urine sample. With microalbuminuria (<300 mg/day), monitoring is also performed with this urinary ratio. (See "Quantitative measurements" above).
- With significant proteinuria (>300 to 500 mg/day) or with standard urinary dipstick positive proteinuria (1+ or greater), we suggest that monitoring and measurement of urinary protein excretion be performed with either the albumin-to-creatinine ratio or the total protein-to-creatinine ratio on a random urine specimen.
7.Measurement of urinary protein excretion
http://www.utdol.com/online/content/top ... view=print
SUMMARY AND RECOMMENDATIONS
* Daily urinary protein excretion is normally less than 150 mg, of which approximately 10 mg is albumin. Persistent albumin excretion between 30 and 300 mg/day is called microalbuminuria. Values of albumin excretion above 300 mg/day are considered to represent overt proteinuria or macroalbuminuria. At these levels, proteinuria consists primarily of albumin. (See "Amounts of proteinuria" above).
* We recommend NOT using the semiquantitative regular and albuminuria dipsticks to accurately quantify proteinuria. Limitations include significant error due to variations in urine concentrations and the decreased ability to detect non-albumin proteins, particularly immunoglobulin light chains. (See "Screening and semiquantitative measurements" above)
* We recommend obtaining a first morning specimen to quantify proteinuria, but a random specimen is acceptable if a first morning specimen is not available.
- We recommend that initial quantification of urinary proteinuria be performed using the urinary albumin-to-creatinine ratio on a random urine sample. With microalbuminuria (<300 mg/day), monitoring is also performed with this urinary ratio. (See "Quantitative measurements" above).
- With significant proteinuria (>300 to 500 mg/day) or with standard urinary dipstick positive proteinuria (1+ or greater), we suggest that monitoring and measurement of urinary protein excretion be performed with either the albumin-to-creatinine ratio or the total protein-to-creatinine ratio on a random urine specimen.
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
From:UpToDate
8.Epidemiology of chronic kidney disease and screening recommendations
http://www.utdol.com/online/content/top ... view=print#
以上從UpToDate找到的資料...
都已整理成PDF檔了...
放在下面網址之中...
有興趣的人可以連過去下載唷...
http://forum.doctorvoice.org/viewtopic. ... 18#p458818
8.Epidemiology of chronic kidney disease and screening recommendations
http://www.utdol.com/online/content/top ... view=print#
以上從UpToDate找到的資料...
都已整理成PDF檔了...
放在下面網址之中...
有興趣的人可以連過去下載唷...
http://forum.doctorvoice.org/viewtopic. ... 18#p458818
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- 文章: 2676
- 註冊時間: 週六 1月 12, 2008 3:26 am
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
看中華民國糖尿病學會是說如果U/A是沒有proteinuria再考慮驗MAU，
所以反之糖尿病學會是認為proteinuria是不考慮驗MAU的，
所以反之糖尿病學會是認為proteinuria是不考慮驗MAU的，
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
感謝fromformosa大大提供檔案連結...fromformosa 寫:看中華民國糖尿病學會是說如果U/A是沒有proteinuria再考慮驗MAU，
所以反之糖尿病學會是認為proteinuria是不考慮驗MAU的，
http://www.endo-dm.org.tw/db/book/2/糖尿病簡介.pdf
第30頁表格下方的小字:
*如果設備允許且蛋白尿呈「陰性」反應，則應加測微量白蛋白尿， r：初診有異常，則需執行。
==>沒說若成『陽性』反應，就不需加驗ＭＡＵ的準確數值.
JPG檔案如下:
-
SIMON
- 部長級
- 文章: 6661
- 註冊時間: 週三 8月 09, 2006 11:29 am
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
若是PERSISTED PROTEINURIA,應以 是MACROPROTIENURIA,其實驗MAU沒多大意思.
還請NEPHRO. COMMENT 一下
還請NEPHRO. COMMENT 一下
年年是好年，
不被病人嫌，
看病不被醃，
快樂勝神仙！
不被病人嫌，
看病不被醃，
快樂勝神仙！
-
HHCHANG
- R1
- 文章: 112
- 註冊時間: 週日 12月 30, 2007 5:55 pm
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
兩次 U/A protein 陽性, 要定量 proteinuria (決定 proteinuria 嚴重程度)
可以驗 spot urine albumin (microalbumin) / urine Cr ratio (ACR)
目前大致上來說 ACR = 24 hr urine protein amount (還有一些limitation不考慮的話)
可以驗 spot urine albumin (microalbumin) / urine Cr ratio (ACR)
目前大致上來說 ACR = 24 hr urine protein amount (還有一些limitation不考慮的話)
-
SIMON
- 部長級
- 文章: 6661
- 註冊時間: 週三 8月 09, 2006 11:29 am
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
偶也是都算ACR!HHCHANG 寫:兩次 U/A protein 陽性, 要定量 proteinuria (決定 proteinuria 嚴重程度)
可以驗 spot urine albumin (microalbumin) / urine Cr ratio (ACR)
目前大致上來說 ACR = 24 hr urine protein amount (還有一些limitation不考慮的話)
年年是好年，
不被病人嫌，
看病不被醃，
快樂勝神仙！
不被病人嫌，
看病不被醃，
快樂勝神仙！
-
JIMMY
- V1
- 文章: 1502
- 註冊時間: 週三 9月 13, 2006 9:08 am
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
urine CR不會被刪嗎?SIMON 寫:偶也是都算ACR!HHCHANG 寫:兩次 U/A protein 陽性, 要定量 proteinuria (決定 proteinuria 嚴重程度)
可以驗 spot urine albumin (microalbumin) / urine Cr ratio (ACR)
目前大致上來說 ACR = 24 hr urine protein amount (還有一些limitation不考慮的話)
-
SIMON
- 部長級
- 文章: 6661
- 註冊時間: 週三 8月 09, 2006 11:29 am
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
DM照護當時在彰基實習,JIMMY 寫:urine CR不會被刪嗎?SIMON 寫:偶也是都算ACR!HHCHANG 寫:兩次 U/A protein 陽性, 要定量 proteinuria (決定 proteinuria 嚴重程度)
可以驗 spot urine albumin (microalbumin) / urine Cr ratio (ACR)
目前大致上來說 ACR = 24 hr urine protein amount (還有一些limitation不考慮的話)
他們好像都算ACR,
當時DM照護照護學會的資料好像有2種說法,
但記的MICROALBUMIN要收集24HRS URINE,
SPOT URINE MICROALBUMIN好像不準,
但spot urine albumin (microalbumin) / urine Cr ratio (ACR) 較能真正評估 24 hr urine protein amount
所以偶也是都算ACR.
一年一次不大會被刪. （賊）
年年是好年，
不被病人嫌，
看病不被醃，
快樂勝神仙！
不被病人嫌，
看病不被醃，
快樂勝神仙！
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
我就是在等這一份公文...
主管機關有『健保局各區分局』、『衛生局』 、『醫師公會』等三個單位...
一切依照『老闆』說的算...
ＪＰＧ下載：
http://img43.imageshack.us/img43/7461/mauj.jpg
縮圖如下：
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sunnysunny
- R4
- 文章: 430
- 註冊時間: 週日 3月 30, 2008 6:00 pm
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
DM nephropathy 分5 期:
第3期 :microalbuminuria
第4期 :proteinuria
DM初次照護: 驗urine routine & microalbuminuria 應尚屬合理
--->若urine routine 尿蛋白陽性 則需評估有無影響尿液蛋白排出的情況?
1. 若無影響尿液蛋白排出的情況 -->則定量測量---->臨床蛋白尿期 開始治療
2. 若有影響尿液蛋白排出的情況--->治療 --->待影響情況消失-->重驗urine routine
(1) --->陽性--->定量測量---->臨床蛋白尿期 開始治療
(2)--->陰性----->驗microalbuminuria
影響尿液蛋白排出的情況:
1.偽陽性 :鹼化的尿液(PH>7);過濃縮的尿液(尿比重>1.02);血尿:白血球尿;24Hr 內使用過含碘顯影劑...etc
2.取尿前 24 Hr 劇烈運動
3.發燒
4.心衰竭時
5.考慮postural proteiuria
第3期 :microalbuminuria
第4期 :proteinuria
DM初次照護: 驗urine routine & microalbuminuria 應尚屬合理
--->若urine routine 尿蛋白陽性 則需評估有無影響尿液蛋白排出的情況?
1. 若無影響尿液蛋白排出的情況 -->則定量測量---->臨床蛋白尿期 開始治療
2. 若有影響尿液蛋白排出的情況--->治療 --->待影響情況消失-->重驗urine routine
(1) --->陽性--->定量測量---->臨床蛋白尿期 開始治療
(2)--->陰性----->驗microalbuminuria
影響尿液蛋白排出的情況:
1.偽陽性 :鹼化的尿液(PH>7);過濃縮的尿液(尿比重>1.02);血尿:白血球尿;24Hr 內使用過含碘顯影劑...etc
2.取尿前 24 Hr 劇烈運動
3.發燒
4.心衰竭時
5.考慮postural proteiuria
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vigorchar88
- Intern
- 文章: 38
- 註冊時間: 週六 2月 14, 2009 10:39 am
-
tedwang
- V3
- 文章: 3820
- 註冊時間: 週五 2月 27, 2009 10:29 pm
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
算個學分吧vigorchar88 寫:真是太厲害了各位前輩
小弟我從來不敢開
現在可以試試看了
努力學習中
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evernew
- Intern
- 文章: 14
- 註冊時間: 週四 7月 09, 2009 9:39 pm
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
所以應該是U/A的protein為陰性時
才考慮加驗MAU嗎
不過ACR是NKDI在Diabetic nephropathy的建議追蹤項目
若是想知道ACR的話
應該也可以驗urine creatinine and albumin level吧
(咦)
才考慮加驗MAU嗎
不過ACR是NKDI在Diabetic nephropathy的建議追蹤項目
若是想知道ACR的話
應該也可以驗urine creatinine and albumin level吧
(咦)
Re: 糖尿病/高血壓患者Urine Analysis中的Protein為+或++，還需要驗MAU嗎??
http://my2.tmu.edu.tw/b104094070/doc/1702
Microalbumin(微白蛋白)的臨床應用
Albumine(白蛋白)是血液中含量相當高的蛋白質，當腎臟功能正常時，並不會有Albumine(白蛋白)會滲漏到尿液中，而當腎衰竭(renal failure)時(腎功能緩慢降低的最後階段)，大量的Protein會滲漏到尿中。而在此程度的損傷發生之前，在腎臟的血液過濾系統微小的變化，將會使非常微量的Albumin(白蛋白)滲漏到尿液中，通常乃是由糖尿病患者之併發症所造成的。此情形稱為Microalbuminuria(微白蛋白尿)，而測定此非常微量的白蛋白試驗稱之為：Microalbumin(微白蛋白)。
糖尿病諸多的慢性併發症中，腎臟病變是發生率最高且耗費醫療成本最多的一項，糖尿病腎病變已成為全球導致腎衰竭的主因；且在亞洲族群有較高的發生率。
第一型或第二型糖尿病患者約20~30%會發生腎臟病變(nephropathy)；但第二型糖尿病患者，有相當少的比例會進展到末期腎疾病(ERSD)。然而，因第二型糖尿病有相當高的盛行率，因此在糖尿病洗腎患者中佔有相當大的比例。
腎病變最早出現的臨床證據為尿液中出現低但是異常濃度的白蛋白(≧30 mg/day or 20 ug/min)，稱之為微白蛋白尿，並且此病患患有初期腎病變(incipient nephropathy)，若沒有適當處理，則第一型糖尿病患者會產生持續性微白蛋白尿，約有80%患者的尿液白蛋白排泄量，每年增加10~20%；在10~15年間將會演變成嚴重性腎病變(overt nephropathy)或臨床性白蛋白尿(clinical albuminuria)(≧300mg/24 h or≧200 ug/min)，並且也會合併產生高血壓。一旦發生嚴重性腎病變(overt nephropathy)，若沒有適當處理，病患的腎絲球過濾率(GFR)將會逐漸地以每年2~20ml/min的速度遞減，在十年內，第一型糖尿病患者約有50%會進展到末期腎疾病(ERSD)，二十年則大於75%。
第二型糖尿病有高比例的患者，在診斷出糖尿病後不久既發現具有微白蛋白尿及嚴重性腎病變(overt nephropathy)，實際上，此乃因為診斷罹患出糖尿病之前早已存在多年，並且白蛋白尿(albuminuria)的出現也並不是專指糖尿病腎病變(diabetic nephropathy)者。出現微白蛋白尿的第二型糖尿病患者，若沒有適當處理，約有20~40%患者將會進展到嚴重性腎病變(overt nephropathy)，而在發生嚴重性腎病變二十年左右，約有20%會進展到末期腎疾病(ERSD)。
診斷出第二型糖尿病時，就應進行Microalbumin (微白蛋白)的檢驗。因第一型糖尿病患者短期間內發生微白蛋白尿的情形相當罕見，因此在五年後，每年應進行Microalbumin (微白蛋白)的篩檢。一些證據已證明，在青春期前患糖尿病者可能是產生微小血管併發症(microvascular complications)的重要因子。由於很難能精確地指出第二型糖尿病發生的時間，因此Microalbumin (微白蛋白)的篩檢在診斷時就應該開始，在最初篩檢及證實無微白蛋白尿之後，則每年應再進行Microalbumin(微白蛋白)的篩檢。
美國糖尿病學會(ADA)建議成人糖尿病患者每年應接受尿液常規(routine urinalysis)的檢查，如尿蛋白為陰性，則建議進行Microalbumin (微白蛋白)的檢驗。ADA也建議小孩於青春期開始時或羅患糖尿病五年之後，應每年接受篩檢。至於診斷出Microalbuminuria(微白蛋白尿)及開始使用angiotensin-converting enzyme(ACE) inhibitor或angiotensin receptor blocker(ARB)治療及控制血壓之後，專家學者仍建議繼續監測微白蛋白尿，以評估對於治療的反應及疾病的進展。
Microalbuminuria(微白蛋白尿)的篩檢可藉由三種方式：
(1)收集單次小便(random spot collection)以測定albumin與creatinine的比率
(2)收集24小時尿液，並可同時測定creatinine clearance
(3)計時收集(timed collection)(例如：4 hr or overnight collection)。
第一種方式較容易實行，並可提供準確的訊息，因此較受歡迎，清晨第一次尿或早晨尿液的收集是最好的，乃因白蛋白的排泄隨晝夜略為不同(diurnal variation)，但是此時段不能配合時，對於同一個體不同檢体的收集，應在相同的時段實行。如果尿液中之白蛋白的排泄≧30mg/24hr(timed specimen為20ug/min；random sample為30mg/g creatinine)則具有Microalbuminuria(微白蛋白尿)的存在。
由於尿液中之白蛋白的排泄每天的變化相當大，所以在3~6個月內所收集3個檢体中至少要有兩個檢体呈現異常，才可診斷具有Microalbuminuria(微白蛋白尿)的存在。
※運動(24hrs內)，感染，發燒，心臟衰竭，血糖太高(marked hyperglycemia)，血壓太高(marked hypertension)，膿尿(pyuria)及血尿會引起尿液中白蛋白的排泄暫時性地增加。
Microalbuminuria(微白蛋白尿)已成為糖尿病病患臨床上腎功能惡化早期的重要指標，此可必免日後因腎臟病變走上血液透析(洗腎)或腎臟移植之途，可大大地提升病患的生活品質及減少醫療成本的支出，已被歐美糖尿病學會所接受，定期地篩檢尿液中白蛋白的排泄量(urinary albumin excretion)以監控第一型及第二型糖尿病。
此外，因腎衰竭由於鹽類及水分代謝的改變，時常導致高血壓，進而惡化發展至末期腎疾病(ERSD)，並且高血壓本身可能引發腎病變(例如：在初期子癇(preeclampsia)和原發性高血壓(idiopathic essential hypertension))，因此更有效地確認高血壓病患產生腎病變(hypertensive nephropathy)的檢查乃為監測尿液中白蛋白的排泄量(urinary albumin excretion)，另外，微白蛋白尿也可作為心血管疾病(CVD)危險性增加的指標。
但很可惜地，國內microalbumin(微白蛋白)的檢驗並不普遍，也沒有健保給付，但尿液微量白蛋白的檢驗是非常值得推動的檢查，期望將來能將microalbumin(微白蛋白)的檢驗納入糖尿病照護甚至高血壓病患照護計劃之常規檢查，以提高照護品質，減輕社會醫療成本，創造國民更優質的健康生活。
註：最後一段是錯的，目前健保局已將MAU列為糖尿病患者的照護品質指標之一...
Microalbumin(微白蛋白)的臨床應用
Albumine(白蛋白)是血液中含量相當高的蛋白質，當腎臟功能正常時，並不會有Albumine(白蛋白)會滲漏到尿液中，而當腎衰竭(renal failure)時(腎功能緩慢降低的最後階段)，大量的Protein會滲漏到尿中。而在此程度的損傷發生之前，在腎臟的血液過濾系統微小的變化，將會使非常微量的Albumin(白蛋白)滲漏到尿液中，通常乃是由糖尿病患者之併發症所造成的。此情形稱為Microalbuminuria(微白蛋白尿)，而測定此非常微量的白蛋白試驗稱之為：Microalbumin(微白蛋白)。
糖尿病諸多的慢性併發症中，腎臟病變是發生率最高且耗費醫療成本最多的一項，糖尿病腎病變已成為全球導致腎衰竭的主因；且在亞洲族群有較高的發生率。
第一型或第二型糖尿病患者約20~30%會發生腎臟病變(nephropathy)；但第二型糖尿病患者，有相當少的比例會進展到末期腎疾病(ERSD)。然而，因第二型糖尿病有相當高的盛行率，因此在糖尿病洗腎患者中佔有相當大的比例。
腎病變最早出現的臨床證據為尿液中出現低但是異常濃度的白蛋白(≧30 mg/day or 20 ug/min)，稱之為微白蛋白尿，並且此病患患有初期腎病變(incipient nephropathy)，若沒有適當處理，則第一型糖尿病患者會產生持續性微白蛋白尿，約有80%患者的尿液白蛋白排泄量，每年增加10~20%；在10~15年間將會演變成嚴重性腎病變(overt nephropathy)或臨床性白蛋白尿(clinical albuminuria)(≧300mg/24 h or≧200 ug/min)，並且也會合併產生高血壓。一旦發生嚴重性腎病變(overt nephropathy)，若沒有適當處理，病患的腎絲球過濾率(GFR)將會逐漸地以每年2~20ml/min的速度遞減，在十年內，第一型糖尿病患者約有50%會進展到末期腎疾病(ERSD)，二十年則大於75%。
第二型糖尿病有高比例的患者，在診斷出糖尿病後不久既發現具有微白蛋白尿及嚴重性腎病變(overt nephropathy)，實際上，此乃因為診斷罹患出糖尿病之前早已存在多年，並且白蛋白尿(albuminuria)的出現也並不是專指糖尿病腎病變(diabetic nephropathy)者。出現微白蛋白尿的第二型糖尿病患者，若沒有適當處理，約有20~40%患者將會進展到嚴重性腎病變(overt nephropathy)，而在發生嚴重性腎病變二十年左右，約有20%會進展到末期腎疾病(ERSD)。
診斷出第二型糖尿病時，就應進行Microalbumin (微白蛋白)的檢驗。因第一型糖尿病患者短期間內發生微白蛋白尿的情形相當罕見，因此在五年後，每年應進行Microalbumin (微白蛋白)的篩檢。一些證據已證明，在青春期前患糖尿病者可能是產生微小血管併發症(microvascular complications)的重要因子。由於很難能精確地指出第二型糖尿病發生的時間，因此Microalbumin (微白蛋白)的篩檢在診斷時就應該開始，在最初篩檢及證實無微白蛋白尿之後，則每年應再進行Microalbumin(微白蛋白)的篩檢。
美國糖尿病學會(ADA)建議成人糖尿病患者每年應接受尿液常規(routine urinalysis)的檢查，如尿蛋白為陰性，則建議進行Microalbumin (微白蛋白)的檢驗。ADA也建議小孩於青春期開始時或羅患糖尿病五年之後，應每年接受篩檢。至於診斷出Microalbuminuria(微白蛋白尿)及開始使用angiotensin-converting enzyme(ACE) inhibitor或angiotensin receptor blocker(ARB)治療及控制血壓之後，專家學者仍建議繼續監測微白蛋白尿，以評估對於治療的反應及疾病的進展。
Microalbuminuria(微白蛋白尿)的篩檢可藉由三種方式：
(1)收集單次小便(random spot collection)以測定albumin與creatinine的比率
(2)收集24小時尿液，並可同時測定creatinine clearance
(3)計時收集(timed collection)(例如：4 hr or overnight collection)。
第一種方式較容易實行，並可提供準確的訊息，因此較受歡迎，清晨第一次尿或早晨尿液的收集是最好的，乃因白蛋白的排泄隨晝夜略為不同(diurnal variation)，但是此時段不能配合時，對於同一個體不同檢体的收集，應在相同的時段實行。如果尿液中之白蛋白的排泄≧30mg/24hr(timed specimen為20ug/min；random sample為30mg/g creatinine)則具有Microalbuminuria(微白蛋白尿)的存在。
由於尿液中之白蛋白的排泄每天的變化相當大，所以在3~6個月內所收集3個檢体中至少要有兩個檢体呈現異常，才可診斷具有Microalbuminuria(微白蛋白尿)的存在。
※運動(24hrs內)，感染，發燒，心臟衰竭，血糖太高(marked hyperglycemia)，血壓太高(marked hypertension)，膿尿(pyuria)及血尿會引起尿液中白蛋白的排泄暫時性地增加。
Microalbuminuria(微白蛋白尿)已成為糖尿病病患臨床上腎功能惡化早期的重要指標，此可必免日後因腎臟病變走上血液透析(洗腎)或腎臟移植之途，可大大地提升病患的生活品質及減少醫療成本的支出，已被歐美糖尿病學會所接受，定期地篩檢尿液中白蛋白的排泄量(urinary albumin excretion)以監控第一型及第二型糖尿病。
此外，因腎衰竭由於鹽類及水分代謝的改變，時常導致高血壓，進而惡化發展至末期腎疾病(ERSD)，並且高血壓本身可能引發腎病變(例如：在初期子癇(preeclampsia)和原發性高血壓(idiopathic essential hypertension))，因此更有效地確認高血壓病患產生腎病變(hypertensive nephropathy)的檢查乃為監測尿液中白蛋白的排泄量(urinary albumin excretion)，另外，微白蛋白尿也可作為心血管疾病(CVD)危險性增加的指標。
但很可惜地，國內microalbumin(微白蛋白)的檢驗並不普遍，也沒有健保給付，但尿液微量白蛋白的檢驗是非常值得推動的檢查，期望將來能將microalbumin(微白蛋白)的檢驗納入糖尿病照護甚至高血壓病患照護計劃之常規檢查，以提高照護品質，減輕社會醫療成本，創造國民更優質的健康生活。
註：最後一段是錯的，目前健保局已將MAU列為糖尿病患者的照護品質指標之一...