Abstract
Background Urine protein detection could be underestimated using the conventional dipstick method because of variations in urine aliquots. This study aimed to assess the efficacy of the semi-quantitative urine protein-to-creatinine (P/C) ratio compared with other laboratory methods.MethodsRandom urine samples were requested from patients undergoing chronic kidney disease screening. Significant proteinuria was determined by the quantitative P/C ratio of at least 150 mg protein/g creatinine. The semi-quantitative P/C ratio, dipstick protein and quantitative protein concentrations were compared and analyzed.ResultsIn the 2932 urine aliquots, 156 (5.3 %) urine samples were considered as diluted and 60 (39.2 %) were found as significant proteinuria. The semi-quantitative P/C ratio testing had the best sensitivity (70.0 %) and specificity (95.9 %) as well as the lowest underestimation rate (0.37 %) when compared to other laboratory methods in the study. In the semi-quantitative P/C ratio test, 19 (12.2 %) had positive, 52 (33.3 %) had diluted, and 85 (54.5 %) had negative results. Of those with positive results, 7 (36.8 %) were positive detected by traditional dipstick urine protein test, and 9 (47.4 %) were positive detected by quantitative urine protein test. Additionally, of those with diluted results, 25 (48.1 %) had significant proteinuria, and all were assigned as no significant proteinuria by both tests.ConclusionsThe semi-quantitative urine P/C ratio is clinically applicable based on its better sensitivity and screening ability for significant proteinuria than other laboratory methods, particularly in diluted urine samples. To establish an effective strategy for CKD prevention, urine protein screening with semi-quantitative P/C ratio could be considered.
Highlights
Urine protein detection could be underestimated using the conventional dipstick method because of variations in urine aliquots
The quantitative urine protein and creatinine concentrations were determined by an automated chemistry analyzer (Hitachi 911, Roche, Minnesota, USA), in which the former was measured by a turbidimetric method (U/CSF Protein, Roche, Minnesota, USA) and the latter was measure by Jaffe’s method (Crea, Roche, Minnesota, USA)
Significant proteinuria was considered as the quantitative urine protein level of at least 30 mg/dL or the quantitative P/C ratio of at least 150 mg protein/g creatinine (Stevens and Levin 2013)
Summary
Urine protein detection could be underestimated using the conventional dipstick method because of variations in urine aliquots. This study aimed to assess the efficacy of the semi-quantitative urine protein-to-creatinine (P/C) ratio compared with other laboratory methods. The prevalence of chronic kidney disease (CKD) has been increasing worldwide in recent decades. CKD in early stage is characterized by an increased glomerular filtration rate (GFR) with elevated urinary protein excretion. Protein detection in urine has been widely performed as part of the laboratory diagnosis in early CKD screening. The gold standard for measuring urine protein has been 24-h urine protein excretion. This method is notorious for its inconvenience and the inaccuracy involved in collecting the 24-h urine sample.
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