Detection Of Significant Proteinuria Research Articles

Protein/creatinine ratio versus 24-hours urine protein in preeclampsia.

Proteinuria is one of the diagnostic criteria of preeclampsia (PE). Measurement of 24-hour urine protein is the gold standard method for detection of proteinuria in PE. The 24-hour urine sampling is time-consuming, and inconvenient. To evaluate the accuracy of protein/creatinine (P/C) ratio in detection of significant proteinuria (> 1 g/24-hours urine) in PE. One hundred and ten (110) preeclamptic women were included in this study and admitted for blood pressure monitoring, 24-hour urine collection, fetal well-being assessment and spot urine sample for measuring of P/C ratio. After thorough history and clinical examination, routine antenatal investigations were done for the women included in the study according to the hospital`s protocol, and to exclude pre-existing chronic renal disease. Twenty-four-hour urine collection started on the morning following hospital admission. Spot urine samples were obtained shortly before the 24-hour urine collection for measuring of P/C ratio. Collected data statistically analyzed to evaluate the accuracy of P/C ratio in detection of significant proteinuria in PE. The P/C ratio of 1.35 ± 2.54 had 94.4% sensitivity, 94.9% specificity, 97.1% positive predictive value (PPV), 90.2% negative predictive value (NPV), and 94.5% overall accuracy in detection of significant proteinuria (> 1 g/24-hour urine) in PE. The P/C ratio of 1.35 ± 2.54 had 94.4% sensitivity, 94.9% specificity, 97.1% PPV, 90.2% NPV, and 94.5% overall accuracy in detection of significant proteinuria (> 1 g/24-hour urine) in PE. This study suggests the use of P/C ratio as an alternative to 24-hour urine protein to detect significant proteinuria in PE.

A Comparison of Spot Urine Protein-Creatinine Ratio vs. 24 hours Urinary Protein Excretion in Women with Pre Eclampsia.

Objective: To evaluate diagnostic accuracy of spot urine protein-creatinine ratio for the diagnosis of proteinuria among patients with preeclampsia taking 24 hours urinary protein concentration > 300 mg/24hrs as gold standard. Study Design: This was a cross sectional study. Introduction: Preeclampsia can lead to significant morbidity and mortality. One of the important characteristic of diagnosis of preeclampsia is proteinuria. Gold standard for detection of significant proteinuria among these patients is 24 hours urinary proteins level (>300 milli grams). However, spot urinary protein-creatinine ratio can also detect proteinuria and save patients from botheration for collection of 24 hours urine. Previously, variable sensitivities, specificities and diagnostic accuracy of spot urinary protein-creatinine ratio had been calculated. So, this study was designed to determine diagnostic accuracy of spot urinary protein-creatinine ratio. Methods: 551 patients with preeclampsia were included. All patients had spot urinary protein-creatinine ratio (>0.3 was cutoff for proteinuria). All patients had 24 hours urinary protein test (>300 grams cutoff for proteinuria) as gold standard. Diagnostic accuracy of urinary protein-creatinine ratio was detected by determining sensitivity, specificity and accuracy. Results: Sensitivity, specificity, and accuracy of spot urinary protein-creatinine ratio were 95.8%, 94.2% and 91.6%, respectively. Conclusions: Due to its high sensitivity, specificity and diagnostic accuracy, urinary protein-creatinine ratio is a reliable test for diagnosing proteinuria among patients with preeclampsia.

Diagnostic Accuracy of Spot Urinary Protein and Albumin to Creatinine Ratios for Detection of Significant Proteinuria or Adverse Pregnancy Outcome in Patients With Suspected Pre-eclampsia

Objective To determine the diagnostic accuracy of two “spot urine” tests for significant proteinuria or adverse pregnancy outcome in pregnant women with suspected pre-eclampsia. Design Systematic review and meta-analysis. Data sources Searches of electronic databases 1980 to January 2011, reference list checking, hand searching of journals, and contact with experts. Inclusion criteria Diagnostic studies, in pregnant women with hypertension, that compared the urinary spot protein to creatinine ratio or albumin to creatinine ratio with urinary protein excretion over 24 hours or adverse pregnancy outcome. Study characteristics, design, and methodological and reporting quality were objectively assessed. Data extraction Study results relating to diagnostic accuracy were extracted and synthesised using multivariate random effects meta-analysis methods. Results Twenty studies, testing 2978 women (pregnancies), were included. Thirteen studies examining protein to creatinine ratio for the detection of significant proteinuria were included in the multivariate analysis. Threshold values for protein to creatinine ratio ranged between 0.13 and 0.5, with estimates of sensitivity ranging from 0.65 to 0.89 and estimates of specificity from 0.63 to 0.87; the area under the summary receiver operating characteristics curve was 0.69. On average, across all studies, the optimum threshold (that optimises sensitivity and specificity combined) seems to be between 0.30 and 0.35 inclusive. However, no threshold gave a summary estimate above 80% for both sensitivity and specificity, and considerable heterogeneity existed in diagnostic accuracy across studies at most thresholds. No studies looked at protein to creatinine ratio and adverse pregnancy outcome. For albumin to creatinine ratio, meta-analysis was not possible. Results from a single study suggested that the most predictive result, for significant proteinuria, was with the DCA 2000 quantitative analyser (>2 mg/mmol) with a summary sensitivity of 0.94 (95% confidence interval 0.86 to 0.98) and a specificity of 0.94 (0.87 to 0.98). In a single study of adverse pregnancy outcome, results for perinatal death were a sensitivity of 0.82 (0.48 to 0.98) and a specificity of 0.59 (0.51 to 0.67). Conclusion The maternal “spot urine” estimate of protein to creatinine ratio shows promising diagnostic value for significant proteinuria in suspected pre-eclampsia. The existing evidence is not, however, sufficient to determine how protein to creatinine ratio should be used in clinical practice, owing to the heterogeneity in test accuracy and prevalence across studies. Insufficient evidence is available on the use of albumin to creatinine ratio in this area. Insufficient evidence exists for either test to predict adverse pregnancy outcome.

868: The diagnostic utility of urinary protein to creatinine ratio (UPC) for the detection of significant proteinuria

868: The diagnostic utility of urinary protein to creatinine ratio (UPC) for the detection of significant proteinuria

Comparison of methods to identify significant proteinuria in pregnancy in the outpatient setting

The efficacy of the albumin/creatinine ratio (ACR) measurement in detection of significant proteinuria when performed in a high-risk antenatal clinic was compared with automated dipstick, protein/creatinine ratio (PCR), and 24-hour urine protein measurements. Both the ACR (DCA 2000) and PCR were strongly predictive for the presence or absence of significant proteinuria, with positive likelihood ratios (LRs) of 27.4 and 31.6 and negative LRs of 0.0 and 0.1, respectively. Both the ACR (DCA 2000) and PCR are effective tests for both identifying and excluding significant proteinuria in the outpatient setting. The ACR (DCA 2000) has the advantage of providing an immediate result.