Random Urine Protein-creatinine Ratio Research Articles

Comparison of random urine protein/creatinine ratio with 24-hour urine protein in suspected pre-eclampsia

IntroductionProteinuria is one of the classical criteria for the diagnosis of pre-eclampsia. The gold standard remains the measurement of 24-h urine protein which is time consuming and prone to preanalytical errors. Random urine protein creatinine ratio (UPCR) is endorsed by clinical practice guidelines as a faster alternative. The aim of this study was to evaluate the correlation between the 24-h urine protein excretion and UPCR in the identification of proteinuria in suspected preeclamptic patients. MethodA total of 51 women with suspected pre-eclampsia from the maternal fetal clinic of our institution were retrospectively studied. The correlation between the UPCR in random urine samples and protein excretion in the 24-h urine collection was determined by Deming Regression analysis and Pearson correlation on EP evaluator and SPSS respectively. ResultThere was a significant positive correlation between the numerical values obtained by 24-h urine protein and the UPCR (R = 0.88, P < 0.001). Concordance analysis showed 81.1% positive agreement for proteinuria between methods (>300 mg/24hr and >0.3) and 71.4% negative agreement. The clinical sensitivity and specificity of the UPCR was 74% and 69% respectively. ConclusionOverall, UPCR was well correlated with 24-h urine protein and could be an effective and compliant screening tool to indicate proteinuria in preeclamptic patients.

Effect of Rituximab on 24-Hour Urine Protein and Albumin or Renal Function in Patients with Glomerulonephritis.

This study aimed to investigate the correlation between the urine protein/creatinine ratio (PCR) and 24 h urine total protein quantity (24hUTP) in morning and random urine and its prediction equation. Rituximab (RTX), a monoclonal antibody that acts on the B cell epitope CD20, has been used in the renal field since 2005 and has become a hot topic in the clinical treatment of many glomerulonephritis diseases. Apart from focusing on the safety and efficacy of RTX in clinical treatment, some scholars are still working on the mechanism of its action in the treatment of renal diseases, trying to find its specific targets in renal tissues. Results. There was no significant difference between morning urine PCR, random urine PCR, and 24hUTP (P=0.81); there was a significant positive correlation between morning urine PCR and 24hUTP (r = 0.90, P < 0.01) and between random urine PCR and 24hUTP (r = 0.95, P < 0.01), and the correlation between random urine PCR and 24hUTP was higher than that between morning urine PCR and 24hUTP. The results of the ROC curve analysis showed that the correlation between morning urine PCR, random urine PCR, and 24hUTP was higher than that between morning urine PCR and 24hUTP in different groups. The optimal threshold values for random urine PCR to predict 2.4hUTP were 0.56 g/g (sensitivity 93.5%; specificity 75.4%), 1.11 g/g (sensitivity 98.3%; specificity 92.4%), and 3.43 g/g (sensitivity 87.9%; specificity 89.9%), respectively. The equations for predicting 24hUTP by morning urine PCR and random urine PCR were as follows: (1) 24hUTP(g) = 0.793 + 0.793 × morning urine PCR + 0.124 × total cholesterol − 0.177 × Alb (coefficient of determination R2 = 0.87); (2) 24hUTP(g) = 0.369 + 0.856 × random urine PCR + 0.132 × total cholesterol − 0.092 × Alb (coefficient of determination R2 = 0.92); the prediction equation of random urine was more accurate than that of morning urine. The correlation was not affected by gender, age, 24 h urine volume, etiology, eGFR, Alb, or total cholesterol level, and the correlation between random urine PCR and 24hUTP was higher than that of morning urine PCR. CR prediction equation was used instead of the 24hUTP test.

Diagnosis of proteinuria using a random urine protein-creatinine ratio and its correlation with adverse outcomes in pregnancy with preeclampsia characterized by renal damage.

Based on a limited number of studies, a random urine protein‐creatinine ratio (uPCR) value of ≥ 0.3 indicates abnormal proteinuria in preeclampsia with renal damage. However, current guidelines do not recommend a reasonable diagnostic threshold of uPCR for severe preeclampsia with renal damage. Furthermore, the correlation between the uPCR value and clinical adverse outcomes remains poorly understood. The aim of the present study was to evaluate the value of uPCR in the diagnosis of significant proteinuria and to assess its correlation with adverse pregnancy outcomes in preeclampsia characterized by renal damage. In all, 1837 women were enrolled in this retrospective cohort study. Eventually, 961 women were enrolled under the exclusion criteria. First, the authors found that uPCR and 24‐hour proteinuria showed a significant association (r = 0.901). The optimal threshold of uPCR for diagnosing preeclampsia was 0.295, and for diagnosing severe preeclampsia the cut‐off was 0.625. Meanwhile, the adjusted odds ratio per 1 unit increase in ln (uPCR) was 1.679 (95% confidence interval [CI]:1.142–2.469) for severe adverse perinatal outcomes; 1.456 (95% CI: 1.242–1.705) for small for gestational age; 1.380 (95% CI: 1.051–1.811) for severe small for gestational age; 1.672 (95% CI: 1.210–2.310) for very early preterm birth; 1.989 (95% CI 1.726–2.293) for severe hypertension; and 2.279 (95% CI 1.906–2.724) for preterm birth. This study indicated that there was a significant and positive correlation between uPCR and 24‐hour urine protein. For neonatal and maternal adverse outcomes, uPCR is an independent predictor of prognosis.

Point-of-Care vs Laboratory Based Urine Protein-Creatinine Ratio as an Indicator of Proteinuria in Pregnancy [9N

INTRODUCTION: Proteinuria is a hallmark finding in preeclampsia and a value of 300 mg or more in a 24 hour urine collection aids the diagnosis. A random urine protein-creatinine ratio (UPCR) of at least 0.3 mg/dL has emerged as a surrogate indicator of proteinuria. Point-of-care (POC) UPCR tests have been developed and may provide a convenient and timely extrapolation of proteinuria at the bedside. Although such testing has demonstrated excellent correlation with central laboratory methods in studies of non-pregnant patients, its validity and clinical utility have yet to be established in the pregnant population. Our objective was to evaluate POC UPCR as an indicator of proteinuria in pregnancy and compare it to the central laboratory method. METHODS: 108 urine samples from pregnant women presenting to triage for preeclampsia evaluation were collected prospectively from January to June 2015. For clinical purposes, a urine specimen was collected and sent to the laboratory for standard measurement of protein, creatinine and PC ratio using a Beckman Coulter Au5800, measuring turbidimetry by immunocomplexation with an anti-albumin antibody. A sample of the collected urine was tested via POC UPCR using Multistix Pro 11 reagent strips. Utilizing the manufacture interpretation guide, a “normal” strip ratio was defined as urine containing less than 300 mg protein/g creatinine. RESULTS: There was moderate agreement between POC UPCR and laboratory UPCR (k=0.512). After triage evaluation was complete, 31 women had a clinical diagnosis of preeclampsia. CONCLUSION: Results indicate that the POC UPCR is not reliable for the diagnosis of proteinuria when compared to the central laboratory UPCR.

The relatively poor correlation between random and 24-hour urine protein excretion in patients with biopsy-proven glomerular diseases

Random urine protein creatinine ratios are used to estimate 24-hour urine protein excretion, which is considered a diagnostic gold standard. However, few studies are available of the sensitivity and specificity of this estimation in patients with glomerular proteinuria. To clarify this, wemeasured the urine protein and creatinine centrally in random and 24-hour urine collections at biopsy and longitudinally every 6 months in individuals participating in the Nephrotic Syndrome Study Network (NEPTUNE) cohort with glomerular disease. In the initial developmental cohort, 302 patients had same day random and 24-hour samples with a total of 827 paired measurements across all visits. The protein excretion (g/day) was higher in adult than pediatric patients. The correlation between the random urine protein creatinine ratio and 24-hour urine protein excretion was moderate in both groups (r of 0.60 and 0.67, respectively). However, the log10 transformation of values strengthened correlations in both groups (r of 0.85 and 0.82, respectively). Associations were moderately stronger among obese patients. Prediction equations were developed and validated in 232 unique cases from NEPTUNE (R2 of 0.65). Thus, in patients with glomerular disease and proteinuria, the urine protein creatinine ratio correlates only moderately with 24-hour urine protein excretion. However an estimating equation was developed to derive 24-hour urine protein excretion from random urine protein creatinine ratio values with improved precision. The long-term prognostic value of log10-transformed random protein creatinine ratios values requires future study.

Correlation between the random urine protein-creatinine ratio and 24-hour proteinuria

Introduccion: la cuantificacion de proteinas en orina es un estudio que evalua la afectacion renal por ciertas enfermedades. Su medicion puede realizarse tambien a traves del cociente proteinuria/creatininuria. Objetivo: determinar la correlacion entre el cociente proteinuria/creatininuria y la proteinuria de 24 horas. Metodologia: se realizo un estudio descriptivo observacional, prospectivo con componente analitico de corte transverso, de muestreo no probabilistico. Se incluyo a 60 pacientes con factores de riesgo de padecer enfermedad renal cronica, que acudieron al Hospital Nacional (Itaugua) en el ano 2014. Todos se realizaron analisis de orina de 24 horas y de una muestra de orina al azar para estimar el cociente proteinuria/creatininuria. Resultados: se observo que existe una correlacion muy significativa (r= 0,9 p < 0,001) entre los valores del cociente de proteinuria/creatininuria en una orina al azar y la proteinuria de 24 horas, con una sensibilidad 94,1% (IC95% 79-100), especificidad 100% (IC95% 98-100%), valor predictivo positivo 100% (IC95% 96-100) y valor predictivo negativo 97,7% (IC95% 92-100). Conclusiones: el cociente proteinuria/creatininuria es util para detectar proteinuria en rango no nefrotico.

A STUDY OF RANDOM URINE PROTEIN TO CREATININE RATIO IN THE DIAGNOSIS OF NEPHROTIC SYNDROME IN CHILDREN

Background: The objective of the study was to evaluate the accuracy of urine protein creatinine ratio (UP/UC) in a random sample for quantitative measurement of proteinuria in comparison with 24 hours urinary protein excretion in children of nephrotic syndrome having normal Glomerular Filtration Rate (GFR).Methods: The present study was a descriptive type of study which was conducted in the department of paediatrics, Jay Kay Lon mother and child hospital, government medical college, Kota. Cases were noted down into the proforma with respect to history, examination and investigation. All the patients were advised regarding 24 hours urine collection. They were asked to give a 24 hours urine sample starting at 9.00 am for total protein excretion rate. A random urine sample was obtained and urine protein/creatinine ratio was calculated. The data was analyzed by linear regression and by calculating the correlation coefficient between urinary protein/creatinine ratio and 24 hour urinary protein. Also chi-square test was applied for non-parametric data.Results: Urine total protein in a timed 24 hour sample of nephrotic syndrome patients was in the range of 41.98-114.36 mg/m2/hour with the mean value of 64.76 mg/m2/hour. While as UP/UC ratio ranged from 2.33-5.2 with the mean value of 3.28. A significant correlation (r = 0.886) was found between timed 24 hour urinary protein and UP/UC ratio. Conclusions: Thus we conclude that random urine protein-creatinine ratio is highly reliable and rapid test for quantification of proteinuria in children. It reflects the amount of protein in a 24 hour collection. Thus it avoids all the drawbacks which are associated with time collection method.

Bucillamine-induced Nephropathy

Objective: Bucillamine is a disease-modifying antirheumatic drug that’s widely used in Korea and Japan, and it is reported to be a cause of proteinuria. However, the clinical course of the nephropathy associated with the use of bucillamine in rheumatoid arthritis patients has not been described in detail in Korea. Methods: We examined clinical records of 835 patients who were treated with bucillamine for rheumatoid arthritis at least 2 months at Ajou University Hospital from 2003 to 2008, and we found 23 patients (2.75%) with proteinuria. Each patient was followed up until the proteinuria had resolved. Results: At the time the proteinuria developed, the mean age of patients was 53.8±11.0 years. Only one patient had marked hypoalbuminemia (＜3.0 g/dL). The mean value of the random urine protein-creatinine ratio was 3.44±2.99. The proteinuria appeared 4∼18 months after the initiation of the treatment with bucillamine. Among the patients, renal biopsy was carried out in 18 patients, and pathological findings were 17 cases of membranous glomerulopathy and 1 case of focal segmental glomerulosclerosis. On the follow-up of the 18 patients, the proteinuria in all the patients had resolved completely without deterioration of renal function. But the time to resolution of the proteinuria was positively correlated with the length of bucillamine treatment after the onset of proteinuria (p＜0.001, r=0.744). Conclusion: Prevalence of proteinuria in patients receiving bucillamine was 2.75%, and bucillamine-induced nephropathy showed a good prognosis in Korea. The most important thing for resolving the bucillamine-induced proteinuria is to discontinue the bucillamine.