Spot Protein Creatinine Ratio Research Articles

Long-term effect of eplerenone treatment in children with chronic allograft nephropathy.

Literature supports the protective role of mineralocorticoid antagonist (MRA) against the renal injury induced by aldosterone in kidney transplant recipients. However, there is limited data available regarding the safety and efficacy of MRAs in pediatric renal transplant patients. Therefore, we aimed to investigate the effect of long-term eplerenone administration in children with chronic allograft nephropathy (CAN). Twenty-six renal transplant children with biopsy-proven CAN, an estimated glomerular filtration rate (eGFR ) > 40 mL/min per 1.73 m2 and with a significant proteinuria were included. Selected patients were randomly divided into two groups as follows; Group 1 (n = 10) patients received 25 mg/day eplerenone and Group 2 (n = 16) patients did not receive eplerenone for 36 months. Patients were examined in the renal transplant outpatient clinic biweekly for the first month and once a month thereafter. The primary outcome of the patients was compared. Mean eGFR stayed stable in group 1 patients, but significantly decreased in group 2 at 36 months (57.53 ± 7.53 vs. 44.94 ± 8.04 mL/min per 1.73 m2 , p = .001). Similarly, spot protein-creatinine ratio was significantly lower in group 1 compared to group 2 patients at 36 months (1.02 ± 7.53 vs. 3.61 ± 0.53, p < .001). Eplerenone associated hyperkalemia was not observed in group 1 patients (4.6 ± 0.2 vs. 4.56 ± 0.3, p = .713). The long-term eplerenone administration blunted the chronic allograft nephropathy by maintaining a stable eGFR levels and decreasing urine protein-creatinine ratio. Eplerenone associated hyperkalemia was not observed in our study.

Cross-sectional diagnostic accuracy study of self-testing for proteinuria during hypertensive pregnancies: The UDIP study.

To determine the accuracy of self-testing for proteinuria during pregnancy. Diagnostic accuracy study. Antenatal clinics, maternity assessment units and inpatient wards at three hospital sites. 345 pregnant women. Pregnant women self-tested in-clinic for urinary protein using visually read dipsticks with samples then sent for laboratory estimation of the spot protein-creatinine ratio (PCR) (primary reference test). Secondary index tests included testing by antenatal healthcare professionals and an automated colorimetric reader. Sensitivity, specificity, negative predictive value, positive predictive value and likelihood ratios were calculated for self-testing (primary index test) along with healthcare professional and colorimetric testing compared to the primary reference test (PCR). 335/345 (97%) had sufficient data to be included in the analysis. Self-testing had a sensitivity of 0.71 (95% confidence interval [CI] 0.62-0.79) and a specificity of 0.89 (95% CI 0.84-0.92) compared to PCR. Sensitivity and specificity of testing by healthcare professionals and the colorimetric reader were similar: sensitivity 0.73 (95% CI 0.64-0.80) and 0.78 (95% CI 0.69-0.85), respectively; specificity 0.88 (95% CI 0.82-0.92) and 0.83 (95% CI 0.78-0.88), respectively. Pregnant women can visually read a dipstick for urinary protein with similar accuracy to antenatal healthcare professionals. Automated colorimetric testing was not significantly different, in contrast to some previous studies. Self-testing has the potential to form part of a self-monitoring regime in pregnancy.

Comparative Evaluation of Quantitative Protein Measurement of 12-Hour and 24-hour Urine Sample for the Diagnosis of Nephrotic Syndrome and their Correlation with Spot Urinary Protein Creatinine Ratio

Background: The amount of protein excretion is a reflection of disease activity in Nephrotic Syndrome. 24-hour urine collection has remained as the method of choice to quantify proteinuria. An alternative method for quantitative evaluation of proteinuria is measuring the ratio of protein or albumin to creatinine in an untimed ‘‘spot’’ urine specimen.&#x0D; Objective: To compare 12-hour versus 24-hour proteinuria in nephrotic syndrome and its correlation to spot urinary protein creatinine ratio.&#x0D; Materials &amp; Methods: A comparative cross-sectional study was conducted in the Department of Pediatrics, Sir Salimullah Medical College Mitford Hospital (SSMC &amp; MH), Dhaka over a period from September 2016 to June 2017. All the babies developing 1st attack of Nephrotic Syndrome and meeting the clinical criteria were included in the study. Complete history was taken from accompanying attendants. Thorough clinical examinations and relevant laboratory investigations (12- hour day urinary protein, 12-hour night urinary protein, 24-hour urinary total protein, S. Albumin, S. Cholesterol, Urinary spot Protein Creatinine ratio) were done. All the information was recorded in the fixed protocol. Collected data were classified, edited, coded and entered into computer for statistical analyses.&#x0D; Results: Out of 50 cases, the mean age was found 58.3±29.0 months. 12-hour day urinary protein was found 2.02±0.167 gm/m2/12 hours, mean; 12-hour night urinary protein was found 2.12±2.18 gm/m2/12 hours, mean; 24-hour urinary total protein was found 4.10±3.32 gm/m2/24 hours. The mean spot urinary protein creatinine ratio was found 12.58±7.21 with range from 2.02 to 29.85. There was no statistically significant difference between 12- hour day sample and 12-hour night sample. There was also no significant difference between 12-hour day &amp; night sample with 24-hour sample. Results of all 03 samples were comparable to urinary protein creatinine ratio.&#x0D; Conclusion: This study reveals no statistically significant difference in quantitative estimation of 12-hour day and night protein with 24-hour urinary total protein. The 12- hour day and night protein and urinary total protein were comparable with each other and also with urinary spot protein creatinine ratio.So 12-hour day or night urinary total protein may be a diagnostic tool for nephrotic syndrome.&#x0D; Sir Salimullah Med Coll J 2021; 29(2): 105-111

Urine Spot Protein Creatinine Ratio as a Predictor of Disease Severity and Adverse Outcome in Children with Dengue: A Cross-sectional Study

Introduction: Dengue is a viral infection with different presentations, hence predicting the disease severity at admission is essential to triage patients needing meticulous monitoring. In severe dengue there is increase of urinary protein clearance due to the increase in systemic vascular permeability. Simple urine protein excretion screening test could guide the triage and monitor the patients with suspected dengue infection. Aim: To evaluate the urine spot Protein Creatinine Ratio (PCR) as a tool in predicting the disease severity and adverse outcome in children with dengue. Materials and Methods: The present cross-sectional study was conducted in Institute of Child Health, Egmore, Tamil Nadu, India, from October 2021 to December 2021. All children aged 1 month to 12 years presenting with symptoms of fever, thrombocytopenia (less than 1, 50, 000 /µL) with or without dengue non structural protein component (NS1)/ Immunoglobulin M Enzyme Linked Immunosorbent Assay (ELISA) positivity were recruited for the study. Study parameters included were demographic factors, severity of dengue classification based on National Vector Borne Disease Control Programme (NVBDCP) guidelines, urine spot PCR. The UPCR (urine protein creatinine ratio) was compared between dengue and non dengue cases and within the different categories of dengue cases. Chi-square was used for comparing proportions. Results: Among 150 children enrolled in present study, 134 (89.3%) were dengue positive, 16 (10.7%) were non dengue. Most predominant age group involved was 6-9 years followed by 3 to 6 years. Among 134 children with dengue, 98 (73.1%) had high UPCR and among 16 non dengue children, 2 (12.5%) had high UPCR which was statistically significant (p&lt;0.0001). Mean spot UPCR was 0.32±0.12 in mild dengue, 0.77±0.40 in moderate dengue and 1.68±1.67 in severe dengue which was statistically significant (p&lt;0.0001). Children with severe dengue had higher PCR values in comparison to mild and moderate dengue. Conclusion: There was a statistically significant association of urine spot PCR with severity of dengue and this simple test can be used for triaging and monitoring children with suspected dengue.

Protein-creatinine ratio and albumin-creatinine ratio for the diagnosis of significant proteinuria in pregnant women with hypertension: Systematic review and meta-analysis of diagnostic test accuracy.

The gold standard for assessment and diagnosis of significant proteinuria in pregnancy has been by 24-hour urine collection and analysis. Determining fast, accurate methods to identify clinically significant proteinuria would aid diagnosis of pre-eclampsia. The objective of this study was to determine the accuracy of spot protein-creatinine ratio (PCR) and albumin-creatinine ratio (ACR) measurements compared with 24-hour urine collection for the identification of clinically significant proteinuria in women with hypertensive disorders of pregnancy. Search strategies were developed for electronic databases from inception to 1st October 2020. Data were assessed for methodological quality using the QUADAS-II checklist for risk of bias and quality of the evidence using GRADE. Meta-analysis was performed where there were at least four studies presenting data for the same comparison (test and threshold). This is an update of the review for NICE guideline NG133 (published June 2019) and includes additional data. Twenty-nine studies were included. PCR measurements (28 studies) showed high sensitivity (91%) and specificity (89%) at a threshold of 30mg/mmol (n=3577). Higher thresholds (>60mg/mmol) increased specificity, but reduced sensitivity. At a threshold of PCR 30mg/mmol, diagnostic accuracy improved for sensitivity and specificity (93% for both) in studies where the first morning void was excluded (n=1868). Data available (4 studies) for ACR supports ruling out of significant proteinuria at less than 2mg/mmol, though evidence was limited by paucity of data and wide confidence intervals around the result. PCR and ACR have high accuracy compared to the gold standard 24-hour urine collection.

Rituximab use in pediatric systemic lupus erythematosus: Indications, efficacy and safety in an Indian cohort.

Introduction: Children with systemic lupus erythematosus have a more challenging and difficult course as compared to their adult counterparts. Today, the aim of therapy for any child with lupus is to keep the child in a state of sustained remission with minimal or no use of steroids. This laudable goal is often difficult to achieve for the child with lupus. In addition to the use of disease modifying agents, sometimes in combination, Rituximab (RTX) is also used as an off-label indication to manage such patients.Objectives: To study the use, efficacy and safety of RTX in a cohort of patients with pediatric lupus followed at a single tertiary level center in Northern India.Methods: This paper is a retrospective review looking at the use of RTX in children with systemic lupus at a tertiary level pediatric rheumatology center in North India over a period of seventeen years. This paper describes the indications, use, efficacy and safety of RTX in childhood systemic lupus erythematosus.Results: RTX was used in 17 of 225 pediatric lupus patients (7.5%), with the most common indication being resistant renal disease (53%). Significant improvement was seen in all domains studied: The mean SLEDAI was 16.25 prior to RTX and reduced to 1.43 six months after the RTX (p value 0.001), steroid use dropped from 100% pre- RTX to 33% at 2 years, there was a sustained reduction in proteinuria in the patients with nephritis from a mean urine spot protein creatinine ratio of 3.1 pre RTX to 0.4 at one year post RTX (p= .006). Finally, 82% of the children had no flare during the follow up (median 24 months). No patient had any adverse event.Conclusions: This study confirms that RTX is very effective in childhood lupus and can be safely used even in a country with a very high burden of infectious diseases. This data adds to the scarce literature in this area from the developing world.

Blood Pressure Changes during Initial and Relapsing Episodes in Children with Nephrotic Syndrome: A Comparative Study

Hypertension is an important feature arising from altered homeostasis related to the disease process in nephrotic syndrome. It indicates the disease state and response to therapy as well as dictates the treatment plan.The present study aims to detect changes in diastolic and systolic blood pressure during the initial and relapsing episode of nephrotic syndrome and compare them for future guidance in therapy.This observational, cross-sectional study was conducted between October 2016 and January 2019 with patients attending the pediatric clinic with either initial episode or relapse of nephrotic syndrome. A total of 100 patients with 50 patients in each group were included. The blood pressure was recorded and blood, and urine samplesof each subject analyzed.The present study indicates that though the majority of the patients in both the groups have normal systolic and diastolic pressure, diastolic blood pressure was significantly high in the relapse group. There was alsoa significant reduction in serum albumin and spot protein creatinine ratio in the relapse group.Blood pressure measurement needs to be part of the routine examination of any child attending a nephrology consultation clinic or admitted to the hospital. Children who developed hypertension during treatment or relapse indicate that nephrotic syndrome should be followed up over a long duration. Altered blood pressure may necessitate encouragement for regular follow up in nephrology clinic for early recognition and treatment of long term complications.

Primary Hyperaldosteronism in Pregnancy: A Case Report

Background: Primary aldosteronism (PA) is a renin-independent hypersecretion of aldosterone that remains an underdiagnosed etiology of hypertension. Less than 50 cases of primary hyperaldosteronism in pregnancy have been reported in literature that are associated with pregnancy complications including preeclampsia. Clinical Case: A 41-year-old female G9P4 at 32 weeks gestation was admitted for suspected preeclampsia due to elevated blood pressure during a routine prenatal visit. Her comorbidities include type 2 diabetes, uncontrolled hypertension, and preeclampsia in a previous pregnancy. Home medications included Lisinopril 10 mg once daily which was discontinued upon pregnancy and switched to Labetalol 400 mg twice daily and Nifedipine ER 30 mg daily. She was on a total of 220 units of insulin daily.On presentation, patient complained of anxiety but denied any headache, nausea, visual disturbances, chest pain, palpitations, muscle cramps, or fatigue. Her blood pressure was 180/100 mmHg with heat rate of 73. Laboratory values was notable for potassium: 2.8 mmol/L (n 3.5–5 mmol/L), bicarbonate: 28 mmol/L (n 24–31 mmol/L), and magnesium: 1.4 mEq/L (n 1.3–1.9 mEq/L). Liver function test and platelet count were normal. Spot protein-creatinine ratio was 0.3 (n 0–0.2). ECG was normal sinus rhythm with a heart rate of 82 without decreased T wave amplitude or U waves. She received three doses of oral 40 mEq potassium chloride over twelve hours and potassium level post repletion was 3.0 mmol/L.Initially, her hypokalemia was attributed to high insulin dose requirements. Despite down titration of insulin, patient continued to have hypokalemic episodes (nadir 2.7 mmol/L) refractory to oral and parenteral potassium supplementation. She remained hypertensive despite Labetalol 600 mg every 8 hours, Nifedipine ER 30 mg every 12 hours, with as needed hydralazine 10 mg IV pushes, and underwent urgent cesarean delivery. Uncontrolled hypertension persisted postpartum with recurrent episodes of hypokalemia. Further investigations revealed a plasma aldosterone concentration (PAC) and plasma renin activity (PRA) levels of 43.5 ng/dL (n <10 ng/dL) and 1.67 ng/mL/hr (n 0.17–5.38 ng/mL/hr) respectively, potassium at time of testing was 3.6 mmol/L. PAC to PRA ratio was greater than 20:1 with an absolute PAC greater than 15 ng/dL, which is highly suggestive of PA. Conclusion: We present a case of suspected PA with spontaneous hypokalemia potentially masked by the use of ACE inhibitors uncovered during pregnancy. Given the changes to the renin-angiotensin-aldosterone system (RAAS) during pregnancy, the diagnosis of PA is difficult to establish during gestation. Still, little is known on how to optimally treat these patients. Reference: Morton, A., 2015. Primary Aldosteronism and Pregnancy. Pregnancy and hypertension. An International Journal of Women’s Cardiovascular Health, Volume 5 Issue 4, 259–262.

Estimation of 24h Urine Protein Versus Spot Urine Protein Creatinine Ratio in Patients with Kidney Disease.

This cross-sectional study was undertaken to compare 24-h urine protein estimation with spot urine protein-creatinine ratio (PCR). 72 patients having proteinuria of > 150mg/day were included in this study. 24-h urine total protein (UTP) test were also asked to give their mid-morning spot urine sample the following day for urine protein-creatinine ratio. The subjects were grouped according to their UTP into Groups as described follows: Group A < 1g/day, Group B 1-3.5g/day and Group C > 3.5g/day. Pearson's correlation (r) and paired Student's T test were done. The paired T test showed no difference in the UTP and PCR in the subgroup having qualitative protein of zero and in group A. There was no agreement between the two methods used for quantitation. In the overtly proteinuric patients, the correlation between the UTP and PCR was positive in group A which was statistically significant (p = 0.05) whereas it was not significant (p = 0.07) in group B. Though there was a negative correlation in the massive proteinuria group C it was not significant (p = 0.65). Our study demonstrates that spot PCR can be reliable parameter for initial diagnostic criterion of proteinuria but for follow-up measurements and for proteinuria > 0.5 gm/day, 24-h UTP is the single most accurate measurement of protein excretion.

Evaluation of Spot Urine Protein Creatinine Ratio as an Index of Quantitative Proteinuria in Varying Renal Disorders

This study is conducted to evaluate the correlation between 24 hrs urine protein and urine Protein Creatinine Ratio (PCR) in spot urine sample and if found comparable the estimation of spot protein creatinine ratio could be adopted as an alternative method for quantification of proteinuria in our clinical lab setting.

To evaluate and standardize the method of spot urine protein creatinine ratio for estimation of proteinuria

Background: Proteinuria is an independent risk factor for diabetic nephropathy and a predictor of end-stage renal disease. Measurement of protein excretion in a 24hr urine collection is the gold standard for the quantitative evaluation of proteinuria in diabetes. However, this is cumbersome, subjective to collection errors and required good compliance. Aims: To evaluate and standardize the method of spot urine protein creatinine ratio for estimation of Proteinuria. Materials and methods: We compared 24 hr urine protein estimation with urine spot protein creatinine ratio in type 2 diabetes mellitus patients with proteinuria. Results: In our study of 73 patients with type 2 diabetes mellitus and proteinuria, it was found that A maximum number of patients were noted in the age group 41-50 years. Males were more than females in the ratio of 2.04:1. The majority of patients had a duration of diabetes between 5 -10 yrs (52.05%). The mean duration of diabetes was 9.24+/- 6.1 yrs. Twenty-five patients (34.25%) had nephrotic range proteinuria. There was a good correlation between urine PCR and 24 hr urine protein at different levels of GFR. Maximum correlation between urine PCR and 24 hr urine protein was seen in the GFR >60 group. There was a good correlation between urine PCR and 24 hr urine protein at different ranges of proteinuria. A maximum correlation between urine PCR and 24 hr urine was seen in the proteinuria group

Evaluation of spot urinary protein creatinine ratio for quantification of proteinuria in women with hypertension in pregnancy: A prospective observational study

To calculate the cut off value of the spot urine protein/creatinine ratio (PCR) for predicting significant proteinuria in our population of patients with HTN (hypertension) in pregnancy, and study its correlation with total urine estimation in 24 hour collection of urine. We conducted a prospective observational study among pregnant women with HTN attending Department of Obstetrics and Gynaecology, Lok Nayak Hospital, Maulana Azad Medical College, New Delhi. Two hundred patients with singleton pregnancy with hypertension and gestational age &amp;#62;20 weeks were included in the study. Both 24-hour urine protein measurement and a spot urine PCR was done for every patient. Follow up was performed till delivery and outcomes were noted. Significant proteinuria was found in 64 (32%) patients. The study suggested moderate degree of correlation between spot urine PCR and 24 hour urine protein, with a correlation coefficient of 0.47, p&amp;#60;0.001 (n=200). The correlation coefficient for ambulatory patients was 0.415 whereas it was much higher i.e. 0.776 for nonambulatory patients.The ROC curve analysis revealed an excellent sensitivity of 96.3% and specificity of 84.2% with AUC 0.91 (excellent) for a cut-off value of spot PCR &amp;#62;0.19 to detect significant proteinuria in our population. The negative predictive value was 98.4% and positive predictive value was 69.3%. The spot urine Protein Creatinine ratio can be considered an excellent ruling out test. However, women with abnormally high spot urine PCR should undergo 24-hour urine protein measurement before clinical intervention is done.

A comparative study of the accuracy of the spot Protein-Creatinine Ratio (PCR) vs 24 hours urine collection for detection of proteinuria in pre- eclamptic patients and its effect maternal and fetal outcomes

Proteinuria is a major component of preeclampsia. Urine protein measurement after 24-hour urine collection is the traditional standard method for the detection of proteinuria. It is time-consuming. As an alternative, spot sampling for a urine protein to creatinine ratio (PCR) ratio has been investigated. To determine the accuracy of the spot protein- creatinine ratio in comparison with 24 hours urine collection for detection of proteinuria in pre- eclamptic patients. A hospital based prospective study was conducted with 120 patients to assess the quantification of proteinuria in preeclamptic patient and comparing the two methods i.e. 24-hr urine protein levels and random protein creatinine ratio conducted at tertiary care centre. There was a good positive statistical correlation between 24-hour total urinary protein level and spot protein: creatinine ratio with a correlation coefficient (r) of 0.769.Conclusion: Random and spot urine protein creatinine ratio can predict with high accuracy the amount of 24- hour urine protein excretion. The urine PCR is reliable, relatively faster and accurate for proteinuria and can correlate well with 24-hour urinary protein excretion which is gold standard.

Limited Reliability of the Spot Urine Protein/Creatinine Ratio in the Longitudinal Evaluation of Patients With Lupus Nephritis

IntroductionCross-sectional studies document that the spot protein/creatinine ratio (PCR) is often an inaccurate estimate of proteinuria magnitude compared with the 24-hour PCR, which is the gold standard. However, the extent to which the inaccuracy of the spot PCR varies over time and between individuals has not previously been reported. We address these crucial questions using a unique database, an National Institutes of Health trial in which lupus nephritis (LN) patients (N = 103) provided spot PCR testing each month and 24-hour PCR testing every 3 months for up to 15 months after induction therapy.MethodsA gold standard proteinuria trend line was constructed for each patient by joining the points that represented the serial 24-hour PCR values of the patient. The spot PCR values of the patient were then plotted in relationship to the 24-hour PCR trend line. Using our previous work, which estimated the 95% confidence intervals for the 24-hour PCR at specific levels, we determined in each patient whether the spot PCR values were “reliable,” “problematic,” or “unreliable.” The sequential spot PCR of the patients deviated widely and often from the 24-hour PCR trend line, to the extent that, if the spot PCR results were used in real time for clinical decision-making, it was likely management errors would occur.ResultsSpot PCRs were reliable in 41%, problematic in 24%, and unreliable in 35% of patients. Those with unreliable spot PCRs could not be predicted and were more likely to respond poorly to treatment.ConclusionThe spot PCR should not be used for management of LN, and perhaps, other glomerulopathies.

24-Hour Proteinuria Versus Spot Protein-Creatinine Ratio for Kidney Transplant Management in Clinical Practice

Background24-hour proteinuria (24h-P) has been the most widespread test for clinical follow-up of proteinuria after kidney transplantation (KT), but urine collection is often not properly collected. Spot protein-creatinine ratio (P/Cr) has become the alternative to 24h-P for proteinuria evaluation in many KT units. However, its reliability, equivalence to 24h-P, and prognostic value regarding allograft outcome remain unknown. Therefore, the aim of this study was to evaluate the correlation and agreement between both methods for assessing proteinuria and to analyze which of them is a better predictor of graft survival. MethodsWe collected proteinuria measurements from KT patients in our center. 24h-P was adjusted for body surface area. Pearson correlation test and the Bland-Altman method were used to analyze correlation and agreement. Survival analysis was performed with the use of the Kaplan-Meier method and multivariate Cox proportional hazard model. ResultsA total of 8,549 urine samples were analyzed from 472 patients in whom 24h-P and P/Cr were simultaneously measured. A significant correlation was observed between 24h-P and P/Cr (r = .76; P < .001); however, the agreement between methods showed that P/Cr overestimated proteinuria compared with 24h-P, particularly when the latter was >1 g/24 h. The Cox regression multivariate model showed an increased risk of graft loss associated with proteinuria when assessed by either 24h-P (hazard ratio [HR] 6.53, 95% confidence interval [CI] 2.49–17.1) or P/Cr (HR 3.34, 95% CI 1.04–10.7). ConclusionsP/Cr is an method interchangeable with 24h-P for detecting proteinuria after KT. When proteinuria increases, the P/Cr overestimates 24h-P, even though it also has a significant and similar prognostic value for predicting graft survival.

Spot protein-creatinine ratio and spot albumin-creatinine ratio in the assessment of pre-eclampsia: a diagnostic accuracy study with decision-analytic model-based economic evaluation and acceptability analysis.

The National Institute for Health and Care Excellence (NICE) guidelines highlighted the need for 'large, high-quality prospective studies comparing the various methods of measuring proteinuria in women with new-onset hypertensive disorders during pregnancy'. The primary objective was to evaluate quantitative assessments of spot protein-creatinine ratio (SPCR) and spot albumin-creatinine ratio (SACR) in predicting severe pre-eclampsia (PE) compared with 24-hour urine protein measurement. The secondary objectives were to investigate interlaboratory assay variation, to evaluate SPCR and SACR thresholds in predicting adverse maternal and fetal outcomes and to assess the cost-effectiveness of these models. This was a prospective diagnostic accuracy cohort study, with decision-analytic modelling and a cost-effectiveness analysis. The setting was 36 obstetric units in England, UK. Pregnant women (aged ≥ 16 years), who were at > 20 weeks' gestation with confirmed gestational hypertension and trace or more proteinuria on an automated dipstick urinalysis. Women provided a spot urine sample for protein analysis (the recruitment sample) and were asked to collect a 24-hour urine sample, which was stored for secondary analysis. A further spot sample of urine was taken immediately before delivery. Outcome data were collected from hospital records. There were four index tests on a spot sample of urine: (1) SPCR test (conducted at the local laboratory); (2) SPCR test [conducted at the central laboratory using the benzethonium chloride (BZC) assay]; (3) SPCR test [conducted at the central laboratory using the pyrogallol red (PGR) assay]; and (4) SACR test (conducted at the central laboratory using an automated chemistry analyser). The comparator tests on 24-hour urine collection were a central test using the BZC assay and a central test using the PGR assay. The primary reference standard was the NICE definition of severe PE. Secondary reference standards were a clinician diagnosis of severe PE, which is defined as treatment with magnesium sulphate or with severe PE protocol; adverse perinatal outcome; one or more of perinatal or infant mortality, bronchopulmonary dysplasia, necrotising enterocolitis or grade III/IV intraventricular haemorrhage; and economic cost and outcomes. Health service data on service use and costs followed published economic models. In total, 959 women were available for primary analysis and 417 of them had severe PE. The diagnostic accuracy of the four assays on spot urine samples against the reference standards was similar. The three SPCR tests had sensitivities in excess of 90% at prespecified thresholds, with poor specificities and negative likelihood ratios of ≥ 0.1. The SACR test had a significantly higher sensitivity of 99% (confidence interval 98% to 100%) and lower specificity. Receiver operating characteristic (ROC) curves were similar (area under ROC curve between 0.87 and 0.89); the area under the central laboratory's SACR curve was significantly higher (p = 0.004). The central laboratory's SACR test was the most cost-effective option, generating an additional 0.03 quality-adjusted life-years at an additional cost of £45.07 compared with the local laboratory's SPCR test. The probabilistic analysis showed it to have a 100% probability of being cost-effective at the standard willingness-to-pay threshold recommended by NICE. Implementation of NICE guidelines has led to an increased intervention rate in the study population that affected recruitment rates and led to revised sample size calculations. Evidence from this clinical study does not support the recommendation of 24-hour urine sample collection in hypertensive pregnant women. The SACR test had better diagnostic performance when predicting severe pre-eclampsia. All four tests could potentially be used as rule-out tests for the NICE definition of severe PE. Testing SACR at a threshold of 8 mg/mmol should be studied as a 'rule-out' test of proteinuria. Current Controlled Trials ISRCTN82607486. This project was funded by the National Institute Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 61. See the NIHR Journals Library website for further project information.

PM.52 Diagnostic Accuracy of Spot Protein Creatinine Ratio(PCR) in Comparison to 24 Hour Urine Protein

ObjectiveTo review the use of spot protein creatinine ratio as a diagnostic test for preeclampsia in comparison to 24 hour urine.MethodsThis was a retrospective observational study on 100 pregnant women...

Is the urine spot protein/creatinine ratio a valid diagnostic test for pre-eclampsia?

The objective of this study was to assess the value of the spot protein/creatinine ratio as the diagnostic test for pre-eclampsia by correlating it to the 24 h urine protein. For the spot test, this study uses the cut-off value recognised by the International Society for the Study of Hypertension in Pregnancy (ISSHP). Ours was a correlational study made in the setting of the antenatal assessment unit/antenatal ward in a District General Hospital. Patients at >24 weeks' gestation with hypertension and >1+ proteinuria (n = 32) were included in the study. A 10 ml sample of urine was collected for the spot protein/creatinine ratio (PCR) before the 24 h collection was started. Spot PCR samples were stored at –18°C until the end of the study period. The results of the spot PCR were correlated to 24 h results using Pearson's correlation coefficient. Main outcome measures were correlation coefficient, sensitivity, specificity, positive and negative predictive values. Correlation was significant (r2 = 0.82). Sensitivity, 83%; specificity, 92%; positive likelihood ratio, 10.3; negative likelihood ratio, 0.18. The spot PCR correlates well to the 24 h urine protein. The new cut-off values recognised by the ISSHP are producing consistent results. The evidence in favour of the spot PCR needs to be reassessed by larger studies.

Review: Spot protein–creatinine ratio has moderate diagnostic performance for proteinuria in pregnant women with hypertension

Source Citation Côté AM, Brown MA, Lam E, et al. Diagnostic accuracy of urinary spot protein:creatinine ratio for proteinuria in hypertensive pregnant women: systematic review. BMJ. 2008;336:1003-6. 18403498

The epidemiology of chronic kidney disease stages 1 to 4 and cardiovascular disease: A high-risk combination

A 70-YEAR-OLD white woman has a 15-year history of hypertension that is currently being treated with a calcium channel blocker. She has no other medical problems. On physical examination, her blood pressure is 150/90 mm Hg. Blood tests show a serum creatinine level of 1.7 mg/dL (150 μmol/L) and an estimated glomerular filtration rate (GFR) of 37 mL/min/1.73 m2. Her serum low-density lipoprotein cholesterol level is 130 mg/dL (3.36 mmol/L). Urine studies show a bland urinalysis and spot protein-creatinine ratio of 1,500 mg/g. Is this patient at high risk for the development of cardiovascular disease (CVD)? If so, how should this patient be treated to reduce the risk for CVD and slow the progression of chronic kidney disease (CKD)?