Spot Urine Protein Creatinine Ratio Research Articles

Comparison of 24 Hour Urinary Protein and Spot Urinary Protein- Creatinine Ratio in the Assessment of Proteinuria in Patients with Glomerulonephritis

Context: Glomerulonephritis is an important cause of morbidity and mortality among all age group in Bangladesh. This cross sectional study was carried out with an aim to observe the comparison of 24 hour urinary protein and spot urinary protein- creatinine ratio in patients with glomerulonephritis in 3 group: on basis of 24 hour total protein, GFR level and serum albumin level.Methods: A total number of 128 consecutive patients having glomerulonephritis with 18 to 70 years who came in the Nephrology Unit, Dhaka Medical College Hospital, Dhaka, during the period of January to December of 2011 were included in this study. Patients with proteinuria other than glomerulonephritis like DM, UTI and Hypertension and <18 years of age were excluded from the study.Results: A significant positive correlation was found between 24 hour Urine Protein with Protein Creatinine Ratio on the patients having 24 hour Urinary protein <0.2 gm, 0.2-<1 gm, 1- 3.4 gm and 3.5-6 gm respectively. No correlation was found between 24 hr Urine Protein with Protein Creatinine Ratio on the patients having 24 hour Urinary protein >6 gm. A significant positive correlation was also found between 24 hour Urine Protein (gm/24 hour) with Protein Creatinine Ratio, which were in patients having GFR <15 ml/min/1.73m2 body surface area, 15-29 ml/min/1.73m2 body surface area, 30-59 ml/min/1.73m2 body surface area, 60-89 ml/ min/1.73m2 body surface area and e”90 ml/min/1.73m2 body surface area respectively. However, the result of the group having GFR <15 ml/min/1.73m2 body surface was positively correlated but not very convincing. In this present series it was observed that a significant positive correlation was found between 24 hr Urine Protein (gm/24 hour) with Spot Urinary Protein Creatinine Ratio in relation to serum albumin level; r=0.658; (p<0.001) and r=0.707; (p<0.001) in patients having serum albumin level >30gm/dl and 20-30 gm/dl respectively. But because of only one sample in the group having <20 gm/dl serum albumin, no comparison could be carried out.Conclusion: P/C ratio provided a very useful, simple and convenient method for quantitative assessment of protein and can replace 24 hour urine collection method in indoor, outpatients and in follow up clinics as it gives quick and reliable results and avoids the inconvenience and short comings associated with 24 hour urine collection.J Dhaka Medical College, Vol. 23, No.2, October, 2014, Page 194-202

Outcomes of Renal Transplantation in Patients With Alport Syndrome

AimWe evaluated the outcomes of patients who underwent renal transplantation (Rtx) due to end-stage renal disease (ESRD) related to Alport syndrome in our study. Materials and MethodsTwenty-five patients (female/male: 9 [36%]/16 [64%]) who underwent Rtx at our center between 2002 and 2014 were enrolled in the study. Mean ages of patients and donors (cadaveric/living: 8 [32%]/17 [68%]) were 28.2 ± 11.6 and 42.3 ± 15.8 years, respectively. As immunosuppressive therapy, tacrolimus plus mycophenolic acid were used for 17 (68%) patients and cyclosporin plus mycophenolic acid were used for 8 (32%) patients where induction therapy was basiliximab 20 mg (day 0 and 4) for 11 (44%) patients and anti-thymocyte globulin for 8 (32%) patients. Acute rejection was diagnosed using biopsy and evaluated with Banff classification. Analyses were performed by using SPSS 20.0 software with outcomes of mean 75.4 ± 31.4 months follow-up. Patient and graft survival were measured by using Kaplan-Meier survival curve and compared by using log-rank test. ResultsGraft survival rate was 89%, patient survival rate was 92.9%, and acute rejection rate was 12% (3 cases; 1 was cellular and 2 were antibody-mediated). Delayed graft function was observed in 4 (16%) cases, 1 patient (4%) had BK virus nephropathy and 2 (8%) patients required hemodialysis and had cytomegalovirus infection. At the last follow-up, mean serum creatinine level was 1.57 ± 1.23 mg/dL, spot urine protein creatinine ratio was 0.13 (0.04–1.84), and glomerular filtration rate was 71.7 ± 34.9 mL/min. ConclusionRtx is an effective and successful treatment modality for ESRD cases related to Alport syndrome.

Urinary Protein/Creatinine Ratio Weighted by Estimated Urinary Creatinine Improves the Accuracy of Predicting Daily Proteinuria

BackgroundThe spot urine protein/creatinine ratio (UPCR) is proposed to be a substitute for 24-hour urinary protein (24h-UP). This study is aimed to determine whether the predictive accuracy of 24h-UP using UPCR can be improved by simply multiplying estimated daily urine creatinine excretion (eUCr) and UPCR together. MethodsThis study enrolled 120 participants to investigate the correlation between spot UPCR and 24h-UP. Three sets of spot urine samples were randomly collected throughout the day and night, along with the first morning void. UPCR was weighted by eUCr to investigate the improvement of accuracy in using spot urine samples to predict 24h-UP. ResultsThere were strong correlation and concordance between UPCR and 24h-UP irrespective of the time of spot urine sampling, and the correlation, concordance and agreement were improved after multiplying the UPCR value by the eUCr. Greater improvement was found in the subgroups with measured daily urine creatinine excretion ≤0.8g/d and ≥1.2g/d. ConclusionsThis investigation demonstrated that multiplying UPCR by eUCr can improve the accuracy of only using UPCR to predict 24h-UP.

Comparison of spot urine protein-creatinine ratio with 24-hour urine protein excretion in women with preeclampsia

Results: There was a strong correlation between the spot P/C ratio and 24-hour urine protein excretion (r = 0.84; P < .001). The optimal spot P/C ratio cut-off point was 0.20 for 300 mg/24 h of protein excretion (preeclampsia), with a sensitivity, specificity, positive predictive value, and negative predictive value of 91.2%, 87.8%, 94.4%, and 96.8%, respectively.A spot P/C ratio less than 0.19 could exclude preeclampsia with a sensitivity of 100%. Conclusions: We found that there is a significant correlation between the spot urine P/C ratio and 24-hour urine protein excretion in women with preeclampsia. Urine P/C ratio could be used for exclusion of preeclampsia.

Comparison of Spot Urine Protein/Creatinine Ratio, Spot Urine Protein/Osmolality Ratio with Measured 24-Hour Urine Protein in HIV Subjects in Nigeria

Background and Objectives: Urine protein examination is a veritable tool in the management of renal diseases. Proteinuria evaluation from 24-hour urine collection is the gold standard. Prompt urine protein assessment from spot urine sample has become necessary to eliminate inaccuracies inherent in timed urine collection. This study aims at comparing spot urine protein/creatinine ratio (SUPCR) and measured 24-hour urine protein (24 HUP), and also spot urine protein/osmolality ratio (SUPOR) and 24 HUP against measured 24-hour urine protein (24 HUP) for assessment of proteinuria in human immunodeficiency virus (HIV) subjects. Methodology: Three hundred and ninety three HIV subjects from the HIV/AIDS clinic and 136 age- and sexmatched non-HIV subjects as Control. Investigations performed included 24-hour urine protein (24 HUP), spot urine protein (SUP), spot urine creatinine (SUCr), spot urine osmolality (SUOsm), fasting blood sugar (FBS), urinalysis, HIV screening and confirmatory test, electrolyte, urea and creatinine. SUPCR and SUPOR were calculated. Correlation statistics, 2 × 2 contingency table analysis, receiver operator characteristics (ROC) Curve analysis and Bland Altman plots were used to compare SUPCR and 24 HUP, and also SUPOR and 24 HUP in HIV subjects and control. SPSS version 17 and Medcal statistical software were used to analyze the data. P<0.050 was taken as statistically significant. Results: Using the 2 × 2 contingency table in the HIV subjects, the Sensitivity for SUPCR and SUPOR with 24 HUP was 43.4% and 11.5% respectively. Specificity for SUPCR and SUPOR with 24 HUP was 92.9% and 99.2% respectively. The SUPCR had a correlation (r) of 0.734 (p<0.001) with 24 HUP. In addition, SUPOR had a correlation coefficient of 0.417 (p<0.001) with 24 HUP. Using the Bland Altman plots, SUPCR compared with 24HUP the limits of agreement were +0.361 g/day to -0.248 g/day in HIV subjects. In addition for SUPOR the limits of agreements were +0.440 g/day to-0.180 g/day in HIV subjects. The bias was 0.060 g/day and 0.130 g/day for SUPCR and SUPOR respectively. The receiver operating characteristics (ROC) curve showed that SUPCR randomly chosen value of 0.042 mg/mg and SUPOR chosen value of 0.010 mg/dl/mOsm/kg H2O predicted 24 HUP at urinary excretion threshold of 0.150 g. Conclusion: The SUPCR and SUPOR are reliable tests, for quantifying proteinuria in HIV subjects, and should be used in assessment of proteinuria in HIV subjects in Sub Saharan African countries.

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.

Increase in Spot Urine Protein-Creatinine Ratio Before Kidney Graft Rejection: A Marker to Predict Rejection Phenotype and Graft Outcome.

Increase in Spot Urine Protein-Creatinine Ratio Before Kidney Graft Rejection: A Marker to Predict Rejection Phenotype and Graft Outcome.

Estimated Protein Excretion Rate From Second Morning Spot Urine Protein-Creatinine Ratio: A Diagnostic Study in Kidney Transplant Recipients.

Estimated Protein Excretion Rate From Second Morning Spot Urine Protein-Creatinine Ratio: A Diagnostic Study in Kidney Transplant Recipients.

Maternofoetal complications and their association with proteinuria in a tertiary care hospital of a developing country.

Objective. To investigate association between maternofoetal complications and the amount of proteinuria measured by spot urine protein creatinine ratio in patients with preeclampsia. Methods. 200 consecutive patients with preeclampsia were recruited in the study. The complications like first episode of severe hypertension, renal insufficiency, raised level of aspartate transaminase, signs of neurological involvement, thrombocytopenia, eclampsia, and need to shift in intensive care units were studied. The maternal outcome was studied in terms of type of labour, outcome of pregnancy, mode of delivery, indication of cesarean section, and maternal mortality. The foetal complications and outcome parameters were birth weight, Apgar score at the time of birth and at five minutes, need of high dependency unit care, and perinatal mortality. Result. The frequency of various maternal and foetal complications was between 14–53% and 22–92%, respectively. Maternal mortality was 3%, whereas perinatal mortality was 23%. Statistically significant association was found between the frequencies of various complications in mother and newborn and spot UPCR. Conclusion. The rate of various maternofoetal complications in preeclampsia is higher in developing countries than in developed world. Maternofoetal complications and outcome correlate with maternal spot UPCR.

Spot urine protein–creatinine ratio and 24-h urine protein excretion: Diagnostic accuracy in women with pre-eclampsia

To compare the efficacy of spot urinary protein/creatinine ratio with 24h urinary protein excretion in women with pre-eclampsia. A total of 85 women with hypertensive disorders during pregnancy were prospectively studied. Urine protein/creatinine ratio in spot urine sample was compared with 24h urinary protein. Sensitivity and specificity for urinary spot P/C (protein/creatinine) ratio was assessed, and receiver operating curve was used to determine the value against the gold standard of >300mg proteinuria in 24h urinary sample. Of 85 women, complete data were available for 81 women. There was a strong correlation between spot urinary P/C ratio and 24h urine protein excretion (r=0.81, P value <0.000). The optimal spot P/C ratio cut-off point was 0.14 for 300mg/24h of protein excretion (preeclampsia) with a sensitivity of 82% and specificity of 79%. We found a strong correlation between spot urinary P/C and 24h urinary protein. Spot urinary protein/creatinine ratio is a good predictor of proteinuria for pre-eclampsia.

Evaluation of Rapid Diagnostic Methods of Urinary Protein Estimation in Patients of Preeclampsia of Advanced Gestational Age

24-h urine protein is traditionally used as a gold standard method for protein estimation. Because of the operational difficulty, there is the necessity to use rapid, convenient, and reliable method of proteinuria estimation. We carried out this study to compare the two rapid methods of protein estimation: dipstick method and spot urine protein creatinine ratio (UPCR) with that of 24-h urine protein in patients of preeclampsia with advanced gestational period. The values of proteinuria estimated by dipstick method and spot UPCR were compared with that of 24-h urine protein. The strength of correlation was measured by Pearson's correlation coefficient (r). A p value of <0.05 is considered to be statistically significant. The most discriminant spot UPCR value for detecting significant proteinuria (≥300mg/day) was determined by plotting receiver-operator curve (ROC). The value of spot UPCR strongly correlated with 24-h urine protein (r=0.88 with p value <0.001). The most discriminant spot UPCR value for detecting significant proteinuria (≥300mg/day) was 0.3. The estimation of proteinuria by dipstick method was poorly correlated with 24-h urine protein with r=-0.09. Spot UPCR can be used as a rapid and reliable alternative method in preference to 24-h proteinuria in patients of preeclampsia of advanced gestational age.

Mean Platelet Volume and Its Relation With Arterial Stiffness in Patients With Normotensive Polycystic Kidney Disease

BackgroundAutosomal-dominant polycystic kidney disease (ADPKD) demonstrates cardiovascular manifestations, such as hypertension, myocardial infarction, and increased carotid intimae-media thickness. These complications are the main cause of morbidity and mortality in patients...

Accuracy of spot urine protein creatinine ratio in measuring proteinuria in chronic kidney disease stage 3 and 4

We studied the accuracy of spot urine protein creatinine ratio (SpUr-PCR) to assess 24 h urine protein excretion (24 h-UP) in patients with chronic kidney disease (CKD). A total of 100 proteinuric CKD patients of stages 3 and 4 were studied. 24 h urine was collected to measure 24 h-UP and creatinine. A random day time urine sample was analyzed to measure the PCR. A formula to estimate 24 h creatinine excretion was derived from linear regression analysis and a correction factor was introduced to assess whether this improves the accuracy of the SpUr PCR in predicting 24 h-UP. Accuracy of the SpUr-PCR was assessed by Pearson's correlation, regression analysis, and Bland Altman analysis. Mean age was 51.85 ± 12 years and 81% of the patients were male. SpUr-PCR predicted 24 h-UP with good accuracy (r = 0.86 on a data transformed to a logarithmic scale, P < 0.001) and there was a good agreement between these two measures of proteinuria. However, SpUr-PCR was inaccurate in the subgroup with nephrotic range proteinuria (r = 0.35, P = 0.062), but when a correction factor for 24-h urine creatinine (24 h-UCr) was introduced, the accuracy of SpUr-PCR improved significantly in this group (r = 0.45, P = 0.013). Introduction of the correction factor improved the degree of agreement between these two measures in women, but not the correlation. Overall, SpUr-PCR accurately predicted 24 h-UP. Adding a correction factor for 24 h-UCr improved correlation in the subgroup of patients with the nephrotic range proteinuria and the degree of agreement in female patients, and hence may be used in expressing proteinuria measured by SpUr-PCR to improve its accuracy in them.

Quiz Page December 2012: Bilateral Kidney Enlargement and Acute Kidney Injury in a Patient With HIV Infection

Quiz Page December 2012: Bilateral Kidney Enlargement and Acute Kidney Injury in a Patient With HIV Infection

Serum phosphate varies with degree of proteinuria in nephrotic syndrome and is associated with elevated pulse wave velocity

The occurrence of vascular stiffness in the setting of the nephrotic syndrome and the influence of serum phosphate on this association is unknown. A retrospective study of 42 prevalent, adult nephrotic patients who underwent carotid-femoral pulse wave velocity (PWV) measurement, a median of 24 months after kidney biopsy. Elevated PWV was determined using published age-specific reference ranges. The association, statistical significance and independence of serum phosphate with spot urine protein-creatinine ratio (PCR) and the association of phosphate with PWV was examined. Mean PCR was 5.5 g/g and mean eGFR (CKD-EPI) was 70 mL/min/1.73 m2. Serum phosphate was statistically significantly associated with severity of nephrotic syndrome independently of eGFR and age. Median (intra-quartile range) PWV was 7 m/s (4-11), with a linear trend for higher PWV across tertile of average serum phosphate over follow-up, P<.001. Twenty subjects (48%) had elevated age-specific PWV, which on logistic regression was statistically significantly associated with mean serum phosphate, OR (95% CI) per 0.1 mmol/L: 2.7 (1.5, 4.9), P = .001, which in separate analyses was independent of eGFR and other laboratory data. In this cohort of patients with the nephrotic syndrome serum phosphate was commonly elevated, despite well preserved eGFR, which was significantly and independently associated with elevated PWV over follow-up.

Factors Predicting Improvement of Renal Function After Pyeloplasty in Pediatric Patients: A Prospective Study

We assessed the specific preoperative sonographic and urinary factors that may be important in predicting renal function outcomes after pyeloplasty. We prospectively studied 52 consecutive patients with ureteropelvic junction obstruction who underwent pyeloplasty at our tertiary care center between September 2009 and January 2011. Mean ± 2 SD patient age was 4.26 years (range 3 months to 18 years), and minimum followup was 6 months. Preoperative ultrasound findings recorded were pelvic anteroposterior diameter, pelvic cortical thickness, pelvic volume and pelvic cortical ratio. Spot urine protein-to-creatinine ratio from the renal pelvis and bladder was measured intraoperatively. Based on changes in differential renal function on diuretic renogram, patients were divided into 3 groups. Group 1 had stable differential renal function with less than 5% change, group 2 had improved differential renal function greater than 5% and group 3 had deterioration of differential renal function greater than 5%. Data were analyzed using SPSS®, version 17 with cross-tabulation, nonparametric tests and logistic regression. On ultrasound only anteroposterior diameter (p = 0.018) and pelvic cortical ratio (p = 0.038) were significantly different among the 3 groups. Difference in bladder sample protein-to-creatinine ratio was not significant (p = 0.69), while pelvic urine protein-to-creatinine ratio was significant (p = 0.001). Anteroposterior diameter, pelvic protein-to-creatinine ratio and pelvic cortical ratio were less than 50 mm, 0.5 and 15, respectively, in all patients with improved renal function. Sonographic and urinary biochemical parameters may predict improvement in renal function after pyeloplasty. Pelvic anteroposterior diameter, pelvic cortical ratio and pelvic urine protein-to-creatinine ratio are the most useful parameters.

Day-to-Day Variability in Spot Urine Protein-Creatinine Ratio Measurements

Accurate measurement of proteinuria is important in the diagnosis and management of chronic kidney disease (CKD). The reference standard test, 24-hour urinary protein excretion, is inconvenient and vulnerable to collection errors. Spot urine protein-creatinine ratio (PCR) is a convenient alternative and is in widespread use. However, day-to-day variability in PCR measurements has not been evaluated. Prospective cohort study of day-to-day variability in spot urine PCR measurement. Clinically stable outpatients with CKD (n = 145) attending a university hospital CKD clinic in Australia between July 2007 and April 2010. Spot urine PCR. Spot PCR variability was assessed and repeatability limits were determined using fractional polynomials. Spot PCRs were measured from urine samples collected at 9:00 am on consecutive days and 24-hour urinary protein excretion was collected concurrently. Paired results were analyzed from 145 patients: median age, 56 years; 59% men; and median 24-hour urinary protein excretion, 0.7 (range, 0.06-35.7) g/d. Day-to-day variability was substantial and increased in absolute terms, but decreased in relative terms with increasing baseline PCR. For patients with a low baseline PCR (20 mg/mmol [177 mg/g]), a change greater than ±160% (repeatability limits, 0-52 mg/mmol [0-460 mg/g]) is required to indicate a real change in proteinuria status with 95% certainty, whereas for those with a high baseline PCR (200 mg/mmol [1,768 mg/g]), a change of ±50% (decrease to <100 mg/mmol [<884 mg/g] or increase to >300 mg/mmol [>2,652 mg/g]) represents significant change. These study results need to be replicated in other ethnic groups. Changes in PCR observed in patients with CKD, ranging from complete resolution to doubling of PCR values, could be due to inherent biological variation and may not indicate a change in disease status. This should be borne in mind when using PCR in the diagnosis and management of CKD.

Could peak proteinuria determine whether patient with dengue fever develop dengue hemorrhagic/dengue shock syndrome? - A prospective cohort study

BackgroundWorldwide there is a need to develop simple effective predictors that can distinguish whether a patient will progress from dengue fever (DF) to life threatening dengue hemorrhagic (DHF) or dengue shock syndrome (DSS). We explored whether proteinuria could be used as such a marker.MethodsWe included patients admitted to hospital with suspected dengue fever. Starting at enrollment until discharge, each patient's daily spot urine protein creatinine ratio (UPCR) was measured. We classified those with confirmed dengue infection as DF or DHF (including DSS) based on WHO criteria. Peak and day of onset of proteinuria was compared between both groups.ResultsCompared to those with DF, patients with DHF had significantly higher median peak proteinuria levels (0.56 versus 0.08 g/day; p < 0.001). For patients with DHF, the median day of onset of proteinuria was at 6 days of defervescence, with a range of -2 to +3 days after defervescence. There were three patients with DF who did not have proteinuria during their illness; the five remaining patients with DF had a median day of onset of proteinuria of was at 6 days of defervescence with a range of 0 to +28 days.ConclusionsPeak UPCR could potentially predict DHF in patients with dengue requiring close monitoring and treatment.

A systematic review and meta-analysis of the diagnostic accuracy of the spot urinary protein creatinine ratio (PCR) and the spot urinary albumin creatinine ratio (ACR) in the management of suspected pre-eclampsia

ObjectiveTo determine the diagnostic accuracy of the albumin creatinine ratio (ACR) and protein creatinine ratio (PCR) compared to the 24 h total urine (24 h TU) and how well they...

Tacrolimus is an alternative therapeutic option for the treatment of refractory lupus nephritis

We conducted an open-labeled, prospective study to determine the efficacy and safety of tacrolimus as an alternative therapeutic option for those patients with refractory lupus nephritis. The study population comprised one male and eight female patients with diffuse proliferative lupus nephritis. All patients had failed to respond to sufficient intravenous cyclophosphamide therapy with proteinuria of >or=1 g/day and active urinary sediments. Tacrolimus (0.1 mg/kg/day) was administered for 1 year with adjusting drug level (4-10 microg/l). The mean serum creatinine level and spot urine protein creatinine ratio (UPCR) at baseline were 1.39 mg/dl and 2.27, respectively. After the treatment, proteinuria reduced significantly from median UPCR value of 2.19 (range, 1.19-3.34) to 0.44 (range, 0.12-2.13) (p < 0.05). Seven (78%) of the nine patients showed a complete clinical response, which was defined as stabilization in the disease-activity markers and serum creatinine level with reduction of >or=50% in UPCR; two patients showed complete remission with UPCR <0.2. One patient showed treatment failure because of the disease progression. No serious adverse effects were observed during the study. This study demonstrates that tacrolimus can show a significant therapeutic response in cases that are refractory to the standard regimen for diffuse proliferative lupus nephritis.