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

Nayak, Rajeshwari; Annigeri, Rajeev A; Vivek, V.; Seshadri, R.; Balasubramanian, Sowmya; Rao, Bolla Govinda; Kowdle, PC; Mk, Mani

doi:10.4103/0971-4065.120340

Cited by 10 publications

(5 citation statements)

References 13 publications

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“…Studies restricted to patients with chronic kidney disease and diabetic nephropathy have also shown weaker correlations in patients with nephrotic range proteinuria. 22, 23 …”

Section: Discussionmentioning

confidence: 99%

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

Hogan

Reich

Nelson

et al. 2016

Kidney International

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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, we measured 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.

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“…Studies restricted to patients with chronic kidney disease and diabetic nephropathy have also shown weaker correlations in patients with nephrotic range proteinuria. 22, 23 …”

Section: Discussionmentioning

confidence: 99%

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

Hogan

Reich

Nelson

et al. 2016

Kidney International

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“…Previous authors have reported disagreement between 24UP and PCR depending on gender in smaller populations [24,26]. Nayak et al [26] studied 100 patients (81 men and 19 women) with CKD and provided a correction factor for creatinine excretion that minimized disagreement between 24UP and PCR in females [26]. However, our study is the first to provide and validate an equation to estimate 24UP directly from PCR in a large Caucasian population adjusting for gender.…”

Section: Discussionmentioning

confidence: 70%

“…As a general rule, it is therefore expected that patients with large body sizes will exhibit lower PCR than 24UP values [25]. Furthermore, the difference in muscular mass between males and females also suggests that assessment of proteinuria by means of the PCR could be subjected to a gender bias, as earlier described in other ethnic groups [26] and for microalbuminuria [27,28,29]. …”

Section: Introductionmentioning

confidence: 92%

“…This resulted into different steepness of the regression lines, reflecting a different equation to define the relationship between 24UP and PCR in each gender. Previous authors have reported disagreement between 24UP and PCR depending on gender in smaller populations [24,26]. Nayak et al [26] studied 100 patients (81 men and 19 women) with CKD and provided a correction factor for creatinine excretion that minimized disagreement between 24UP and PCR in females [26].…”

Section: Discussionmentioning

confidence: 99%

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A New Gender-Specific Formula to Estimate 24-Hour Urine Protein from Protein to Creatinine Ratio

Mayayo

Alonso

Valdivielso

et al. 2016

Nephron

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Background: The quantification of proteinuria with the protein to creatinine ratio (PCR) is influenced by the excretion of creatinine, which, in turn, varies according to muscle mass and hence, to gender. Aims: To assess the difference between urine PCR and 24-hour urine proteinuria in men and women and to provide a formula to overcome bias caused by gender. Methods: Four hundred and forty four CKD patients were randomly divided into 2 groups: 70% were used to develop the models, while the remaining 30% were reserved to validate the formula. Epidemiological data were analyzed with chi-square and Student's t tests. Association between 24-hour proteinuria and PCR was studied with Spearman coefficient in men and women separately. Multivariate analysis was used to find variables predictive of disagreement between the 24-hour urine protein and the PCR. Equations to predict 24-hour proteinuria from PCR for men and women were plotted and validated. Results: Disagreement between 24-hour proteinuria and PCR was more pronounced in men (2.16 and 1.64 g in mean, respectively) than in women (2.00 and 2.06 g in mean, respectively). Age and gender were independent predictors of disagreement. Gender-specific equations for predicting 24-hour proteinuria were: males: 24-hour proteinuria = 1.3350*exp^0.9108*^ln(PCR); females: 24-hour proteinuria = 1.0068*exp^0.9030*^ln(PCR). Conclusions: Estimation of proteinuria with the PCR improves accuracy if gender-specific equations are used. Use of the PCR without correction for gender leads to the underestimation of proteinuria in men and overestimation in women.

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“…The renal impairment was characterized in HSF group by the increased protein/creatinine ratio and albuminuria. Total proteinuria (represented by the protein/creatinine ratio) and albuminuria are important markers of kidney damage used as prognostic indicators in patients with chronic kidney disease [50]. Moreover, albuminuria is likely a reflection of early damage to the glomerular vascular endothelium as well as decreased ability of the tubule to reabsorb urinary albumin [51].…”

Section: Discussionmentioning

confidence: 99%

High Sugar-Fat Diet Induces Metabolic-Inflammatory Disorders Independent of Obesity Development

Garcia¹,

Francisqueti²,

Ferraz³

et al. 2019

FNS

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Background: The modern dietary habit, which is rich in refined carbohydrates and saturated fats, increases the risk of chronic diseases due to the proinflammatory effect of these nutrients. Aim: To evaluate the impact of high sugar-fat diet in the development of metabolic-inflammatory disorders in non-obese animals. Methods: Male Wistar rats were distributed into two groups according to the diet: control and high sugar-fat for 30 weeks. It was analyzed: dietary efficiency; chow, water and caloric intake; metabolic and hormonal profile in plasma and inflammatory cytokines in epididymal adipose tissue. Data were compared by Student's t test or by Mann-Whitney U test with p < 0.05 as significant. Results: HSF presented lower chow intake, higher water consumption and dietary efficiency with no difference in the caloric intake. The final body weight (FBW) and weight gain (WG) were lower in the HSF group and there was no difference in the adiposity index (AI). HSF diet-induced hyperglycemia and hyperinsulinemia with no difference for Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Triglycerides, uric acid, adiponectin and leptin levels were higher in the HSF group. The HSF group showed increased interleukin-6 (IL-6) and tumoral necrosis factor-alpha (TNF-α) levels in epidydimal adipose tissue. The urinary protein-creatinine ratio and albuminuria were higher in the HSF group. Conclusion: HSF diet intake is directly involved in the development of metabolic-inflammatory disorders independent of obesity, dissociating the view that increased adiposity is the major risk factor for complications commonly found in obese individuals.

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

Cited by 10 publications

References 13 publications

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

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

A New Gender-Specific Formula to Estimate 24-Hour Urine Protein from Protein to Creatinine Ratio

High Sugar-Fat Diet Induces Metabolic-Inflammatory Disorders Independent of Obesity Development

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