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

Shidham, Ganesh; Ayoub, Isabelle; Birmingham, Dan; Hebert, Paul L.; Rovin, Brad H.; Diamond, Betty; Wofsy, David; Hebert, Lee

doi:10.1016/j.ekir.2018.04.010

Cited by 15 publications

(17 citation statements)

References 23 publications

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“…Table 6. Key points in the evaluation of the spot urine P/C ratio in different states [5,10,[12][13][14][15][16][17]21,27,[33][34][35][36][37]54,55,60,61,63,65,67,70,72,79,82,84,86,87,89,90,94,96,97,99,103,108,110,113,115,[117][118][119][120][121][122][123][124][125][126][127][128][129][130].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic utility of protein to creatinine ratio (P/C ratio) in spot urine sample within routine clinical practice

Kamińska

Dymicka-Piekarska

Tomaszewska

et al. 2020

Critical Reviews in Clinical Laboratory Sciences

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The spot (random) urine protein to creatinine ratio (P/C ratio) is an alternative, fast and simple method of detecting and estimating the quantitative assessment of proteinuria. The aim of the work was to review the literature concerning the usefulness of spot urine P/C ratio evaluation in the diagnosis of proteinuria in the course of kidney disease, hypertension, gestational hypertension, preeclampsia, immunological diseases, diabetes mellitus, and multiple myeloma, and in the diagnosis of proteinuria in children. We searched the PubMed and Google Scholar databases using the following keywords: proteinuria, spot urine protein to creatinine ratio, spot urine P/C ratio, protein creatinine index, PCR (protein to creatinine ratio), P/C ratio and methods, Jaffe versus enzymatic creatinine methods, urine protein methods, spot urine protein to creatinine ratio versus ACR (albumin to creatinine ratio), proteinuria versus albuminuria, limitations of the P/C ratio. More weight was given to the articles published in the last 10-20 years. A spot urine P/C ratio >20 mg/mmol (0.2 mg/mg) is the most commonly reported cutoff value for detecting proteinuria, while a P/C ratio value >350 mg/mmol (3.5 mg/mg) confirms nephrotic proteinuria. The International Society for the Study of Hypertension in Pregnancy recommends a P/C ratio of 30 mg/mmol (0.3 mg/mg) for the classification of proteinuria in pregnant women at risk of preeclampsia. A high degree of correlation was observed between P/C ratio values and the protein concentration in 24-h urine collections. The spot urine P/C ratio is a quick and reliable test that can eliminate the need for a daily 24-h urine collection. However, in doubtful situations, it is still recommended to assess proteinuria in a 24-h urine collection. The literature review indicates the usefulness of the spot P/C ratio in various disease states; therefore, this test should be available in every laboratory. However, the challenge for the primary care physician is to know the limitations of the methods used to determine the protein and creatinine concentrations that are used to calculate the P/C ratio. Moreover, the P/C ratio cutoff used should be determined in individual laboratories because it depends on the patient population and the laboratory methodologies.

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Section: Discussionmentioning

confidence: 99%

Diagnostic utility of protein to creatinine ratio (P/C ratio) in spot urine sample within routine clinical practice

Kamińska

Dymicka-Piekarska

Tomaszewska

et al. 2020

Critical Reviews in Clinical Laboratory Sciences

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“…Patients who do not achieve CR most often exhibit an insignificant reduction in proteinuria levels. Compared to 24-hour urine protein, spot protein/creatinine ratio is more effective at monitoring high levels due to the relatively short collection interval 48. Therefore, it is necessary to dialectically interpret the laboratory data.…”

Section: Discussionmentioning

confidence: 99%

<p>Clinical efficacy and safety of rituximab in lupus nephritis</p>

Zhong¹,

Li²,

Zhong

et al. 2019

DDDT

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BackgroundLong-term treatment programs with low toxicity represent a therapeutic challenge in lupus nephritis (LN). Although a therapeutic benefit of rituximab (RTX) has been reported in LN patients who have failed conventional treatment, the results are controversial. We aimed to assess the clinical efficacy and safety of RTX as a new immunosuppressive medicine in the treatment of LN with a meta-analysis.MethodsBased on predetermined criteria, PubMed, Embase, and Cochrane Library were used to identify the eligible studies. Cochrane Review Manager version 5.3 was applied to pool the data extracted from individual investigations and provide summary effect estimates.ResultsTwenty-four studies with 940 patients were analyzed. In case series trials with specific LN assessment, the complete remission (CR) rate at 12 months was 35.9% (95% CI: 24.2%–49.5%), and total remission (TR: CR plus partial remission) was 73.4% (95% CI: 66.0%–79.7%). In controlled trials, RTX was associated with a higher probability of TR (OR =2.02, 95% CI: 1.23–3.32, P<0.01). The CR in the RTX group was higher than that in the control group, although there was no significant difference between the two groups (OR =1.98, 95% CI: 0.90–4.39, P>0.05). Additionally, RTX treatment significantly decreased proteinuria (mean difference: −2.79, 95% CI: −3.95 to −1.62, P<0.01) as well as the renal activity index in patients with LN (mean difference: −3.46, 95% CI: −4.43 to −2.50, P<0.01). In controlled trials, the relative risks of the adverse events of infection and infusion reaction were not notably different between the two groups.ConclusionRTX is a promising therapy for the treatment of LN due to significant clinical efficacy and a favorable safety profile. In future studies, larger study populations and longer-term time points may identify additional important patient-centered outcomes.

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“…Conventional laboratory markers, such as proteinuria, urinary protein-to-creatinine ratio, serum complement 3 and complement 4 and anti-dsDNA antibodies, are non-invasive biomarkers for evaluating kidney damage in patients with SLE. However, they play a limited role in diagnosing ongoing or relapsing SLE-associated kidney injury because of restrictive sensitivity and speci city [4][5][6][7][8] .Renal biopsy is a gold standard method of diagnosing SLE-associated kidney injury,and it is a useful tool for evaluating clinical e cacy [9,10] .However, renal biopsy is an invasive procedure with a high risk of complications, which limits its widespread application. Therefore, it is necessary to nd non-invasiveand effective biomarkers to improve the diagnosis of SLEassociatedkidney injury [4,9] .…”

Section: Introductionmentioning

confidence: 99%

Association of Triglycerides With Systemic Lupus Erythematosus-associated Kidney Injury

et al. 2021

Preprint

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Background: Kidney injury of systemic lupus erythematosus (SLE) contributes to major mortality of SLE. To explore biomarkers is necessary for diagnosing and supervising SLE-associated kidney injury. However, few effective biomarkers can be used for it.Methods: Apriori algorithm of association rules was employed to identify laboratory biomarkers related to SLE-associated kidney injury. Logistic regression analysis was conducted to identify its risk factors, and spearman correlation analysis was used to evaluate the correlation between biomarkers and disease activity of SLE-associated kidney injury.Results: Ten biomarkers were mined by association rule mining. Among them, triglycerides, lactate dehydrogenase and α-hydroxybutyrate dehydrogenase were significantly higher, and haemoglobin and haematocrit were significantly lower in patients with SLE-associated kidney injury than in those without kidney injury. Furthermore, triglycerides were an independent risk factor for SLE-associated kidney injury. There were more patients with SLE-associated kidney injury, SLE disease activity index 2000, blood urea nitrogen, creatinine, proteinuria and urine pathology cast (P-CAST) in the high-triglyceride group. Triglycerides were positively correlated with proteinuria and P-CAST, and they were negatively correlated with albumin and immunoglobulin G. The area under the receiver operating characteristic curve for triglycerides was 0.72,and the optimal cut-off level was 1.84 mmol/l, which provided 64.4% sensitivity and 75.9% specificity in predicting SLE-associated kidney dysfunction. 50% SLE-associated kidney injuries patients with negative proteinuria could be identified by high triglyceride levels. In addition, higher levels of triglycerides were found at the time of onset of kidney injury. With the change in SLE-associated kidney injury, the variation in triglyceride levels is opposite to the evaluated glomerular filtration rate.Conclusion: triglycerides are associated with SLE-associated kidney injury and may be a potential biomarker for auxiliary diagnosis of SLE-associated kidney injury.

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

Cited by 15 publications

References 23 publications

Diagnostic utility of protein to creatinine ratio (P/C ratio) in spot urine sample within routine clinical practice

Diagnostic utility of protein to creatinine ratio (P/C ratio) in spot urine sample within routine clinical practice

<p>Clinical efficacy and safety of rituximab in lupus nephritis</p>

Association of Triglycerides With Systemic Lupus Erythematosus-associated Kidney Injury

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