Sensitivity of total protein creatinine ratio in urine for diagnosis diabetic nephropathy

Abstract

Diabetic nephropathy is one of diabetic complications characterized by proteinuria and impaired renal function. Confirmation of diagnosis based either on urine value of albumin excretion rate (AER) 30-300 mg/24 hours or albumin creatinine ratio (ACR) 30-300 mg/g or total protein creatinine ratio (TPCR) 150-500 mg/g. It is reported that TPCR measurement is more acceptable since it is convenient, fast and does not require special preparation. The aim of this study was to investigate the accuracy of TPCR for diagnosis of diabetic nephropathy among patients with type 2 diabetes (type 2 DM). A diagnostic test study was conducted which involved 86 patients with type 2 DM where urine TPCR value equal or more than 150mg/g was independently and blindly compared with AER as a refference standard to diagnose diabetic nephopathy. The inclusion criteria were patients with type 2 DM who suspected suffer from diabetic nephropathy (suffer from DM more than 4 years) and agree to participate in this study. Those whom were suffer from at least on of the following diseases urinary tract infection, congestive heart failure, liver dysfunction, pregnancy, multiple myeloma, microangiopathy hemolytic anemia (MAHA) and incomplete data were excluded from the study. Contingency (2x2) table analysis was used to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio for positive test result/LR(+), likelihood ratio for negative test result/ LR(-), and accuracy. The average of TPCR among diabetic nephropathy patient was 248.07 mg/g. It was significantly higher than compared to those non diabetic nephropathy patient (103.52 mg/g). It was found 75 true positive, 9 true negative, and 2 false positive. The result showed that TPCR had a sensitivity, specificity, PPV, and NPV of 97.4%, 100%, 100%, and 81,8% respectively to diagnose diabetic nephropathy.The TPCR with value equal or more than 150 mg/g in the morning sample urine can be used to diagnose diabetic nephropathy. 75 positif benar, 9 negatif benar, dan 2 positif palsu. Hasil pemeriksaan menunjukkan bahwa TPCR memiliki sensitifitas 97,4%, spesifisitas 100%, NPP 100%, dan NPN 81,8% untuk diagnosis nefropati diagnostik. TPCR dengan nilai sama atau lebih dari 150 mg/g pada sampel urin pagi dapat digunakan untuk diagnosis nefropati diabetik.

Potential Role and Excretion Level of Urinary Transferrin, KIM-1, RBP, MCP-1 and NGAL Markers in Diabetic Nephropathy

“…Total protein/Cr was reported to be significantly correlated with ACR and considered as a diagnostic marker for nephropathy in patients with type 2 diabetes. 20 , 21 RBP is a low molecular weight protein, identified as a biomarker of proximal tubular dysfunction, filtered freely through glomeruli and completely reabsorbed in the proximal tubule. 22 In previous studies, urinary RBP level was reported to be increased with progression of albuminuria, showing a threshold for the increase in RBP with eGFR and proteinuria.…”