Spot PC ratio estimates of 24-hour proteinuria are more unreliable in lupus nephritis than in other forms of chronic glomerular disease

Birmingham, Daniel J.; Shidham, Ganesh; Perna, Annalisa; Fine, Derek M.; Bissell, M.G.; Rodby, Roger A.; Remuzzi, Giuseppe; Petri, Michele; Hebert, Paul L.; Rovin, Brad H.; Hebert, Lee A.

doi:10.1136/annrheumdis-2013-203790

Cited by 25 publications

(14 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is well established that spot PCR testing often produces a highly variable estimate of 24-hour P or 24-hour PCR. 6 , 8 , 9 , 10 , 11 This is most clearly shown in calibration plots from cross-sectional studies in which a gold standard estimate of 24-hour P (24-hour PCR) is displayed in relationship to the ratio: spot PCR/24-hour PCR. 6 , 8 , 9 In these studies, spot PCRs were determined in morning collections provided at the time of the clinic visit of the patient, which was a morning visit.…”

Section: Discussionmentioning

confidence: 98%

“…Over more restricted ranges (e.g., subnephrotic range proteinuria, ≤3.5 g/d, the most common range of abnormal proteinuria), the correlation coefficient between the spot PCR and 24-hour P is weak, and concordance is poor. 5 , 6 , 7 , 8 , 9 , 10 , 11 …”

mentioning

confidence: 99%

“…The rationale was that 24-hour PCR (or 24-hour P) was the most reliable estimate of the proteinuria magnitude. 5 , 6 , 9 , 10 , 11 , 12 Therefore, the line created by joining the individual 24-hour PCR values is the most reliable estimate of the proteinuria trend. The individual spot PCR values of the patients were compared with this trend line.…”

mentioning

confidence: 99%

See 2 more Smart Citations

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

Shidham

Ayoub

Birmingham

et al. 2018

Kidney International Reports

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

See 1 more Smart Citation

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

Shidham

Ayoub

Birmingham

et al. 2018

Kidney International Reports

Self Cite

View full text Add to dashboard Cite

show abstract

“…Such changes should be based on 24-hour urine collections for proteinuria or the urine protein-tocreatinine ratios from a 24-hour urine. 101 Anti-double-stranded DNA, complement C3, C4, anti-C1q testing. The combination of elevated anti-double-stranded DNA, low serum complement, and anti-C1q autoantibody levels, if available, is strongly associated with renal involvement in SLE and should be monitored in patients at risk for LN or LN flare.…”

Section: Pathogenesismentioning

confidence: 99%

Management and treatment of glomerular diseases (part 2): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Rovin

Caster

Cattran

et al. 2019

Kidney International

145

View full text Add to dashboard Cite

In November 2017, the Kidney Disease: Improving Global Outcomes (KDIGO) initiative brought a diverse panel of experts in glomerular diseases together to discuss the 2012 KDIGO glomerulonephritis guideline in the context of new developments and insights that had occurred over the years since its publication. During this KDIGO Controversies Conference on Glomerular Diseases, the group examined data on disease pathogenesis, biomarkers, and treatments to identify areas of consensus and areas of controversy. This report summarizes the discussions on primary podocytopathies, lupus nephritis, anti-neutrophil cytoplasmic antibody-associated nephritis, complementmediated kidney diseases, and monoclonal gammopathies of renal significance.

show abstract

“…Birmingham et al, showed poor agreement between PCR and 24H-P for SLE patients with proteinuria of 0.5 to 3.0 g/day [84]. Recently, these authors showed that the PCR is more unreliable in SLE than in other causes of CKD [85]. Medina-Rosas et al, studied 1,233 paired samples from 322 SLE patients and found a high correlation for all samples with lower correlation for subgroups of 24H-P, and poor agreement for all samples and subgroups, being worse for 24H-P higher than 1.0 g/day [80].…”

Section: How To Accurately Measure Proteinuria In Lupusmentioning

confidence: 99%

A Brief Comment On The Treatment Of Internal Hemorrhoids By Rubber Band Ligation Combined With Sclerotherapy

Zhixian¹

2019

AVS

View full text Add to dashboard Cite

Spot PC ratio estimates of 24-hour proteinuria are more unreliable in lupus nephritis than in other forms of chronic glomerular disease

Cited by 25 publications

References 10 publications

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

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

Management and treatment of glomerular diseases (part 2): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

A Brief Comment On The Treatment Of Internal Hemorrhoids By Rubber Band Ligation Combined With Sclerotherapy

Contact Info

Product

Resources

About