Abstract:BACKGROUND:Proteinuria, in addition to haematuria, is the most important laboratory parameter in patients with nephro-urological diseases. Low molecular weight proteinuria (LMWP) is of particular importance because some diseases genetic and tubulointerstitial are diagnosed based on its presence.AIM:The purpose of this study is to describe the clinical features, the course and outcome of pediatric patients with a renal disease associated with LMWP.MATERIAL AND METHODS:This retrospective observational study incl… Show more
“…9 Previous reports showed that dipstick urinalysis in screening for proteinuria missed 8-56% of cases in a sample population, further highlighting a possible reason for the observed disparity. [20][21][22] The McNemar test of signi cance for the paired proportions shows 70% discordant result between UPr/UCr and dipstick proteinuria re ecting the higher false positive value for dipstick urinalysis at sub-nephrotic range proteinuria as previously reported. 3,6 The reason could be poor sensitivity of dipstick to proteinuria or its' inability to detect other forms of non-albumin proteinuria.…”
Section: Discussionsupporting
confidence: 67%
“…3,6 The reason could be poor sensitivity of dipstick to proteinuria or its' inability to detect other forms of non-albumin proteinuria. 3,22 The 18% prevalence using UPr/Cr ≥ 0.2 found in this study is higher than the average prevalence of 12.2% (1.6-26.4%) in the reviewed studies in Table IIa. The few reported studies in Nigeria (Lagos-6.0% & Calabar-1.6%) and Turkey (7.2%) among apparently healthy children were far lower than the 18.0% observed in this study.…”
Background
Although, the use of manual dipstick urinalysis for proteinuria has been a common practice, the Kidney Disease Improving Global Outcomes (KDIGO) guideline on screening for chronic renal disease least advocate it use. Besides, several studies have assessed the performance of dipstick urinary in screening for proteinuria to be inaccurate, unreliable with a poor predictive values. The goal of this study was to determine and compare the presence of significant proteinuria (SP) in high-risk African children using the spot urine protein creatinine ratio (UPr/UCr) as a primary screening tool besides dipstick proteinuria screening.
Methods
This cross-sectional study involved 1,316 apparently healthy children recruited through a multi-stage sampling technique in Ogbomoso land, Nigeria. We performed a dipstick urinalysis on early-morning urine samples. Urinary protein content was determined using a turbidimetric method and Jaffe’s reaction to measure the urinary creatinine concentration. Statistical analysis was performed using the IBM Statistical Package for Social Sciences (SPSS)TM, Version 23.0 for Windows.
Results
The prevalence of SP using spot UPr/UCr (≥ 0.2) and dipstick proteinuria screening (≥1+) were 18% and 0.8%, respectively (p<0.001). Of the 224 subjects determined to have SP using UPr/UCr, the females (140; 20.1%) had a higher proportion compared to males (84; 15.4% -p=0.032). Nephrotic range proteinuria was detected in nine out of 10 subjects (90%) using UPr/UCr but in only three out of ten (30%) using the urinary dipstick method. The biserial correlation coefficient (r= 0.092; p=0.001) and inter-rater-agreement (Cohen’s Kappa = 0.01) were poor, and the McNemar’s test result was (p<0.001).
Conclusion
The UPr/UCr ratio technique appeared to perform better than dipstick urinalysis as a primary screening tool for renal disease. Hence, it may be adopted for early detection of SP as a kidney disease marker especially among the high risk population.
“…9 Previous reports showed that dipstick urinalysis in screening for proteinuria missed 8-56% of cases in a sample population, further highlighting a possible reason for the observed disparity. [20][21][22] The McNemar test of signi cance for the paired proportions shows 70% discordant result between UPr/UCr and dipstick proteinuria re ecting the higher false positive value for dipstick urinalysis at sub-nephrotic range proteinuria as previously reported. 3,6 The reason could be poor sensitivity of dipstick to proteinuria or its' inability to detect other forms of non-albumin proteinuria.…”
Section: Discussionsupporting
confidence: 67%
“…3,6 The reason could be poor sensitivity of dipstick to proteinuria or its' inability to detect other forms of non-albumin proteinuria. 3,22 The 18% prevalence using UPr/Cr ≥ 0.2 found in this study is higher than the average prevalence of 12.2% (1.6-26.4%) in the reviewed studies in Table IIa. The few reported studies in Nigeria (Lagos-6.0% & Calabar-1.6%) and Turkey (7.2%) among apparently healthy children were far lower than the 18.0% observed in this study.…”
Background
Although, the use of manual dipstick urinalysis for proteinuria has been a common practice, the Kidney Disease Improving Global Outcomes (KDIGO) guideline on screening for chronic renal disease least advocate it use. Besides, several studies have assessed the performance of dipstick urinary in screening for proteinuria to be inaccurate, unreliable with a poor predictive values. The goal of this study was to determine and compare the presence of significant proteinuria (SP) in high-risk African children using the spot urine protein creatinine ratio (UPr/UCr) as a primary screening tool besides dipstick proteinuria screening.
Methods
This cross-sectional study involved 1,316 apparently healthy children recruited through a multi-stage sampling technique in Ogbomoso land, Nigeria. We performed a dipstick urinalysis on early-morning urine samples. Urinary protein content was determined using a turbidimetric method and Jaffe’s reaction to measure the urinary creatinine concentration. Statistical analysis was performed using the IBM Statistical Package for Social Sciences (SPSS)TM, Version 23.0 for Windows.
Results
The prevalence of SP using spot UPr/UCr (≥ 0.2) and dipstick proteinuria screening (≥1+) were 18% and 0.8%, respectively (p<0.001). Of the 224 subjects determined to have SP using UPr/UCr, the females (140; 20.1%) had a higher proportion compared to males (84; 15.4% -p=0.032). Nephrotic range proteinuria was detected in nine out of 10 subjects (90%) using UPr/UCr but in only three out of ten (30%) using the urinary dipstick method. The biserial correlation coefficient (r= 0.092; p=0.001) and inter-rater-agreement (Cohen’s Kappa = 0.01) were poor, and the McNemar’s test result was (p<0.001).
Conclusion
The UPr/UCr ratio technique appeared to perform better than dipstick urinalysis as a primary screening tool for renal disease. Hence, it may be adopted for early detection of SP as a kidney disease marker especially among the high risk population.
“…The datasets for both refractive methods displayed a negative skew (manifest = −1.23, VASR = −1.46), which is to be anticipated in this particular population; most of the subjects were graduate students, who tend to have a higher prevalence of myopia (Figure 3). 11,12 Platykurtosis was also observed (manifest = 1.79, VASR = 2.85). Because of these factors, non-parametric analyses were performed using the Wilcoxon test.Figure 2Box plot of results (Manifest vs VASR).Figure 3Difference plot.…”
PurposeTo compare the accuracy, speed and repeatability of the voice assisted subjective refractor (VASR) to traditional refractive methods.MethodsFifty healthy adult subjects were examined by autorefractor, followed by subjective phoropter refinement. Subjects were then evaluated using the VASR (Vmax Vision) to obtain an objective and subjective result. Three total assessments were performed for each subject using each of the methods described. Corrected visual acuity was recorded for each eye after each procedure. The total time was measured for both the traditional and VASR refraction.ResultsA comparison of the results obtained by traditional refraction and VASR revealed no statistically significant difference from the mean in equivalent sphere measurements (P=0.1383), and the datasets were highly correlated (r=0.993). The data comparisons for cylinder power and axis were similar (cylinder: P=0.6377, r=0.864) (axis: P=0.6991, r=0.738). VASR, on average, required 71 additional seconds to complete when compared to traditional phoropter refraction. In terms of repeatability, the average difference noted upon repeat of equivalent sphere power was 0.01 D for the phoropter (P=0.98) and 0.10 D for the VASR (P=0.23). For sphere power, the average difference was 0.02 D for the phoropter (P=0.55) and 0.07 D for the VASR (P=0.58). For cylinder power, the average difference was 0.02 D for the phoropter (P=0.11) and 0.03 D for the VASR (P=0.39). For all refractive methods, the differences between measurements amounted to ≤0.10 diopters, which is neither clinically nor statistically significant.ConclusionRefractive error results obtained with the VASR were not statistically different from those achieved using traditional phoropter methods. Time elapsed for the VASR was slightly longer than a more traditional refractive sequence. The VASR demonstrated clinically and statistically significant repeatability of measurement, consistent with traditional refraction.
“…Another problem is that urine protein electrophoresis has not been routinely used for screening for LMW proteinuria (10), thus, missing many opportunities to find tubular disease. LMW proteinuria can be found in a number of genetic tubulointerstitial diseases, such as nephronophthisis, Dent disease 1, Dent disease 2, Lowe syndrome, and cystinosis, in addition to the acquired diseases (11), which need next-generation sequencing (NGS) to be diagnosed. Therefore, insufficient awareness of genetic analysis is also an important factor that limits early diagnosis.…”
Dent disease 1 is a rare X-linked recessive inherited disease, caused by pathogenic variants in the chloride voltage-gated channel 5 (CLCN5) gene. Dent disease 1 is characterized by low molecular weight (LMW) proteinuria, hypercalciuria, nephrocalcinosis, and chronic kidney disease. Infants may manifest only asymptomatic LMW proteinuria, which increases the difficulty of early diagnosis. We describe two male infants presenting only with nephrotic-range LMW proteinuria observed on examination using urine protein electrophoresis. Hereditary renal tubular diseases were highly suspected based on early onset age and LMW proteinuria. Thus, next-generation sequencing (NGS) was performed and pathogenic mutations in CLCN5 were identified in both patients. A diagnosis of Dent disease 1 was established based on the above informations. The two patients developed hypercalciuria during late follow-up, which verified the diagnosis. These two cases highlight the importance of next-generation sequencing in the early diagnosis of Dent disease 1 with only LMW proteinuria.
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