Urinary dipstick protein: A poor predictor of absent or severe proteinuria

Meyer, Norman; Mercer, Brian M.; Friedman, Steven A.; Sibai, Baha M.

doi:10.1016/s0002-9378(13)70294-1

Cited by 82 publications

(50 citation statements)

References 13 publications

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“…Furthermore, rapid evaluation of proteinuria by dipstick or spot urinalysis methods has been shown to correlate poorly with the actual level of proteinuria found in a 24-hour urine specimen. 9 As expected, the serum creatinine was found to be significantly correlated between the first and second sample. This is not surprising as, in the absence of acute renal failure, a significant variation in serum creatinine levels would not be expected.…”

Section: Discussionsupporting

confidence: 74%

A 12-Hour Urine Collection Accurately Assesses Proteinuria in the Hospitalized Hypertensive Gravida

et al. 1999

J Perinatol

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OBJECTIVE:To determine whether a urine collection of Ͻ24 hours duration accurately assesses the level of proteinuria in inpatients being evaluated for preeclampsia. STUDY DESIGN:Patients admitted to the University of Mississippi between January and June of 1998 for evaluation of preeclampsia underwent two consecutive 12-hour urine collections. Each collection was analyzed for total protein, total calcium, total volume, and urine creatinine. A concurrent serum creatinine value was obtained. The protein:creatinine ratio, calcium: creatinine ratio, and creatinine clearance were calculated. Pearson's correlation, sensitivity, specificity, and positive and negative predictive values were assessed. RESULTS:A total of 25 patients (86%) were preeclamptic. Total protein, the protein: creatinine ratio, and serum creatinine were significantly correlated between the first and second urine collection. The sensitivity and specificity of the 12-hour urine collection was 96% and 100%, respectively. CONCLUSION:A 12-hour urine collection accurately depicts the amount of proteinuria in hospitalized gravidas being evaluated for preeclampsia.Hypertensive disease is the most commonly encountered significant medical complication of pregnancy, affecting an estimated 5% to 10% of all pregnancies.1 Preeclampsia, as mild or severe disease, is responsible for ϳ70% of the hypertensive disease observed during pregnancy. To insure the accuracy of the diagnosis of preeclampsia, the amount of proteinuria must be accurately evaluated.2 Traditionally, performing a 24-hour urine collection for total protein has been promoted and practiced as a "gold standard." [3][4][5] The rationale behind the 24-hour urine collection is that in preeclamptic patients, the fluctuation of protein loss in the urine varies significantly over a 24-hour period, and collections of less than this duration may not accurately reflect the actual amount of daily protein loss.Collection of a 24-hour urine specimen can be associated with several problems. First, this large volume of urine is heavy and renders the collection vessel cumbersome for patients and hospital personnel to manage. Second, after collection of the 24-hour urine specimen, laboratory analysis takes more time, further delaying diagnosis and directed management. Hence, several investigations have attempted by variable methodologies to shorten the time period and to better identify the patient with preeclampsia. These have included dipstick evaluation of single voided specimens for proteinuria and the use of protein:creatinine ratios in single voided specimens. Reports of the accuracy of these methods have been inconsistent. 6 -8 Neither assessment tool has been found to be sufficiently suitable to replace the 24-hour urine collection as the standard recommended methodology.The purpose of this investigation was to determine whether a shorter period of urine collection would still accurately reflect the level of proteinuria that otherwise would be measured in a 24-hour urine collection, therefore effectively d...

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Section: Discussionsupporting

confidence: 74%

A 12-Hour Urine Collection Accurately Assesses Proteinuria in the Hospitalized Hypertensive Gravida

et al. 1999

J Perinatol

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“…Traditionally, the dipstick urinalysis has been used as this screening test. 2 The dipstick urinalysis measures the concentration of protein in the urine and is susceptible to fluctuations in the water content of the urine. Dilute urine may underestimate the amount of protein that would be collected in a 24-h urine collection, whereas concentrated urine may overestimate it.…”

Section: Introductionmentioning

confidence: 99%

“…Specificities also vary widely. [2][3][4][5] Differences in methodology contribute to this large discrepancy. For example, automated dipstick urinalysis is more specific for predicting 24-h proteinuria than is ward dipstick urinalysis.…”

Section: Introductionmentioning

confidence: 99%

Urinalysis vs urine protein–creatinine ratio to predict significant proteinuria in pregnancy

et al. 2008

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Objective: To compare the urine protein-creatinine ratio with urinalysis to predict significant proteinuria (X300 mg per day).Study Design: A total of 116 paired spot urine samples and 24-h urine collections were obtained prospectively from women at risk for preeclampsia. Urine protein-creatinine ratio and urinalysis were compared to the 24-h urine collection.Result: The urine protein-creatinine ratio had better discriminatory power than urinalysis: the receiver operating characteristic curve had a greater area under the curve, 0.89 (95% confidence interval (CI) 0.83 to 0.95) vs 0.71 (95% CI 0.64 to 0.77, P<0.001). When matched for clinically relevant specificity, urine protein-creatinine ratio (cutoff X0.28) is more sensitive than urinalysis (cutoff X1 þ ): 66 vs 41%, P ¼ 0.001 (with 95 and 100% specificity, respectively). Furthermore, the urine protein-creatinine ratio predicted the absence or presence of proteinuria in 64% of patients; urinalysis predicted this in only 19%. Conclusion:The urine protein-creatinine ratio is a better screening test. It provides early information for more patients.

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“…6,7 Historically, the concern with the standard urine dipstick was the accuracy of this one-time measurement. In particular, the urine dipstick has been demonstrated to have a poor sensitivity and, in studies, greater than 50% of women with negative or trace urine dipsticks have been found to have significant proteinuria.…”

mentioning

confidence: 99%

“…In particular, the urine dipstick has been demonstrated to have a poor sensitivity and, in studies, greater than 50% of women with negative or trace urine dipsticks have been found to have significant proteinuria. 6,8 Although the urine protein/creatinine ratio should alleviate the problem with overall urine concentration, it too has not been found to have a particularly high sensitivity when a ratio of 0.3 has been used as a diagnostic threshold. Lower ratios of 0.15 9 and 0.19 10 have been suggested, but these continue to demonstrate problems with sensitivity, specificity and the corresponding positive and negative predictive values.…”

mentioning

confidence: 99%

Predicting proteinuria in pregnancy: a potential algorithm

Caughey¹

2008

J Perinatol

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Urinary dipstick protein: A poor predictor of absent or severe proteinuria

Cited by 82 publications

References 13 publications

A 12-Hour Urine Collection Accurately Assesses Proteinuria in the Hospitalized Hypertensive Gravida

A 12-Hour Urine Collection Accurately Assesses Proteinuria in the Hospitalized Hypertensive Gravida

Urinalysis vs urine protein–creatinine ratio to predict significant proteinuria in pregnancy

Predicting proteinuria in pregnancy: a potential algorithm

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