Validity of protein-creatinine and protein-osmolality ratios in the estimation of massive proteinuria in children with nephrotic syndrome
Keywords:
nephrotic syndrome, protein-creatinine ratio, protein-osmolality ratio
Abstract
Background Children with nephrotic syndrome have massiveproteinuria, a rate of excretion equal to or greater than 40 mg/
hour/m 2 body surface. The ability to quantitate massive urinary
protein excretion is very important for both diagnostic and
prognostic purposes. Quantification of proteinuria using 24-hour
urine collection (Esbach) is difficult to do especially in children;
moreover, many false-positive and false-negative results are
reported for any semi-quantitative methods such as dipstick and
sulfosalicylic acid measurement.
Objective To determine the accuracy of protein-creatinine ratio
(PCR) and protein-osmolality ratio (POR) in quantification of
massive proteinuria in children with nephrotic syndrome.
Methods Diagnostic tests were conducted on children with
nephrotic syndrome aged 2-12 years with Esbach as a reference
standard. Sensitivity, specificity, positive predictive value (PPV),
negative predictive value, (NPV), pre and posttest probability
were compared between PCR and POR.
Results Study patients consisted of 47 children, 38 (81%) with
massive proteinuria. PCR has sensitivity of 92%, specificity of
78%, PPV of 95%, NPV of 70% and posttest probability of 95%.
POR has sensitivity of 76%, specificity of 78%, PPV of 94%, NPV
of 44% and posttest probability of 94%.
Conclusion Both PCR and POR are accurate to determine massive
proteinuria in children with nephrotic syndrome.
References
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urinary protein- osmolality ratio. Pediatr Nephrol
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Quantification of proteinuria with urinary protein to
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ratio measurements on random urine samples for prediction
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Chemistry 2005;51:1577-86.
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RJ, editor. Clinical paediatric nephrology. 2 nd ed. Oxford:
Butterworth-Heinemann; 1994. p. 15-30.
2. Berstein JM. Conditions particularly associated with
proteinuria. In: Behrman RE, Kliegman RM, Jenson HB,
editors. Nelson textbook of pediatrics. 16 th ed. Philadelphia:
Saunders; 2000. p. 1590-2.
3. Nash MA, Edelmann CM, Bernstein J, Barnett HL. The
nephrotic syndrome. In: Edelmann CH, editor. Pediatric
kidney disease. 2 nd ed. Boston: Little, Brown and Company;
1992. p. 1247-63.
4. Vehaskari VM, Robson AM. Proteinuria. In: Edelmann CH,
editor. Pediatric kidney disease. 2 nd ed. Boston: Little, Brown
and Company; 1992. p. 531-46.
5. Kashif W, Siddiqi N, Dincer HE, Sheldon H. Proteinuria:
how to evaluate an important finding. Cleveland Clinic
Journal of Medicine 2003;70:535-46.
6. Bradley M, Schumann GB. Examination of urine. In: Henry
JB, editor. Clinical diagnosis and management by laboratory
methods. 9 th ed. Philadelphia: Saunders; 2000. p. 405-9.
7. Dalton RN, Haycock GB. Laboratory investigation. In:
Holliday MA, Barrat TM, editors. Pediatric nephrology. 3 rd
ed. Baltimore: Williams & Wilkins; 1994. p. 397-417.
8. Kasiske BL, Keane WF. Laboratory assessment of renal
disease: clearance, urinalysis, and renal biopsy. In: Brenner
MB, editor. The kidney. 6 th ed. Philadelphia: Saunders; 2000.
p. 1141-50.
9. Morgenstern BZ, Butani L, Wollan P, Wilson DM, Larson
TS. Validity of protein- osmolality versus protein-
creatinine ratios in estimation of quantitative proteinuria
from random samples of urine in children. Am J Kidney
Dis 2003;41:760-6.
10. Khan DA, Ahmad TM, Qureshi AH, Halim A, Ahmad M,
Afsal S. Assesment of proteinuria by using protein: creatinin
index in random urine sample. JPMA 2005;55:428-31.
11. Kim HS, Cheon HW, Choe JH, Yoo KH, Hong YS, Lee
JW. Quantification of proteinuria in children using the
urinary protein- osmolality ratio. Pediatr Nephrol
2001;16:73-6.
12. Hooman N, Otoukesh H, Safaii H, Mehrazma M, Yousefi S.
Quantification of proteinuria with urinary protein to
osmolality rasios in children. IJMS 2004;29:168-71.
13. Price CP, Newall RG, Boyd JC. Use of protein: creatinine
ratio measurements on random urine samples for prediction
of significant proteinuria: a systematic review. Clinical
Chemistry 2005;51:1577-86.
14. Levely AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes M,
et al. National kidney foundation practice for chronic kidney
disease: evaluation, classification, and stratification. Ann
Intern. Med 2003;139:137-47.
15. Antony AP, Robert SM, Diana CT, Donald EP. Evaluation of
proteinuria. In: Rudolph AM, Kamei RK, editors. Rudolph’s
fundamentals of pediatrics. 2 nd ed. Stanford: Appleton &
Lange; 1998. p. 520-4.
16. Wila Wirya IGN. Proteinuria. In: Alatas H, Tambunan T,
Trihono PP, Pardede SO, editors. Buku ajar nefrologi anak.
2 nd ed. Jakarta: Balai Penerbit FKUI; 2002. p.126-39.
17. Anderson S, Tank JE, Brenner BM. Renal and systemic
manifestation of glomerular disease. In: Brenner MB,
editor. The kidney. 6 th ed. Philadelphia: Saunder; 2000.
p. 1871-6.
18. Ronald JH, Miliner D, Lemley KV, Allison E, Ingelfiner J.
Evaluation and management of proteinuria and nephrotic
syndrome in children: recommendation from a Pediatric
Nephrology Panel Established at the national Kidney
Foundation Conference on proteinuria, albuminuria, risk,
assesment, detection and elimination (PARADE). Pediatrics
2000;105:1242-9.
19. Ramirez SP, Stephen IH, Friedrich KP. Risk factor for
proteinuria in a large, multiracial, Southeast Asian
population. J Am Soc Nephrol 2002;13:1907-17.
20. Pusponegoro HD, Wila Wirya IGN, Pudjiadi AH, Bisanto J,
Zulkarnain SZ. Uji diagnostik. In: Sastroasmoro S, Sofyan
Ismael, editors. Dasar-dasar metodologi penelitian klinis. 2 nd
ed. Jakarta: Sagung Seto; 2002. p. 166-84.
Published
2007-08-31
How to Cite
1.
Sukmawati M, Suarta K. Validity of protein-creatinine and protein-osmolality ratios in the estimation of massive proteinuria in children with nephrotic syndrome. PI [Internet]. 31Aug.2007 [cited 18Apr.2024];47(4):139-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/364
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Received 2016-08-27
Accepted 2016-08-27
Published 2007-08-31
Accepted 2016-08-27
Published 2007-08-31
