Diagnostic accuracy of single-voided urine protein/ creatinine ratio for proteinuria assessment in children with nephrotic syndrome
Keywords:
proteinuria, nephrotic syndrome, protein/creatinine ratio
Abstract
Background Measurement of protein excretion is not onlyused for diagnostic purpose but also to monitor disease severity
and prognosis in children with nephrotic syndrome (NS).
The common method to measure proteinuria is 24-hour urine
collection. However, 24-hour urine collection is cumbersome,
time consuming, and tedious. An alternative simplified method
is the measurement of protein/creatinine ratio in single-voided
urine specimens.
Objective The aim of this study was to determine whether urine
protein/creatinine ratio is accurate to predict pathologic (> 100
mg/m2/day) and massive proteinuria (> 1 g/m2/day).
Methods Seventy single voided and 24-hour urine specimens
were collected from children aged 3-18 years. The relationship
between urinary protein/creatinine ratio and total daily protein
excretion was calculated using correlation and linear regression
analysis. Diagnostic test was conducted to estimate the accuracy
of protein/creatinine ratio for the diagnosis of pathologic and
massive proteinuria in NS.
Results Correlation coefficient between quantity of protein in
24-hour urine specimens and protein/creatinine ratio in singlevoided urine specimens was 0.96 (R2=0.93). Both sensitivity and specificity of urinary protein/creatinine ratio were 87% in diagnosing pathologic proteinuria, whereas the sensitivity and specificity of the ratio to predict massive proteinuria were 88% and 91%, respectively.
Conclusion The urinary protein/creatinine ratio in single voided
urine specimen has a good accuracy to predict pathologic and
massive proteinuria in children with NS aged 3-18 years.
References
1. Price CP, Newall RG, BoydJC. Use of protein: creatinine ratio
measurements on random urine specimens for prediction
of significant proteinuria: a systematic review. Clin Chern.
2005;51: 1577-86.
2. Eknoyan G. On testing for proteinuria: time for a methodical
approach. Cleve ClinJ Med. 2003;70:493-501.
3. Milford DV, Robson AM. The child with abnormal urinalysis,
haematuria, and/or proteinuria. In: Webb N, Postlethwaite R,
editors. Clinical pediatric nephrology. Jrd edition. New York:
Oxford; 2003.
4. Hogg RJ, Portman RJ, Milliner D, Lemley KV, Eddy A,
Ingelfinger J. Evaluation and management of proteinuria and
nephrotic syndrome in children: recommendations from a
pediatric nephrology panel established at the national kidney
foundation conference on proteinuria, albuminuria, risk,
assessment, detection, and eliminati (PARADE). Pediatrics.
2000;105:1242-9.
5. Bagga A, Man tan M. Nephrotic syndrome in children. Indian
J Med Res. 2005;122:13-28.
6. Wila Wirya IGN. Sindroma nefrotik. In: Tambunan T,
Trihono P, Pardede SO, Alatas H, editors. Buku ajar nefrologi
anak. Vol. II. Jakarta: Balai Penerbit FKUI; 1999.
7. Roth KS, Amaker BH, Chan JCM. Nephrotic syndrome:
pathogenesis and management. Pediatr Rev. 2002;23:237-48.
8. Mustafa G, Khan PA, Iqbal I, Hussain Z, Iqbal MM.
Simplified quantification of urinary protein excretion in
children with nephrotic syndrome. J Coli Physicians Surg
Pak. 2007;17:615-8.
9. Levey AS, Coresh J, BalkE, Kausz A, Levin A, Steffes MW, et
a!. National kidney foundation practice guidelines for chronic
kidney disease: evaluation, classification, and stratification.
Ann Intern Med. 2003;139:137-47.
10. NewmanDJ, PugiaMJ, LottJA, WallaceJF, Hiar AM. Urinary
protein and albumin excretion corrected by creatinine and
specific gravity. Clin Chim Acta. 2000;294: 139-55.
11. Cote AM, Brown MA, Lam E. Diagnostic accuracy of
urinary spot protein/ creatinine ratio for proteinuria in
hypertensive pregnant women: systematic review. BMJ.
2008;336: 1003-6.
12. Leung YY, Szeto CC, Tam LS. Urine protein-to-creatinine
ratio in an un-timed urine collection is a reliable measure of
proteinuria in lupus nephritis. Rheumatology. 2007;46:649-52.
13. Sacket DL, Haynes RB, Guyatt GH, Tugwell P. Clinical
epidemiology: A Basic science for clinical medicine. Boston:
Little Brown and Company; 1991.
14. Abitbol C, Zilleruelo G, Freundlich M, Strauss J. Quantitation
of proteinuria with urinary protein/creatinine ratios and
random testing with dipsticks in nephrotic children. J Pediatr.
1990;116:243-7.
measurements on random urine specimens for prediction
of significant proteinuria: a systematic review. Clin Chern.
2005;51: 1577-86.
2. Eknoyan G. On testing for proteinuria: time for a methodical
approach. Cleve ClinJ Med. 2003;70:493-501.
3. Milford DV, Robson AM. The child with abnormal urinalysis,
haematuria, and/or proteinuria. In: Webb N, Postlethwaite R,
editors. Clinical pediatric nephrology. Jrd edition. New York:
Oxford; 2003.
4. Hogg RJ, Portman RJ, Milliner D, Lemley KV, Eddy A,
Ingelfinger J. Evaluation and management of proteinuria and
nephrotic syndrome in children: recommendations from a
pediatric nephrology panel established at the national kidney
foundation conference on proteinuria, albuminuria, risk,
assessment, detection, and eliminati (PARADE). Pediatrics.
2000;105:1242-9.
5. Bagga A, Man tan M. Nephrotic syndrome in children. Indian
J Med Res. 2005;122:13-28.
6. Wila Wirya IGN. Sindroma nefrotik. In: Tambunan T,
Trihono P, Pardede SO, Alatas H, editors. Buku ajar nefrologi
anak. Vol. II. Jakarta: Balai Penerbit FKUI; 1999.
7. Roth KS, Amaker BH, Chan JCM. Nephrotic syndrome:
pathogenesis and management. Pediatr Rev. 2002;23:237-48.
8. Mustafa G, Khan PA, Iqbal I, Hussain Z, Iqbal MM.
Simplified quantification of urinary protein excretion in
children with nephrotic syndrome. J Coli Physicians Surg
Pak. 2007;17:615-8.
9. Levey AS, Coresh J, BalkE, Kausz A, Levin A, Steffes MW, et
a!. National kidney foundation practice guidelines for chronic
kidney disease: evaluation, classification, and stratification.
Ann Intern Med. 2003;139:137-47.
10. NewmanDJ, PugiaMJ, LottJA, WallaceJF, Hiar AM. Urinary
protein and albumin excretion corrected by creatinine and
specific gravity. Clin Chim Acta. 2000;294: 139-55.
11. Cote AM, Brown MA, Lam E. Diagnostic accuracy of
urinary spot protein/ creatinine ratio for proteinuria in
hypertensive pregnant women: systematic review. BMJ.
2008;336: 1003-6.
12. Leung YY, Szeto CC, Tam LS. Urine protein-to-creatinine
ratio in an un-timed urine collection is a reliable measure of
proteinuria in lupus nephritis. Rheumatology. 2007;46:649-52.
13. Sacket DL, Haynes RB, Guyatt GH, Tugwell P. Clinical
epidemiology: A Basic science for clinical medicine. Boston:
Little Brown and Company; 1991.
14. Abitbol C, Zilleruelo G, Freundlich M, Strauss J. Quantitation
of proteinuria with urinary protein/creatinine ratios and
random testing with dipsticks in nephrotic children. J Pediatr.
1990;116:243-7.
Published
2009-12-31
How to Cite
1.
Kristiani D, Kusuma P, Suryantoro P. Diagnostic accuracy of single-voided urine protein/ creatinine ratio for proteinuria assessment in children with nephrotic syndrome. PI [Internet]. 31Dec.2009 [cited 22Nov.2024];49(6):355-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/601
Section
Articles
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Received 2016-09-12
Accepted 2016-09-12
Published 2009-12-31
Accepted 2016-09-12
Published 2009-12-31
