Detecting proteinuria: A comparison of diagnostic tests

Jeanida Mauliddina; Rosmayanti Siregar; Oke Rina Ramayani; Rafita Ramayati; Rusdidjas Rusdidjas

doi:10.14238/pi51.1.2011.17-21

Jeanida Mauliddina Department of Child Health, University of Sumatera Utara Medical School/H. Adam Malik Hospital, Medan, North Sumatera
Rosmayanti Siregar Department of Child Health, University of Sumatera Utara Medical School/H. Adam Malik Hospital, Medan, North Sumatera
Oke Rina Ramayani Department of Child Health, University of Sumatera Utara Medical School/H. Adam Malik Hospital, Medan, North Sumatera
Rafita Ramayati Department of Child Health, University of Sumatera Utara Medical School/H. Adam Malik Hospital, Medan, North Sumatera
Rusdidjas Rusdidjas Department of Child Health, University of Sumatera Utara Medical School/H. Adam Malik Hospital, Medan, North Sumatera

DOI: https://doi.org/10.14238/pi51.1.2011.17-21

Keywords: sulfosalicylic acid, spectrophotometry, proteinuria

Abstract

Background Proteinuria is a condition when protein is found in urine, a common symptom in children with renal disorders. Proteinuria can also be found in nonnal children and in those with non-renal disorders. A high sensitivity test is needed to detect proteinuria. Spectrophotometry has been used as a standard to detect proteinuria, however, it is expensive and not readily available in health clinics. We tested the use of20% sulfosalicylic add to detect proteinuria, and compared it to spectrophotometry. The sulfosalicylic add test is inexpensive, rapid, and easily performed in primary community health centers.

Objective To compare 2 0 % sulfosalicylic acid test t o spectrophotometry as a diagnostic test for proteinuria.

Methods We conducted a cross-sectional study in Adam Malik Hospital from September 2009 until December 2009. Inclusion criteria were children aged 3 to 18 years who experienced kidney disease. We collected 24 hour urine specimens from 55 children by consecutive sampling. Urine specimens were tested for proteinuria by 20% sulfosalicylic acid test and spectrophotometry.

Results Sensitivity and specificity of 20% sulfosalicylic acid test compared to spectrophotometry were 88.1 % and 69.2%, respectively, with a positive predictive value and a negative predictive value of 90.2% and 64.3%, respectively.

Conclusion The sulfosalicylic acid test had low sensitivity and specificity for detecting proteinuria, but it was more practical and less expensive compared to spectrophotometry.

References

1.. Wila Wirya ION. Proteinuria .. In: Alatas H, Tambunan T, Trihono PP, Pardede SO, editors. Buku ajar nefrologi anak. 2nd Ed. Jakarta: Balai Penerbit FK UI; 2006. p.127-41.
2.. Delaney MP, Price CP, Lamb E. Kidney disease. In: Burtis CA, Ashwood ER, Bruns DE, editors.Tietz textbook of clinical chemistry and molecular diagnostics. 4th Ed. New Delhi: Elsevier; 2006. p.1671-89.
3.. Schumann OB, Schweitzer Sc. Examination of urine. In: Hendry JB, editor. Clinical diagnosis and management by laboratory methods. 18th Ed. New York: WB Saunders; 1991. p.387-90.
4.. Lamb E, Price CPO. Kidney function tests. In: Burtis CA, Ashwood ER, Bruns DE, editors. Tietz textbook of clinical chemistry and molecular diagnostics. 4th Ed. New Delhi: Elsevier; 2006. p.797-826.
5.. Keane WE. Proteinuria: its clinical importance and role in progressive renal disease. Am J Kidney Dis. 2000;35:s97- s105.
6.. Zhao S, EzraJB, Mcpherson RA. Basic examination of urine. In: Zhao S, editor. Henry's clinical diagnosis and management by laboratory methods. 21th Ed. New York: Elsevier; 2007. p.393-425.
7.. Milford DV, Robson AM. The child with abnonnal urinalysis, haematuria and/or proteinuria. In: Webb NJ, Postlethewaite RJ, editors. Clinical paediatric nephrology. 3rd Ed. New York: Oxford University Press; 2003. p.1-27.
8. Makker SP. Proteinuria. In: Kher KK, Makker Sp, editors. Clinical pediatric nephrology. Singapore: Mc Graw Hill; 1992, p.117-36.
9. Agarwal I, Kirubakaran C, Markandeyulu, Selvakumar. Quantitation of proteinuria by spot urine sampling. Indian J Clin Biochem. 2004;19:55-7.
10. Oni MO, Oguntibeju O. Clinical and diagnostic importance of proteinuria: a review. Afr J Biotechnol. 2008; 7:3166-72.
11. Kashif W, Siddiqi N, Dincer HE, Dincer Ap, Hirsch S. Proteinuria: how to evaluate an important finding. Cleveland Clin J Med. 2003;70,535-47.
12. Adham ML. Evaluation proteinuria in children. Am Fam Physician. 1998;58:1145-52.
13. Milford DY. Investigating haematuria and proteinuria. Paediatr Child Health. 2008;18:349-353.
14. Narchi H. Assessment and management of non-nephrotic range proteinuria in children. Sri Langka J Child Health. 2009;37:85-92.
15. Christian MT, WatsonAR. The investigation of proteinuria. CUff Paediatr. 2004;14:547-55.
16. Serdaroglu E, Mir S. Protein-osmolality ratio for quantification of proteinuria in children. Clin Exp Nephrol. 2008;12,354-7.
17. Wilde HM, Banks D, Larsen CL, Connor G, wallace D, Lyon ME. Evaluation of the bayer microalbumin/creatinine urinalysis dipstick. Clin Chimica Acta. 2008;393 :110-13.
18. Fischbach FT, Dunning MB, editors.U rine studies.A manual of laboratory and diagnostic test. 7th Ed. Philadelphia: Lippincott Williams&Wilkins, 1996; p. 164-263.
19. Pegoraro A, Singh A, Bakir AA, Arruda JA, Dunca G. Simplified screening for microalbuminuria. Ann Intern Med. 1997 ;127,817-19.
20. Lin CY, Hsieh CC, Chen Wp, Yang LY, Wang HH. T he underlying diseases and follow-up in Taiwanese children screened by urinalysis. Pediart Nephrol. 2001; 16:232-7.
21. Fogazzi GB, Verdesca S, Garigali G. Urinalysis: core curriculum 2008. Am) Kidney Dis. 2008;51:1052-67.
22. Jahan S, Islam MS, Hossain MM. Spot urinary protein/ osmolality ratio as a predictor for proteinuria of nephritic range. Bangladesh Med Res Counc Bull. 2007;33:65-8.
23. Zhai YH, Xu H, Zhu GH, Wei MJ, Hua BC, Shen Q, et all. Efficacy of urine screening at school: experience in Shanghai, China. Pediatr Nephrol. 2007;22:2073-9.
24. Gyure WL. Comparison of several methods for semiquantitative determination of urinary protein. Clin Chem. 1977;23:876-9.
25. Murakami M, Hayakawa M, Yanaghira T, Hukunaga Y. Proteinuria screening for children. Kidney Internat. 2005;67:s23-7.
26. Grinstead GF, Scott RE, Stevens BS, Ward VL, Wilson DM. T he ames clinitek 200/multistix 9 urinalysis method compared \\lith manual and microscopic methods. Clin Chem. 1987;33:660-2.
27. Lane MK, Pearce RH. Test protinuria a comparison of two new commercial products with standart tests. Canada M A J.1958;15:843-5.
28. Aitman KA, Stellate. Variation of protein content of urine in a 24 hour period. Clin Chem. 1963;9:63-9.
29. Priyana A. Urinalisa. Patologi klinik. Jakarta: Penerbit Universitas Trisakti, 2007; p. 47-58.
30. Lyon SD, Sanderson MW, Vaden SL,Lappin MR,Jensen WA, Grauer GF. Comparison of urine dipstick, sulfosalicylic acid, urine protein-to-creatinine ratio, and species-specific ELISA methods for detection of albumin in urine samples of cats and dogs. J Am Vet Med Assoc. 2010;236:874-9.
31. Dilena BA, Panberthy LA, Fraser CG. Six methods for determining urinary protein compared. Clin Chem. 1983;29:553-7.