Comparison of Urinary Protein/Creatinine Ratio as an Alternative to 24-h Proteinuria in Lupus Nephritis: TUNARI Study

Abstract

Background: Lupus nephritis (LN) occurs in approximately 50% of people with Systemic Lupus Erythematosus (SLE). The 24-hour proteinuria (gold standard) is measured among other tests for the control and monitoring of LN activity. This study investigates the use of the protein/creatinine ratio (PCR) as an alternative for the detection of proteinuria and its accuracy compared to the gold standard in a predominantly non-white population. Methods: This was a prospective study conducted in Salvador, Brazil, between December 2021 and May 2022. We invited adult patients diagnosed with SLE and LN, regardless of their disease activity. The estimation of the PCR and 24-hour proteinuria was performed using conventional methods. The analysis used was the correlation test (rs), coefficient of determination (r2) and concordance by the Bland-Altman method. A specific sensitivity was measured by the ROC curve with its respective cut-off by the Youden Index. Results: We compared 112 samples of 75 patients with LN, with a mean age of 34.5 ± 11.8 years. Of these patients, 85% were women, 87.9% were non-white. A high degree of correlation was observed between PCR with 24-hour proteinuria (rs = 0.77 and r² = 0.59). The ROC analysis shows an area under the curve (AUC) of 0.92 and the cut-off point calculated by the Youden Index was 0.78 with a sensitivity of 90.0% and specificity of 82%. However, the Bland-Altman graph indicated decreasing concordance as the degree of proteinuria increased, despite showing concordance at high levels of proteinuria. Conclusion: The PCR shows high sensitivity to follow-up patients with LN when compared with 24-hour proteinuria. Our findings suggest that PCR is a useful parameter for the evaluating and monitoring patients in complete remission. However, in cases of partial remission, the utility of PCR is limited.

Lupus Nephritis Risk Factors and Biomarkers: An Update

“…The gold standard for proteinuria assessment is the 24 h urine collection assay, but this is a cumbersome and often impractical approach so the proteinuria to creatinuria ratio (PCR) is used as a surrogate, based on a good to high degree of correlation between the two parameters [105,106]. An elevated proteinuria (>0.5 g/24 h) is used as the criteria to perform a renal biopsy and confirm LN in SLE patients [14], and proteinuria (>0.5 g/24 h) with/without hematuria (>5 red blood cells/high-power field) is used to define SLE disease activity (4 + 4 points in SLEDAI-2K).…”