Spot urinary protein analysis for excluding significant proteinuria in pregnancy

Wilkinson, Chris; Lappin, David; Vellinga, Akke; Heneghan, Helen; Ohara, Rie; Monaghan, J. C.

doi:10.3109/01443615.2012.711388

Cited by 17 publications

(9 citation statements)

References 9 publications

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“…12 Cut-off of the present study is almost similar with that of Wilkinson et al, the authors concluded that both PCR and ACR are good rule out tests for significant proteinuria in pregnancy using cut-off point of <20 mg/mmol and <2.5 mg/mmol. 18 In another study by Nisell et al, the optimal cut-off of ACR value of 27 mg/mmol the sensitivity, specificity, positive and negative predictive value for detecting albuminuria >300 mg/24 hour were: 95,100,100 and 86% respectively which is comparable with the present study. 19 In another study by Heerspink et al, spot urinary micro ACR cut-off of >30 mg/g (3.4 mg/mmol) is considered as positive for significant proteinuria and correlate well with 24-hour urine protein with sensitivity of 94% and specifity of 98%.…”

Section: Discussionsupporting

confidence: 89%

Comparison of single spot urinary albumin-creatinine ratio with 24-hour urinary protein excretion in women with preeclampsia

Kaul

Bhagat

Sharma

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONHypertensive disorders are frequently encountered complications in pregnancies and are associated with increased risk of both adverse maternal and fetal outcome. Overall 10-15% of maternal death are directly associated with preeclampsia and eclampsia. Preeclampsia is a disorder of widespread vascular endothelial dysfunction and vasospasm that occur after 20 weeks of gestation and can present as late as 4-6 week postpartum.2 The etiology of preeclampsia is unknown but thought to be related to hypoxia in the placenta due to abnormal placentation. Mild preeclampsia occurs in approximately 15% of pregnancies and severe in 1-2%. 3It complicates 10% of pregnancies in developing countries and responsible for about 76000 maternal deaths every year. 4,5 Minimum criteria for preeclampsia include blood pressure >140/90 mm Hg after 20 weeks gestation, proteinuria >300 mg/24 hours or >1+ dipstick. The measurement of protein excretion in a 24-hour urine collection is used as gold standard for the diagnosis and follow-up of pathological urinary excretion. However, the standard practice of collecting a 24-hour urine for a protein is cumbersome, time consuming and inconvenient ABSTRACT Background: The measurement of albumin: creatinine ratio (ACR) in a spot urine sample avoids the influence of variation in urinary solute concentration and provides a more convenient and rapid method to assess protein excretion. The aim of this study was to evaluate urinary spot ACR as a new marker for proteinuria and to study its correlation and accuracy in comparison with 24-hour urinary protein. Methods:The prospective one-year study was conducted on 100 pregnant women, 18-40 years, >20 weeks gestation with a diagnosis of preeclampsia. A spot midstream urine sample was taken for detection of albuminuria by dipstick method. Another spot sample was taken for detection and calculation of spot ACR. The 24-hour urine collection was taken immediately afterward to evaluate 24-hour urinary protein excretion. Results: A positive linear relation exists between ACR and 24-hour urinary protein excretion The ROC revealed cutoff of 20.4 with 88.5% sensitivity, 75% specificity, 98.8% positive predictive value and 21.4% negative predictive value. Spot urinary ACR >20.4 correctly identified women having 24-hour urinary protein excretion in excess of 0.3 gm/DL. Conclusions: A strong correlation exists between single spot urinary ACR with 24-hour urinary protein excretion in women with preeclampsia.

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Section: Discussionsupporting

confidence: 89%

Comparison of single spot urinary albumin-creatinine ratio with 24-hour urinary protein excretion in women with preeclampsia

Kaul

Bhagat

Sharma

et al. 2018

Int J Reprod Contracept Obstet Gynecol

View full text Add to dashboard Cite

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“…Due to the di culty in adequately collecting 24-hour urine, especially in patients less well educated and/or with poor compliance, there has long been an effort to use results from spot urine to replace 24h UPE during clinical decision making [14][15][16]. Our ndings of an excellent correlation between urine ACR and 24h UPE in not the overall population but also different subgroups were consistent with previous reports on the correlation between these two variables in primary glomerular disease as well as other diseases with secondary proteinuria [17][18][19]. Atkins also reported a strong correlation between urine albumin excretion and total protein excretion in the Australian adult population, particularly among the elderly and patients with comorbidities, but concluded urine albumin measurement should not replace total protein excretion test [20].…”

Section: Discussionsupporting

confidence: 88%

Estimation of 24-hour urine protein excretion using urine albumin-to-creatinine ratio

Liu

Zhao

Hong

et al. 2020

Preprint

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Background There is still a lack of quantitative description of the relationship between urine albumin-to-creatinine ratio (ACR) and 24-hour urine protein excretion (24h UPE). We aimed to study the correlation between 24h UPE and urine ACR and develop a prediction model for 24h UPE employing urine ACR. Methods This was a retrospective and observational study. All individuals with same-day urine ACR and 24h UPE tests in Sichuan Provincial People’s Hospital from September 1, 2018 to December 31, 2019 were enrolled in the study. Correlation and agreement between urine ACR and 24h UPE were evaluated. A prediction model of 24h UPE was developed and validated. Results 671 subjects were identified. Urine ACR correlated well with 24h UPE (Pearson’s coefficient after natural logarithm transformation = 0.908; p<0.001) and the agreement was consistently good (overall ICC = 0.938; 95% CI: 0.928-0.947; p<0.001). Our multivariable transform model had good performance (R 2 =0.869) and high accuracy (RMSE=0.690) to estimate 24h UPE less than 10 g/day. Conclusions Urine ACR correlates well with 24h UPE in a general population. Our prediction model is an useful tool for estimating 24h UPE less than 10 g/day, however, 24h UPE is still mandatory in situation when the majority of proteinuria is of tubular origin.

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“…Due to the difficulty in accurately collecting 24 hour urine, especially in patients who are less well educated and/or with poor compliance, there has long been an effort to use results from spot urine to support clinical decision making. Our findings of excellent correlation between urine ACR and 24 h UPE in not the overall population but also different subgroups were consistent with previous reports on the correlation between these two variables in primary glomerular disease as well as other diseases with secondary proteinuria [10,11]. Be that as it may, using urine ACR as a sole indicator for quantification of proteinuria has not reached a consensus [5][6].…”

Section: Discussionsupporting

confidence: 88%

Estimation of 24 hour urine protein excretion using urine creatinine/albumin ratio

Liu¹,

Zhao²,

Hong³

et al. 2020

Preprint

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BackgroundThere is still a lack of quantitative description of the relationship between urine creatinine/albumin ratio (ACR) and 24 hour urine protein excretion (24 h UPE). We aimed to study the correlation between 24 h UPE and urine ACR and develop a prediction model for 24 h UPE.Methods This was a retrospectively observational study. All individuals with paired urine ACR and 24 h UPE tested on the same day in Sichuan Provincial People’s Hospital during September 1st, 2018 to December 31st, 2019 were enrolled. Correlation and agreement between urine ACR and 24 h UPE were evaluated. A prediction model of 24 h UPE was further developed and validated.Results 671 subjects were identified. Urine ACR had a good correlation with 24 h UPE in general population (Spearman’s coefficient = 0.939; p < 0.001) but the agreement between these two measurements was not consistently good (overall ICC = 0.870; 95% CI: 0.849–0.888; p < 0.001). Our multivariable transform model of 24 h UPE had good performance (R2 = 0.829) and validated high accuracy (RMSE = 0.0227, rRSME = 3.1%).Conclusions Urine ACR has a good correlation with 24 h UPE in general population but is not a reliable surrogate for 24 h UPE. Our prediction model is a useful tool for estimating 24 h UPE, however, 24 h UPE is still mandatory in situations when accurate quantification of proteinuria is required.Key messages:1. urine ACR has a good correlation with 24h UPE but is not a reliable surrogate for 24h UPE.2. Our prediction model is helpful to estimate 24h UPE, with good performance (R2=0.829) and validated high accuracy (RMSE=0.0227, rRSME=3.1%); however, 24h UPE is still mandatory in situations when accurate quantification of proteinuria is required.

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Spot urinary protein analysis for excluding significant proteinuria in pregnancy

Cited by 17 publications

References 9 publications

Comparison of single spot urinary albumin-creatinine ratio with 24-hour urinary protein excretion in women with preeclampsia

Comparison of single spot urinary albumin-creatinine ratio with 24-hour urinary protein excretion in women with preeclampsia

Estimation of 24-hour urine protein excretion using urine albumin-to-creatinine ratio

Estimation of 24 hour urine protein excretion using urine creatinine/albumin ratio

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