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2016 ; 90
(5
): 1080-1089
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The relatively poor correlation between random and 24-hour urine protein
excretion in patients with biopsy-proven glomerular diseases
#MMPMID27528553
Hogan MC
; Reich HN
; Nelson PJ
; Adler SG
; Cattran DC
; Appel GB
; Gipson DS
; Kretzler M
; Troost JP
; Lieske JC
Kidney Int
2016[Nov]; 90
(5
): 1080-1089
PMID27528553
show ga
Random urine protein creatinine ratios are used to estimate 24-hour urine protein
excretion, which is considered a diagnostic gold standard. However, few studies
are available of the sensitivity and specificity of this estimation in patients
with glomerular proteinuria. To clarify this, we measured the urine protein and
creatinine centrally in random and 24-hour urine collections at biopsy and
longitudinally every 6 months in individuals participating in the Nephrotic
Syndrome Study Network (NEPTUNE) cohort with glomerular disease. In the initial
developmental cohort, 302 patients had same day random and 24-hour samples with a
total of 827 paired measurements across all visits. The protein excretion (g/day)
was higher in adult than pediatric patients. The correlation between the random
urine protein creatinine ratio and 24-hour urine protein excretion was moderate
in both groups (r of 0.60 and 0.67, respectively). However, the log(10)
transformation of values strengthened correlations in both groups (r of 0.85 and
0.82, respectively). Associations were moderately stronger among obese patients.
Prediction equations were developed and validated in 232 unique cases from
NEPTUNE (R(2) of 0.65). Thus, in patients with glomerular disease and
proteinuria, the urine protein creatinine ratio correlates only moderately with
24-hour urine protein excretion. However an estimating equation was developed to
derive 24-hour urine protein excretion from random urine protein creatinine ratio
values with improved precision. The long-term prognostic value of
log(10)-transformed random protein creatinine ratios values requires future
study.