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To determine the correlation between the protein/creatinine ratio and 24-h proteinuria; to estimate the sensitivity and specificity of this ratio for the diagnosis of significant proteinuria; to establish its cutoff point with the best predictive value for the diagnosis of significant proteinuria in patients with systemic arterial hypertension.A cross-sectional study of 47 hypertensive patients who had been pregnant for 20 weeks or more seen at the Maternity of the University Hospital of Porto Alegre. The studied factor was the protein/creatinine ratio measured in a single random urine sample and the outcome was protein determination in 24-h urine. The level of significance was set at 0.05.The correlation coefficient between the protein/creatinine ratio and 24-h proteinuria was 0.94 when urine was properly collected. A receiver-operator characteristic curve was constructed to determine the sensitivity and specificity of the ratio for the diagnosis of significant proteinuria (or = 300 mg in 24 h). Specificity and predictive positive value were 100% for a ratioor = 0.8. The best values for sensitivity, specificity, positive predictive value, and negative predictive value in the diagnosis of proteinuriaor = 300 mg in 24 h were obtained when the protein/creatinine ratio was 0.5 (0.96, 0.96, 0.96, and 0.96, respectively).The protein/creatinine ratio measured in a single urine sample taken at random from hypertensive pregnant women showed good sensitivity and specificity for the diagnosis of 24-h proteinuriaor = 300 mg and was strongly correlated with 24-h proteinuria. A ratio of 0.5 mg/mg is predictive of significant proteinuria and can be used for the diagnosis and follow-up of hypertensive pregnant women.

Preeclampsia is a big problem in obstetrics. The diagnosis relies mainly on the detection of both hypertension and proteinuria. The gold standard for the determination of proteinuria is 24 h urinary protein creatinine ratio; however, this approach is inconvenient and it is a considerable time consuming process that might bring a delayed diagnosis which might result in delayed treatment. Although spot urine measurement can be done, it has very poor prediction. The use of periodic urinary protein creatinine ratio is proposed as a possible alternative to solve this problem. Here, the author tries to perform a time effectiveness analysis for reported models on periodical urinary protein creatinine ratio for predicting significant proteinuria in preeclampsia. Data from previously published reports on this topic are used for further analysis. It seems that the alternative, 4 h, gives the most effectiveness in the shortest period of turnaround time. Hence, this alternative is recommended for screening proteinuria.

To evaluate the diagnostic accuracy of the first 4-hour urinary protein - creatinine ratio for prediction of the significant proteinuria in preeclampsia.Diagnostic testOne hundred and sixty-four pregnant women who were initially diagnosed with hypertensive disorder and hospitalized in the obstetric ward and labor room at Bangkok Metropolitan Administration Medical Collage and Vajira Hospital between July 2005 and April 2006.Urine samples were collected within 24 hours in two consecutive periods: the first 4 hours and the next 20 hours. The urine volume, urine protein and creatinine concentration were separately measured and the first 4-hour urinary protein - creatinine ratio were calculated. With the use of a protein levelor = 300 mg in 24 hours urine collection as the gold standard, the sensitivity and specificity of the first 4-hour urinary protein-creatinine ratio for diagnosis of significant proteinuria were determined with cutoffs range.One hundred and sixty four patients were recruited for this study including 112 patients (68.3%) who had preeclampsia. The first 4-hour urinary protein-creatinine ratio was most accurate for diagnosis of preeclampsia is 0.30 with 81% sensitivity, 88% specificity, PPV of 93%, and NPV of 71%.The first 4-hour urinary protein-creatinine ratio at 0.3 is the most accurate value for diagnosis of significant proteinuria in preeclampsia

Background For clinicians, it is important to rely on accurate laboratory results for patient care and optimal use of health care resources. We sought to explore our observations that urine protein:creatinine ratios (PrCr) ≥30 mg/mmol are seen not infrequently associated with normal pregnancy outcome. Methods Urine samples were collected prospectively from 160 pregnant women attending high-risk maternity clinics at a tertiary care facility. Urinary protein was measured using a pyrocatechol violet assay and urinary creatinine by an enzymatic method on Vitros analysers. Maternal/perinatal outcomes were abstracted from hospital records. Results 91/233 (39.1%) samples had a PrCr ≥30 mg/mmol, especially when urinary creatinine concentration was Conclusions Random urinary PrCr was overestimated in dilute urine when tested using a common pyrocatechol violet dye-based method. This effect was reduced in cohorts when pyrogallol red assays were used. False positive results can impact on diagnosis and patient care. This highlights the need for both clinical and laboratory quality improvement projects and standardization of laboratory protein measurement.

The concentrations of protein and creatinine were measured in urine samples from 74 healthy domestic pet rabbits, 54 of them seronegative to Encephalitozoon cuniculi and 20 seropositive. The calculated reference range for the urinary protein:creatinine ratio (UPC) of E cuniculi-seronegative rabbits was 0.11 to 0.40. There was no significant variation in the UPC due to the bodyweight, breed, sex, neutered status or husbandry of the rabbits. Seroconversion to E cuniculi was not found to be associated with clinical renal disease because none of the seropositive rabbits had azotaemia or proteinuria.

Quantitation of urinary protein excretion has traditionally involved collection of a 24-hour urine specimen. Recent reports have suggested that the ratio of protein to creatinine in a single-voided urine specimen may be used as a screening test of proteinuria, obviating the need for a 24-hour urine collection. This study was undertaken to determine whether the urinary protein/creatinine ratio was correlated with 24-hour protein excretion in women with diabetes, to determine whether pregnancy had any effect on the correlation, and to test the accuracy of estimates of 24-hour protein excretion on the basis of the protein/creatinine ratio. We studied 329 24-hour urine specimens from 133 women with classes B through RF diabetes. The protein/creatinine ratio was highly correlated with total protein excretion (r = 0.977, p less than 0.0001). The correlation was not affected by pregnancy, trimester, or preeclampsia. Three methods were used to predict protein excretion on the basis of the ratio. Compared with actual protein excretion, predicted values had mean errors of 19% to 27%; 6% to 13% of predictions were in error by greater than or equal to 50%. Because of these large errors, we conclude that this method of estimating protein excretion has limited value in pregnant women with diabetes.

Background: Albumin:creatinine ratio (ACR) is the recommended method for the detection of incipient kidney disease in diabetic patients. However, protein daily excretion rate is used for the quantification and monitoring of proteinuria in more-advanced stages of chronic kidney disese. We wanted to determine whether measurement of protein:creatinine ratio (PCR) can be used as an alternative to protein excretion rate in detecting clinically significant proteinuria in diabetic patients. Materials and methods: 48 diabetic patients were included in the study. We measured ACR and PCR in random urine samples and protein contents in 24-h urine samples. All measurements were made on Olympus AU600. Urinary albumin was measured by immunoturbidimetric method, while urinary creatinine and protein were measured by the spectrophotometric Jaffe and pyrogallol red method, respectively. Clinically significant proteinuria was considered to be present with the ACR ≥ 30 mg/mmol which is approximately equivalent to PCR 50 mg/mmol. All results were analyzed with MedCalc 9.4.2.0. statistical software (MedCalc Software bvba, Mariakerke, Belgium). Results: ACR was ≥ 30 mg/mmol in 28/48 diabetic patients. Sensitivity was 100% and specificity was 95.0% for PCR as an indicator of clinically significant proteinuria at a cut-off value of 50 mg/mmol. Protein daily excretion rate as an indicator of clinically significant proteinuria gave lower values for sensitivity and specificity at the cut-off value of > 0.5g/24h ; they were 78, 6% and 85, 0% respectively. Conclusions: The protein:creatinine ratio performed better as an indicator of clinically significant proteinuria than the 24-urine collection method in diabetic patients.

The initial goal of this study was to evaluate proteinuria by using the protein to creatinine (UPC) ratio of urine obtained by cystocentesis of healthy adult captive chimpanzees. Urine samples were collected by using ultrasound-guided cystocentesis from 125 (80 male, 45 female) captive chimpanzees. All samples were collected over a 17-mo time period (August 2008 to January 2010) during the animal's annual physical examination. Samples were assayed at a veterinary diagnostic laboratory. Results indicated that both age and blood contamination affect the UPC ratio and therefore alter the diagnostic utility of the UPC ratio in chimpanzees. In addition, this research establishes reference ranges by age for the UPC ratio in healthy adult chimpanzees. Chimps younger than the median age of 24.6 y have a median UPC ratio of 0.098 (range, 0 to 1.76), whereas older animals have a median UPC of 0.288 (range, 0 to 2.44). Our results likely will enable veterinarians working with chimpanzees to better evaluate their renal function.

The quantification of 24 hrs urinary protein excretion is valuable for diagnosing and monitoring renal disease. However, because of its practical difficulties, the spot urinary protein/creatinine (P/C) ratio has been utilized. We aimed to evaluate the analytical performance of P/C ratio by comparing with the qualitative urinary protein values and the microscopic urine sediment analysis.We obtained 5,538 urinary samples from the outpatients of Juntendo University Hospital. Testing for urinary P/C ratio was performed by Atlas Pro12 (cut-off 150 mg/g x Cr), urinary protein (proteinuria) was detected quantitatively by full-automated system ATLAS XL (cut-off 30 mg/dL). Microscopic exams were conducted following to the JCCLS reference method.The P/C ratio demonstrated higher sensitivity but lower specificity for urinary abnormal casts detected by microscopic exams compared to proteinuria (sensitivity; P/C 87%, proteinuria 77%. specificity; P/C 74%, proteinuria 93%). From the comparative study with microscopic exams, both P/C and proteinuria performed high positive rate (80%) for the granular cast type and mixture cast type. For the cellular cast type, however, the positive rate of P/C was 56% and that of proteinuria was only 36%. The overall abnormal casts by microscopic exams showed better correlation with the positive P/C ratio than proteinuria.This study emphasizes that a spot urine P/C ratio is useful in screening for the further microscopic exams. P/C ratio can be a convincing index of urinary protein excretion when attenuation urine is doubted.

To assess the urine protein/creatinine ratio in urine samples of pregnant women with hypertension in regard to: 1) the presence of significant variation at different periods of the day; 2) the differences if they exist, to identify the most reliable period of the day for sampling; and 3) whether the first sample, obtained when the patient arrives at the clinic, correlates with the same accuracy, with the 24-hour proteinuria.Cross-sectional study.Obstetrics Emergency Department, Hospital de Clínicas de Porto Alegre, a teaching hospital in Porto Alegre, Brazil.Seventy-five women with hypertension with 20-week gestation or over.Urine samples for determination of the protein/creatinine ratio were obtained on arrival (first specimen) and every 6 hours thereafter, totaling four samples in 24 hours. Four sampling periods were established: 1) from 8 am to 2 pm, 2) from 2 pm to 8 pm, 3) from 8 pm to 2 am, and 4) from 2 am to 8 am. The protein/creatinine ratio in the four different day periods were compared with the 24-hour proteinuria obtained simultaneously. The results were analyzed by the Spearman correlation and the receiver-operator characteristic (ROC) curve.The urine protein/creatinine ratio is strongly correlated (Spearman correlation equal to 0.8 or greater) with the 24-hour proteinuria at all four periods of the day (p0.001), as well as the first sample obtained on arrival (p=0.003). These findings were corroborated by the ROC curve in which the values of four day periods and that of the first sample were equal to or greater than 0.930.In hypertensive pregnant women, the single voided urine sample protein/creatinine ratio, irrespective of sampling time, is strongly correlated with the 24-hour proteinuria, as is the sample obtained on arrival.

This cross-sectional study was conducted to determine whether a spot urine protein/creatinine ratio (UPr/UCr) provides accurate quantitation of 24-hr urinary protein excretion (24-hr Prot) in out-patients with primary glomerulonephritis (GN) and different renal function levels.Patients were classified into three groups according to creatinine (Cr) clearance (ml/min) and into five categories according to morning UPr/UCr. Correlation between 24-hr Prot and UPr/UCr was calculated according to the three renal function levels. The Bland and Altman method was used to assess agreement between 24-hr Prot and UPr/UCr. Agreement limits were obtained calculating the mean difference between 24-hr Prot and morning UPr/UCr +/- 2SD. Sensitivity and specificity were determined for different renal function levels and UPr/UCr cut-off values.High correlation coefficients (r=0.91, 0.95 and 0.98) were observed in patients with normal, reduced and severely reduced renal function. Differences and variability between 24-hr Prot and UPr/UCr tended to increase with higher proteinuria levels, and this trend was observed for the three renal function levels. The best UPr/UCrcut-off values to detect abnormal or nephrotic proteinuria were, respectively, 0.3 and 2.6.Correlation and agreement between UPr/UCr and 24-hr Prot was good for all renal function levels, but demonstrated more marked differences as urinary protein excretion increased. Morning UPr/UCr had good sensitivity and specificity for the diagnosis of 24-hr Prot, even in patients with reduced renal function.

Background: Nephrotic Syndrome (NS) is very common in children. The typical laboratory finding is high urinary protein creatinine ratio. Apart from it low serum albumin, high cholesterol contribute to hyper coagulable states. Due to this the risk of thromboembolism in both arterial and venous circulation is significant in children and adults. Patients at risk for thromboembolism traditionally have to be screened by ventilation/perfusion scans and Dopplers for the definitive diagnosis of thromboembolic disease. There are several studies performed on adult nephrotic syndrome and thromboembolic events in them worldwide. We wanted to look for simple, affordable tests, that can be performed even when state of the art technology is not available, and can point towards at risk thromboembolic patients. Methods: The study was conducted in 17 nephrotic syndrome children in active disease, 13 nephrotic syndrome children in remission and 15 healthy children as controls, all between 4-14 years age group. Study included both male and female children. Results: Our results revealed prolonged. APTT in NS with active disease when compared to remission and control groups. High fibrinogen levels in relapse group indicated hypercoagulative state, along with routine parameters such as high cholesterol and low albumin. Both relapse and remission groups had proteinuria, with very high P/C ratio in relapse group, indicating at risk group for thromboembolic complications along with basic coagulation parameters. Conclusion: We suggest that when there are indications of hypercoagulable state antiplatelet drugs such as a low dose aspirin 75 mg or low dose warfarin may be given as prophylactic treatment for thromboembolic disease.

The follow-up of renal function in kidney transplant patients requires sensitive and specific parameters which allow the detection of clinically significant changes. In this prospective study, we have evaluated the accuracy of the urinary protein/creatinine ratio (UP/UCreat), determined in morning urine specimens, in assessing 24-hour proteinuria (P24). Fivehundred and twenty paired samples were provided by 133 kidney transplant patients. The correlation coefficient of the linear regression was 0.93 in both in the first set of paired samples (133 samples) and in all paired samples (520 samples). In complete urine collections, the UP/UCreat predicted the level of proteinuria with both a good specificity (95 to 99%) and sensitivity (97 to 99%) at different levels of 24-hour protein excretion. The intraindividual coefficients of variation of P24 and UP/UCreat were evaluated in 82 patients (442 samples) and were 23% and 29% respectively. These results confirm that the UP/UCreat ratio in morning samples is a reliable estimate of the 24-hour proteinuria in kidney transplant patients. Additionally, its variation appears to accurately reflect changes in the rate of protein excretion.

Objectives Mycophenolate mofetil (MMF)has become the primary induction therapy for lupus nephritis (LN). The purpose of this study was to look at the timing of the protein creatinine ratio reaching 500mg after starting Mycophenolate mofetil (MMF) for class III, IV or V lupus nephritis. Methods 21 SLE patients began mycophenolate mofetil (MMF) shortly after a biopsy-confirmed diagnosis of LN. The baseline urine protein ranged between 0.635 to 11.91grams, with only 1 patient being below 1 gram at baseline. They consisted of 18 females, 3 males, 9 African Americans, 8 Caucasians, and 4 other ethnicities. Ages ranged from 18 to 70 with a mean age of 37 (SD=15).The mycophenolate mofetil (MMF) dose ranged between 250 to 3000 mg per day. We estimated the survival function time until the urine protein reached 0.5 grams or less after starting mycophenolate mofetil (MMF) using an approach that accommodates interval censored data. Results The graph shows an estimate of the probability that patients would still have urine protein above 500 mg by various time points after starting mycophenolate mofetil (MMF). We estimate that 50% of patients will have reached 0.5 grams of protein with 51 days of starting mycophenolate mofetil (MMF), and 77% will have reached 0.5 grams within 180 days. Conclusions This study demonstrates that the majority of patients with lupus nephritis (77%) can reach a urine protein creatinine ratio of 0.5 grams or less by 6 months after initiation of mycophenolate mofetil (MMF). These data can be used to determine sample sizes for clinical trials in lupus nephritis; but also suggest that a more stringent goal should be considered. Disclosure of Interest None Declared

Objective To determine the diagnostic accuracy of the albumin creatinine ratio (ACR) and protein creatinine ratio (PCR) compared to the 24 h total urine (24 h TU) and how well they predict adverse outcomes for mother and baby in women with suspected pre-eclampsia (PE). Methods Systematic searches in electronic databases, reference lists and contact with experts. All studies reporting on ACR and/or PCR in hypertensive pregnant women with suspected PE compared to 24 h TU or to predict adverse outcome and with data for a 2×2 table. No language restrictions. Bivariate meta-analysis was conducted. Results 3111 citations were identified, 103 papers for detailed evaluation. 20 papers were included in the review, 2978 women. 15 studies examined the PCR compared to 24 hTU, 4 looked at ACR compared to 24 hTU and one at ACR compared to adverse outcomes. A PCR of 0.3 had a sensitivity of 0.93 (95% CI 0.85 to 0.97) and specificity of 0.90 (95%CI 0.71 to 0.97) to predict significant proteinuria on 24 hTU (>0.3 g/day). For ACR meta-analysis was not possible due to different thresholds and study characteristics. Thus the results from one of the studies in a hypertensive pregnant population were sensitivity 0.94 (95% CI 0.85 to 0.98) and specificity 0.94 (95% CI 0.88 to 0.94). Conclusion The results suggest that PCR and in particular, ACR, may be valuable point of care tests in the management of suspected PE. Further work needs to be performed to look at their role in the management of this condition in the prediction of adverse outcomes for mother and baby and which is the most cost-effective threshold to use.