A study of random urine protein to creatinine ratio in the diagnosis of nephrotic syndrome in children

Rakesh A. Navale, Mallikarjun R. Kobal, Rohit Dixit, Ningshen Themyaola

Abstract


Background: The objective of the study was to evaluate the accuracy of urine protein creatinine ratio (UP/UC) in a random sample for quantitative measurement of proteinuria in comparison with 24 hours urinary protein excretion in children of nephrotic syndrome having normal Glomerular Filtration Rate (GFR).

Methods: The present study was a descriptive type of study which was conducted in the department of paediatrics, Jay Kay Lon mother and child hospital, government medical college, Kota. Cases were noted down into the proforma with respect to history, examination and investigation. All the patients were advised regarding 24 hours urine collection. They were asked to give a 24 hours urine sample starting at 9.00 am for total protein excretion rate. A random urine sample was obtained and urine protein/creatinine ratio was calculated. The data was analyzed by linear regression and by calculating the correlation coefficient between urinary protein/creatinine ratio and 24 hour urinary protein. Also chi-square test was applied for non-parametric data.

Results: Urine total protein in a timed 24 hour sample of nephrotic syndrome patients was in the range of 41.98-114.36 mg/m2/hour with the mean value of 64.76 mg/m2/hour. While as UP/UC ratio ranged from 2.33-5.2 with the mean value of 3.28. A significant correlation (r = 0.886) was found between timed 24 hour urinary protein and UP/UC ratio.  

Conclusions: Thus we conclude that random urine protein-creatinine ratio is highly reliable and rapid test for quantification of proteinuria in children. It reflects the amount of protein in a 24 hour collection. Thus it avoids all the drawbacks which are associated with time collection method. 


Keywords


UP/UC ratio, Kidney disease, Renal function tests, Paediatrics, Nephrology

Full Text:

PDF

References


Arneil GC. The nephrotic syndrome. Pediatr Clin North Am. 1971;18(2):547-59.

Arneil GC, Lam CN. Long-term assessment of steroid therapy in childhood nephrosis. Lancet. 1966;2(7468):819-21.

ISKDC. The primary nephrotic syndrome in children. Identification of patients with minimal change nephrotic syndrome from initial response to prednisone. J Pediatr. 1981;98(4):561-4.

Niaudet P. Steroid-resistant idiopathic nephrotic syndrome in children. In: Avner ED, Harmon WE, Niaudet P, eds. Pediatric Nephrology. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2004.

Priya Pais, Ellis D. Avner. Nephrotic syndrome. In: Kleigman, Stanton, St. Geme, Schor, Behrman, eds. Nelson Textbook of Paediatrics. 19th ed. USA: Elsevier Saunders; 2011: 1801.

Kassirer JP, Harrington JT. Laboratory evaluation of renal function. In: Sclurier RW, Gottschalk CW, eds. Diseases of the Kidney. 4th ed. Boston: Little, Brown; 1988: 393.

Ruggenentic P, Gaspari F, Perna A, Remuzzi G. Cross sectional longitudinal study of spot morning urine proteins: creatinine ratio 24 hours urine proteins excretion rate, glomerular filtration rate and end stage renal failure in chronic renal disease in patients without diabetes. BMJ. 1998;316:504-9.

Ginsberg JM, Chang BS, Matarese RA, Garella S. Use of single voided urine samples to estimate quantitative proteinuria. N Engl J Med. 1983;309:1543-6.

Vestergaard P, Leverett R. Constancy of urinary creatinine excretion. J Lab Clin Med. 1958;51:211-8.

Chahar OP, Bundella B, Chahar CK, Purohit M. Quantitation of proteinuria by use of single random spot urine collection. J Indian Med Assoc. 1993;91(4):86-7.

Shastri NJ, Shendurnikar N, Nayak U, Kotecha PV. Quantitation of proteinuria by urine protein/creatinine ratio. Indian Pediatrics. 1994;31:334-7.

Siegal NJ, Golberg B, Krassner CS. Long term follow-up of children with steroid responsive nephrotic syndrome. J Pediatr. 1972;81:251-8.

Behrman RE, Kleigman RM, Jenson HB. The nephrotic syndrome. In: Behrman RE, Kleigman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 17th ed. New Delhi: Elsevier India Private Limited; 2004: 1753-1757.

Strauss J, Zillreeulo G, Freundlich M. Less commonly recognised features of childhood nephrotic syndrome. Pediatr Clin North Am. 1987;34:591-607.

Hiraoka M, Takeda N, Tsukahara H, Kimura K, Takagi K, Havashi S, et al. Favourable course of steroid responsive nephrotic children with mild initial attack. Kidney Int. 1995;47(5):1392-3.

Appel GB, Blum CB, Chien S. The hyperlipedemia of the nephrotic syndrome - relation to plasma albumin concentration, oncotic pressure, viscosity. N Eng J Med. 1985;312:1544-8.

Iyer RS, Shailaja SN, Bhaskaranand N, Baliga M, Venkatesh A. Quantitation of proteinuria using protein-creatinine ratio in random urine samples. Indian Pediatr. 1991;28(5):463-7.

Wahbeh AM, Ewais MH, Elsharif ME. Comparison of 24-hour urinary protein and protein-to-creatinine ratio in the assessment of proteinuria. Saudi J Kidney Dis Transpl. 2009;20(3):443-7.

Siwach SB, Kalra OP, Sharma R, Singh V, Chopra JS. Estimation of 24 hour protein excretion from single random urine specimen. Indian J Med Res. 1990;92:105-8.

Lane C, Brown M, Dunsmuir W, Kelly J, Mangos G. Can spot urine protein/creatinine ratio replace 24 h urine protein in usual clinical nephrology? Nephrology. 2006;11(3):245-9.

Morales JV, Weber R, Wagner MB, Barros EJ. Is morning urinary protein/creatinine ratio a reliable estimator of 24-hour proteinuria in patients with glomerulonephritis and different levels of renal function? J Nephrol. 2004;17(5):666-72.

Guy M, Borzomato JK, Newall RG, Kalra PA, Price CP. Protein and albumin-to-creatinine ratios in random urines accurately predict 24 h protein and albumin loss in patients with kidney disease. Ann Clin Biochem. 2009;46(6):468-76.

Parag KB, Seedat YK. The protein/creatinine index. A semiquantitative assessment of 24-hour protein excretion. S Afr Med J. 1986;69(1):42-3.