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Diabetic nephropathy (DN) is a chronic microvascular complication of diabetes mellitus (DM). Microalbuminuria is an earliest marker of DN. Effective screening measures are required for early diagnosis and management to halt the progression of diabetic nephropathy. We wanted to evaluate urine Albumin Creatinine Ratio (ACR) as an earlier predictor of diabetic nephropathy in comparison to the gold standard test 24-hours urine protein.METHODSThis is a cross sectional study conducted among 210 patients of type-2 DM admitted in the medical ward of a tertiary care hospital, who fulfilled the inclusion and exclusion criteria. Relevant history including duration of DM, and other comorbidities was taken from the patients. Vital parameters such as heart rate, systolic and diastolic blood pressure were recorded. CBC, RFT, FBS, PPBS, HbA1c, Fundoscopy were done in all patients. Urine analysis for ACR from random urine sample and 24-hours urine protein from 24-hour urine sample were done.RESULTSProteinuria was present in 80.95% of patients and that with 24-hour urinary protein, in 59.04% patients. ACR showed sensitivity of 100%, specificity of 46.51% with PPV of 72.94% and NPV of 100%. ACR has strong positive correlation with 24-hours urinary protein. Positive correlation of urine ACR was seen with serum creatinine, blood urea, HbA1c, anaemia, duration of diabetes and the presence of diabetic retinopathy.CONCLUSIONSACR shows high sensitivity in the detection of proteinuria, especially microalbuminuria and hence can be considered as an alternative to 24-hour urine protein in an early screening for DN.
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Background: Preeclampsia is a multisystem endothelial disease leading to glomeruloendotheliosis with endothelial leak causing significant proteinuria. It is associated with high maternal and fetal risks and fetomaternal morbidity and mortality. Spot urinary albumin to creatinine ratio (ACR) leads to earlier detection of glomerular damage leading to prompt management of preeclamptic patients. To determine the accuracy of Spot Urinary ACR as an indicator to detect proteinuria and its use as a rapid alternative test over 24-hour urinary protein in women with Preeclampsia and to find the correlation between the two.Methods: Spot urinary ACR was measured in 70 consecutive patients with preeclampsia in Assam Medical College, Dibrugarh. The best cut-off value to differentiate between significant and insignificant proteinuria was calculated. The mean, standard deviation and range of various parameters were computed and various statistical tests were used. The Area under the curve and ROC curve were plotted.Results: The best cut-off value to differentiate significant and insignificant proteinuria was calculated as 291.9 mg/g beyond which adverse fetomaternal outcomes and complications were seen. The correlation coefficient between 24-hour urinary protein and spot urinary albumin to creatinine ratio was 0.922 highly significant. The area under the curve was found to be 0.98 with a standard error of 0.0155 which implied that the discriminant ability of spot urinary ACR to differentiate significant proteinuria from insignificant proteinuria in patients with preeclampsia was found to be 98%. Similar studies mentioned in the table below showed a good correlation between 24-hour urinary protein estimation and spot urinary ACR.Conclusions: Compared with 24-hour urinary protein excretion, spot urinary ACR is a simple and accurate indicator of significant proteinuria and helps to detect fetomaternal outcomes in preeclamptic women which may lead to prompt management to reduce fetomaternal complications.
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Objective To evaluate the efficacy and safety of Sanqi Granules (SG) for the treatment of chronic glomerulonephritis(CGN).Methods A prospective randomized controlled trial was carried out in 60 CGN patients with qi deficiency and blood stasis syndrome.The included patients were assigned into SG group,losartan group,and SG plus losartan group,20 cases in each group.The course of intervention was 24 weeks.Before and after treatment,24-hour urine protein quantity,serum creatinine (SCr),estimated glomerular filtration rate (eGFR) and the scores of traditional Chinese medical syndromes were observed.The clinical efficacy of Chinese medicine and western medicine,and the safety was evaluated after treatment.Results (1) After treatment for 12 and 24 weeks,the scores of traditional Chinese medical syndromes in the three groups were markedly improved (P ＜ 0.05),and the improvement in SG group and SG plus losartan group was superior to that in losartan group (P ＜ 0.05).(2) After treatment for 24 weeks,24-hour urine protein quantity in losartan group was significantly decreased (P ＜0.05),while SG group and SG plus losartan group only showed a decreasing trend(P ＞ 0.05).(3) After treatment for 24 weeks,renal function indexes of SCr and eGFR in SG group and SG plus losartan group were improved to some degrees,and the difference of eGFR in SG group was significant (P ＜ 0.05 compared with that before treatment),while the renal function injury in losartan group showed a deteriorative trend.SG group and SG plus losartan group had better effect on improving SCr and eGFR than losartan group (P ＜ 0.05).(4) After treatment for 24 weeks,the total effective rate of Chinese medicine in losartan group,SG group,SG plus losartan group was 50.00％,90.00％,84.21％,and the total effective rate of western medicine was 88.89％,75.00％,63.16％,respectively.SG group and SG plus losartan group had better clinical efficacy of Chinese medicine than losartan group (P ＜ 0.05),while the difference of clinical efficacy of western medicine among the three groups was insignificant (P ＞ 0.05).(5) During the follow-up,no severe adverse events were shown in the three groups.Conclusion SG exert certain therapeutic effect on improving the scores of traditional Chinese medical syndromes and protecting renal function,while have no obvious effect on decreasing urine protein.
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Aims: The present study was undertaken to evaluate the diagnostic value of protein:creatinine ratio in spot voided urine sample for detection of proteinuria as compared to those of 24 hour urine sample in patients with preeclampsia, and also to determine the optimal cut-off value of protein:creatinine ratio with best sensitivity and specificity for the prediction of significant proteinuria. Study Design: Cross sectional study. Place and Duration of the Study: The study was conducted at teaching hospital in North Karnatak, India. The study was conducted from Jan 2012 to February 2013. Methods: This study was conducted on 52 preeclampsia patients. The 24 hour urine protein and random urine protein:creatinine ratio was determined. Pearson’s correlation, sensitivity and specificity were determined using 24-hour urinary protein as a gold standard for spot urine protein:creatinine ratio. Receiver operators characteristic (ROC) curve and area under curve was also determined using SPSS (11.5) software. All the results were expressed in mean±SD. Results: Fifty two preeclampsia patients participated in this study. The average 24 hour urinary protein was 1643.3±2079.5 mg/day. The spot urine protein:creatinine ratio was 1.47±1.68. There was a positive correlation between 24 hour urinary protein and spot urine protein:creatinine ratio (r = 0.86, P<0.0001). The area under the receiver operators characteristic curve for urine protein:creatinine ratio at various cut-off was 0.914 (95% confidence interval: 0.800-0.975, P<0.0001). The sensitivity and specificity was 71.5% and 100% respectively at protein:creatinine ratio cut-off of 0.66. Conclusion: The random urine protein:creatinine ratio predicts the amount of 24-hour urinary protein excretion with high accuracy. Hence it can be used as a faster diagnostic substitute for 24- hour urinary protein estimation in preeclampsia.
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Objective To study the effects of quantitative 24-hour urinary protein on the thyroid hormone levels in patients with severe preeclamp-sia,and clarify the impact of severe urinary protein on hypothyroid in severe preeclampsia patients. Methods A total of 166 patients with severe pre-eclampsia were recruited for the study and divided into mild proteinuria group(2.0-4.9 g/d),midrange group(5-10 g/d)and severe group(>10 g/d)according to the quantitative 24-hour urinary protein. 268 healthy female individuals with normal blood pressure and uric routine in the same stage of pregnancy and of the same age were selected into control group. Serum thyrotropin(TSH),free triiodothyronine(FT3)and free thyroxine (FT4)levels were determined by solid-phase chemiluminescent enzyme immunoassay method(CMIA). The thyroid peroxidase antibody(TPOAb) and thyroglobulin antibody(TGAb)concentration were detected by electrochemiluminescent assay(ECLIA). Results TSH levels were signifi-cantly higher in patients comparing to the control group(P0.05). The incidence of subclinical hypothyroidism and clinical hypothyroidism in severe group was significantly higher than that in mild group and in control group(OR=2.5,P<0.05 and OR=9.0,P<0.05;OR=8.0,P<0.01 and OR=43.4,P<0.01). Conclusion Our re-sults indicated that 24-hour urine protein in severe preeclampsia patients has extensive effects on thyroid hormones levels. With the increasing of quantitative 24-hour urinary protein,the level of TSH increased and the FT4 decreased. Thyroid autoantibody positiveness has extensive effects on 24- hour urine protein. Incidence of hypothyroid increased with the increase of quantitative 24-hour urinary protein. 24-hour urinary protein quantitative was a risk factor for hypothyroidism in severe preeclampsia patients. More attention should be paid to the monitoring of 24-hour urinary protein in se-vere preeclampsia patients.
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OBJECTIVE: To assess the diagnostic accuracy of random urine protein-creatinine (P/C) ratio for prediction of significant proteinuria in preeclampsia as an alternative to the time-consuming 24-hour urine protein collection. METHODS: Retrospective record analysis was performed on 140 pregnant women who were admitted with suspicion for preeclampsia from January 2006 to June 2011. Random urine protein and/or 24-hour urine protein levels were assessed and their correlation to random urine P/C ratio and 24-hour urine protein excretion was evaluated. RESULTS: Out of 140 patients, random urine P/C ratio or/and 24-hour urine protein was performed in 79 patients to evaluate significant proteinuria. Of 79 patients, 46 (58%) underwent both tests whereas in 33 women (42%) 24-hour urine collection was not available due to urgent delivery. In 39 cases (85%), significant proteinuria (> or =300 mg/24 hr) was detected with 6 cases (13%) having values over 5,000 mg/24 hr, corresponding to the diagnosis of severe preeclampsia. Random urine P/C ratio highly correlated with 24-hour urine protein excretion (r=0.823, P<0.01). The optimal random urine P/C ratio cutoff points were 0.63 and 4.68 for 300 mg/24 hr and 5,000 mg/24 hr of protein excretion, respectively. with each sensitivity, specificity, and positive and negative predictive values of 87.1%, 100%, 100%, and 58.3%; and 100%, 85%, 50%, and 100%, for significant and severe preeclampsia, respectively. CONCLUSION: Random urine P/C ratio is a reliable indicator of significant proteinuria in preeclampsia and may be better at providing earlier diagnostic information than the 24-hour urine protein excretion with more accuracy than the urinary dipstick test.
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Female , Humans , Pre-Eclampsia , Pregnant Women , Proteinuria , Retrospective Studies , Sensitivity and Specificity , Urine Specimen CollectionABSTRACT
BACKGROUND: The urinary protein to creatinine ratio in a single voided random urine sample has been widely used as an estimation of 24 hour urine protein excretion because of inconvenience and frequent collection errors during timed collection of 24 hour urine. But the protein to creatinine ratio also showed frequent estimating error, overestimation or underestimation. We thought that protein to creatinine ratio adjusted by daily creatinine excretion estimated by Cockroft-Gault equation can be more accurate than protein to creatinine ratio and compared them as follows. METHODS: This study consisted of 81 patients whose 24 hour urine protein excretion and random spot urine protein to creatinine ratio were measured concomitantly. There was no significant change of body weight or serum creatinine change around the study day. The modified protein to creatinine ratio could be estimated from the measured protein to creatinine ratio in a random spot urine sample by multiplying the ratio by the expected daily creatinine excretion estimated by Cockroft-Gault equation. These results were compared with well collected 24 hour urine protein. RESULTS: The difference between protein to creatinine ratio and 24 hour urine protein was 0.87+/-1.13, on the other hand, the difference between modified protein to creatinine ratio and 24 hour urine protein was 0.52+/-0.65 (p<0.05). Correlation coefficients between protein to creatinine ratio, modified protein to creatinine ratio and 24 hour urine protein were 0.877, 0.957 respectively. CONCLUSION: The protein to creatinine ratio modified by the expected daily creatinine excreation rate calculated by Cockfort-Gault equation was more accurate than simple protein to creatinine ratio.
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Humans , Body Weight , Creatinine , HandABSTRACT
(0.05)).There was significant difference in the decrease of the amount of 24-hour urine protein examination before and after the treatment among three groups.Compared with the single drug group,the effects of the combination group was better.CONCLUSION: Using monopril or valsartan solely or the combination of monopril and valsartan can decrease the 24-hour urine protein effectively.The effect of monopril and valsartan are same.However,the effect of the combination group was better than the two single drug groups.