Accuracy of automated urine dipstick test as a screening tool for proteinuria in hypertensive disorders of pregnancy

Background: Progressive proteinuria implies worsening of the condition in hypertensive disorders of pregnancy and hence its quantification guides clinician in making decision and planning treatment. The gold standard is 24 hour urine protein estimation. Urine sediment cytology, also known as ‘liquid renal biopsy’ identifies and analyses the extent of renal damage.Methods: Objectives of the study were to compare the efficacy of urine dipstick test to 24 hour urine protein estimation in detecting proteinuria in pre-eclampsic patients and to describe the findings in urine sediment examination in assessing proteinuria in above patients. Urine dipstick test and sediment cytology were performed on the urinary samples of 242 pregnant women with high BP recordings (BP>140/90 mm Hg) which were collected and tested in Department of Pathology, Government Medical College, Kottayam during the study period of 18 months. This was compared with 24 hour urine protein values (gold standard).Results: About 154 patients (63.63%) had significant proteinuria of more than 300mg/24hr. Dipstick method showed 78.57% sensitivity and 81.82% specificity for prediction of significant proteinuria. Positive predictive value and negative predictive value of urine dipstick test were 88.32% and 68.57% respectively. Urine sediment examination revealed the presence of casts only in 11.98% of study population. Conclusions: Diagnostic accuracy of automated urine dipstick test in assessing proteinuria was 79.75%. For grade 1 proteinuria, diagnostic accuracy was 79.81%, for Grade 2 it increased to 93.14% and for grade 3 & 4, accuracy was 98.68%. Urine sediment examination didn’t correlate with proteinuria and hence the extent of renal damage in pre-eclampsia.

Clinical Study of Urine Albumin Creatinine Ratio as an Earlier Predictor of Diabetic Nephropathy.

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.

A study to find the correlation between 24-hour urinary protein and spot urinary albumin to creatinine ratio and to determine the accuracy of spot urinary albumin to creatinine ratio as an indicator to detect proteinuria and its use as a rapid alternative test over 24-hour urinary protein in preeclamptic women

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.

Association between 24-hour urinary sodium excretion and obesity in general population aged from 18 to 69 years old / 中华疾病控制杂志

Objective To analyze the association between 24-hour urinary sodium excretion and obesity in a general Chinese population aged from 18 to 69 years old. Methods 2 400 from 18 to 69 year-old subjects were selected from four counties in Shandong Province and Jiangsu Province from 2013 to 2014 by using multi-stage stratified cluster random sampling method. Questionnaire survey, physical measurement and 24-hour urine collection were conducted. The relationship between urinary sodium and obesity was analyzed by multivariate linear regression and Logistic regression analysis. Results 2 275 subjects were finally included in the analysis. Obesity rate of the subjects was 19.1%(95% CI:17.4%-20.6%)and 24-hour urinary sodium was (166.4±71.5) mmol/d. The urinary sodium in obese, and central obesity population calculated according to waist-to-height ratio (WHtR) were higher than the normal population, respectively (All P<0.05). Multivariate linear regression analysis showed that after adjusting for relevant factors, 24-hour urinary sodium was positively correlated with body mass index (BMI), waist circumference (WC) and WHtR. Multivariate Logistic regression analysis showed that compared to population in the lowest quantile, population in highest quantile had an increased risk of being the obesity, abdominal obesity(calculated according to WC) and abdominal obesity(calculated according to WHtR) with OR(95% CI) of 1.61(1.18-2.20), 2.01(1.39-2.89) and 1.47(1.15-1.89), respectively, after adjusting for age, gender, education, smoking, alcohol consumption, physical activity, hypertension and diabetes. Conclusions High sodium is independently associated with obesity. Sodium intake is a potential and important risk factor for obesity.

The evaluation of dietary salt and potassium intake assessed by two 24-hour urine specimens among 284 primary and secondary school students / 中华预防医学杂志

Objective@#To estimate the dietary salt and potassium intake by two 24 hour urine salt and potassium excretion in primary and secondary school students.@*Methods@#The boarders from Grade 5 to 6 in a rural primary school and Grade 1 to 3 in a rural middle school in Changde City, Hunan Province were recruited from October to December in 2017. Subjects who had 2 and more urinary incontinence episodes or a history of kidney disease or diarrhea and girls in menstruation were excluded. The final analysis included 284 subjects. Questionnaires on basic demographic information were collected, and height and weight were examined. Two inconsecutive 24-hour urine specimens were collected in weekdays. The differences and consistency between two 24-hour urine were tested and dietary salt and potassium intake were assessed by the average of two 24-hour urine collections.@*Results@#A Total of 284 participants was (12.1±1.5) years old, of which 148 (52.1%) were boys and 36 (12.7%) were overweight. In the first 24-hour urine, the volume [P50 (P25, P75)=670 (513, 868) ml], potassium concentration [P50 (P25, P75)=29 (21, 39) mmol/L] and potassium excretion [P50 (P25, P75)=0.7 (0.6, 1.0) g] were similar to those in the second 24-hour urine [P50 (P25, P75) values were 660 (490, 916) ml, 30 (21,40) mmol/L, and 0.8 (0.6, 1.0) g, respectively]. But the sodium and creatinine concentrations, salt excretion in the first 24-hour urine [P50 (P25, P75) values were 175 (123, 219) mmol/L, 7.20 (5.15, 10.86) mmol/L and 6.6 (5.0, 8.7) g, respectively] were lower than those in the second 24-hour urine [P50 (P25, P75) values were 188 (133, 248) mmol/L, 8.66 (5.99, 12.47) mmol/L and 7.3 (5.2, 9.2) g, respectively] (all P values<0.05). The intraclass correlation coefficients between salt and potassium excretions in the two 24-hour urine were 0.534 (95%CI: 0.412-0.631) and 0.478 (95%CI: 0.341-0.587) (P<0.001), respectively. The mean±SD of salt consumed was (7.3±2.5) g (range: 2.3 to 18.8 g) per day by all participants. Overweight children consumed more salt [(8.2±2.6) g/d] than those non-overweight [(7.2±2.4) g/d] (P<0.05). The mean±SD of potassium consumed was (1.1±0.3) g (range: 0.4 to 2.3 g) per day. Boys consumed more potassium [(1.1±0.3) g/d] than girls [(1.0±0.3) g/d] (P<0.05), and overweight children had higher potassium intake [(1.2±0.3) g/d] than those non-overweight [(1.0±0.3) g/d] (P<0.05). A total of 212 participants (74.6%) consumed more salt than the recommended level and all participants had inadequate potassium intake.@*Conclusion@#The problem of excessive salt intake and insufficient potassium intake of rural primary and middle school students was serious.

Association between microalbuminuria and cardiovascular risk factors in general population / 中华肾脏病杂志

Objective To investigate the association between microalbuminuria and cardiovascular risk factors in a general Chinese population.Methods A multi-stage cluster randomized sampling method was used to select 2400 residents (18-69 years old) in four counties in Shandong and Jiangsu provinces in October 2013 to March 2014.24-hour MAU were measured for each subject.The prevalence of MAU in different groups was analyzed.The relationship between the aggregation of risk factors and MAU was analyzed.Logistic regression analysis was used to evaluate the association between MAU and cardiovascular risk factors.Results A total of 2265 subjects were included in the analysis.The prevalence of MAU was 8.96％ (203/2265,95％ CI:7.82-10.21).The prevalence of MAU in obesity,hypertension,diabetes,hypertriglyceridemia,and low HDL-C group were 14.65％ (63/430),12.53％ (104/830),20.22％ (36/178),15.57％ (64/411),11.99％ (53/442) respectively,which were significantly higher than the corresponding healthy population (all P ＜ 0.01).Multivariate logistic regression analysis showed that obesity,hypertension,diabetes,and hypertriglyceridemia were risk factors for MAU.The OR(95％ CI) values were 1.491(1.016-2.265),1.660(1.190-2.314),2.291 (1.494-3.515) and 1.734(1.205-2.495) respectively.With the increase in the number of influencing factors,urinary albumin levels and the prevalence of MAU all showed an upward trend.Conclusion MAU was associated with cardiovascular risk factors such as obesity,hypertension,diabetes,and hypertriglyceridemia.

Design and application of 24-hour urine collecting device / 医疗卫生装备

Objective To develop a 24-hour urine collecting device to ensure the accuracy of 24-hour quantitative examination of urinary protein. Methods The device was composed of a barrel, a slot, a sealing bar, a thermometer, a top cover,a sample point,a handle,a holding slot,scale and stirring rod.24-hour urine was put into the barrel,and temperature was considered to determine whether the preservatives was added in to urine.Sampling was executed at the sample point,and the urine amount could be read out and recorded through the scale. Results The device facilitated to read out the urine amount and to ensure the effectiveness of the urine.Conclusion The device has easy operation,simple structure,low cost and high accuracy,and thus is worthy promoting practically.

Association between Sodium Excretion and Obesity of Adults in Gwangju / 대한지역사회영양학회지

PURPOSE: The aim of this study was to analyze the association between sodium excretion and obesity for healthy adults in the Gwangju area. METHODS: The participants included 80 healthy adults aged 19 to 69 years in Gwangju. The dietary intake and sodium excretion were obtained using the 24-hour recall method and 24 hour urine collection. The participants were classified into two groups according to the amount of urinary sodium excretion: (≤ 141.75 mmol/dL, > 141.75 mmol/dL). RESULTS: After adjusting for sex, age, smoking history, and income, the high excretion of sodium group was significantly higher for weight, body mass index, body fat mass, percent body fat, visceral fat area (VFA), waist circumference, hip circumference, and WHR. The energy and nutrients intake were significant after adjusting for sex, age, smoking history, and income. The LSE group had a significantly higher fat intake and Na/K intake ratio. The HSE group had significantly higher fiber intake, and K intake. As the amount of urinary sodium excretion increased, the risk of obesity before correction was 3.57 (95% CI: 1.13–11.25) times greater, and the risk of obesity of T3 increased significantly by 3.33 times (95% CI: 1.05–10.59). After correcting for sex and age, the obesity risk of T2 increased significantly by 4.23 times (95% CI: 1.11–16.06), and after correcting for sex, age, smoking history, and income, the obesity risk of T2 increased significantly by 6.81 times (95% CI: 1.44–32.19) the risk of obesity. CONCLUSIONS: An association exists between sodium excretion and obesity in Korean adults. In this study, the high excretion of sodium group was obese and the risk of obesity was higher than the low excretion of sodium group.

Association between Sodium Excretion and Obesity of Adults in Gwangju / 대한지역사회영양학회지

PURPOSE: The aim of this study was to analyze the association between sodium excretion and obesity for healthy adults in the Gwangju area. METHODS: The participants included 80 healthy adults aged 19 to 69 years in Gwangju. The dietary intake and sodium excretion were obtained using the 24-hour recall method and 24 hour urine collection. The participants were classified into two groups according to the amount of urinary sodium excretion: (≤ 141.75 mmol/dL, > 141.75 mmol/dL). RESULTS: After adjusting for sex, age, smoking history, and income, the high excretion of sodium group was significantly higher for weight, body mass index, body fat mass, percent body fat, visceral fat area (VFA), waist circumference, hip circumference, and WHR. The energy and nutrients intake were significant after adjusting for sex, age, smoking history, and income. The LSE group had a significantly higher fat intake and Na/K intake ratio. The HSE group had significantly higher fiber intake, and K intake. As the amount of urinary sodium excretion increased, the risk of obesity before correction was 3.57 (95% CI: 1.13–11.25) times greater, and the risk of obesity of T3 increased significantly by 3.33 times (95% CI: 1.05–10.59). After correcting for sex and age, the obesity risk of T2 increased significantly by 4.23 times (95% CI: 1.11–16.06), and after correcting for sex, age, smoking history, and income, the obesity risk of T2 increased significantly by 6.81 times (95% CI: 1.44–32.19) the risk of obesity. CONCLUSIONS: An association exists between sodium excretion and obesity in Korean adults. In this study, the high excretion of sodium group was obese and the risk of obesity was higher than the low excretion of sodium group.

Necesidad de armonizar la etapa preanalítica de la orina de 24 horas: evidencias de una encuesta / Need to harmonize the pre-analytical phase of 24-hour urine: evidence from a survey / Necessidade de harmonizar a fase pré-analítica da urina de 24 horas: evidência de uma pesquisa

El objetivo del trabajo consistió en evaluar el estado de armonización de la etapa preanalítica de la orina de 24 horas (orina-24h). Se realizó una encuesta anónima sobre la etapa preanalítica de la orina-24h a bioquímicos de Argentina. Respondieron 92 profesionales. Del análisis de las respuestas surge que el 95% de los bioquímicos facilita a los pacientes instrucciones escritas para la recolección; 11% incluye instrucciones con información visual gráfica además de escrita; 37% registra hora de inicio y finalización de la recolección; 59% recomienda que durante la misma la muestra se mantenga refrigerada; 73% suministra al paciente el recipiente para la recolección; 47% proporciona el envase con conservante, si corresponde; 100% solicita al paciente llevar al laboratorio la totalidad de la orina juntada; 4% solicita al paciente medir y anotar la diuresis y entregar al laboratorio una alícuota de la orina-24h; 78% realiza una o más acciones para evaluar la correcta recolección. Los criterios de rechazo seleccionados en orden decreciente fueron: pérdida de micciones, incumplimiento del tiempo de recolección, según la diuresis, según la eliminación diaria de creatinina y recipiente no apto. Esta encuesta evidenció que existen aspectos de la etapa preanalítica de la orina- 24h que requieren de mejora y armonización entre los laboratorios.

The objective of the present work was to evaluate the harmonization state of the pre-analytical phase of 24-hour urine. To this aim, an anonymous survey on the pre-analytical phase of 24-hour urine (Moreno-Carbonell, et. al) was carried out by biochemists from Argentina. A total of 92 professionals responded to the the survey. As a result, 95% provide patients with written instructions for collection; 11% include visual graphic instructions; 37% record starting and finishing time of collection; 59% recommend sample refrigeration during collection time; 73% supply the container; 47% provide the container with a preservative, if necessary; 100% ask the patient to take the complete 24-hour volume to the laboratory; 4% indicate to measure and record sample volume and to take an aliquot of it; and 78% perform one or more actions to evaluate the proper collection procedure. The rejection criteria selected in decreasing order were: loss of micturition, non-compliance with collection time, according to the volume and daily creatinine excretion, and improper container. To conclude with, this survey showed that there are aspects of the pre-analytical phase of 24-h urine that need improvement and harmonization between laboratories.

O objetivo do trabalho foi avaliar o estado de harmonização da fase pré-analítica da urina de 24 horas (urina-24h). Foi realizado um levantamento anônimo sobre a fase pré-analítica da urina-24h a bioquímicos da Argentina. Responderam 92 profissionais. Da análise das respostas surge que 95% fornecem aos pacientes instruções escritas para a coleta; 11% inclui instruções com informação visual gráfica além de escrita; 37% registra hora de início e finalização da coleta; 59% recomenda que durante a coleta a urina seja mantida refrigerada; 73% fornece o recipiente para a coleta; 47% fornece o recipiente com um conservante, se necessário; 100% solicita ao paciente que leve o volume completo de 24 horas ao laboratório; 4% indica ao paciente medir e registrar a diurese e entregar ao laboratório uma alíquota da urina-24h; 78% realiza uma ou mais ações para avaliar o procedimento apropriado de coleta. Os critérios de rejeição selecionados em ordem decrescente foram: perda das micções, descumprimento do tempo de coleta, de acordo com a diurese, conforme a eliminação diária de creatinina, e recipiente inadequado. Esta pesquisa mostrou que há aspectos da fase pré-analítica da urina de 24h que precisam ser melhorados e harmonizados entre os laboratórios.

Clinical Study of Sanqi Granules in Treating Chronic Glomerulonephritis / 广州中医药大学学报

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.

Changes in serum and urine electrolytes of children with neurally mediated syncope after oral rehydration salts [Ⅰ]treatment / 中华实用儿科临床杂志

Objective To explore the changes in serum and urine electrolytes of children with neurally media-ted syncope (NMS)after oral rehydration salts (ORS)[Ⅰ]treatment.Methods The study group included 135 patients [60 male and 75 female,aged 4 -16 years,average of (10.20 ±2.68)years old]with unexplained syncope and prodro-mal symptoms of syncope in our hospital between May 2014 and April 2015.The patients underwent head -up tilt test (HUTT),and completed serum electrolytes and 24 -hour urine electrolytes,and the serum electrolytes and 24 -hour u-rine electrolytes in different hemodynamic type of HUTT were compared.Positive HUTT patients were treated with health education and ORS[Ⅰ],while negative HUTT patients were received health education.Then 21 -154(42.63 ±27.71) days later,the patients returned to hospital,for the inquiry of symptom improvement,and review of HUTT,24 -hour urine and serum electrolytes.Results (1)The total effective rate of ORS[Ⅰ]treatment was 62.96% (17 /27 cases),while negative conversion rate of HUTT was 48.15% (13 /27 cases).(2)There was no significant difference in serum electro-lytes,24 -hour urine electrolytes or 24 -hour urine volume between HUTT positive group and negative group during the first visit (all P >0.05).(3)In return visit,serum calcium [(2.30 ±0.10)mmol/L vs (2.20 ±0.09)mmol/L,t =2.72,P 0.05).(4)24 -hour urine sodium [(159.06 ±72.76)mmol/24 h vs (118.97 ±52.75)mmol/24 h,t =2.712,P 0.05).(5)There was no significant difference in serum elec-trolytes,24 -hour urine electrolytes or 24 -hour urine volume between vasovagal syncope group and postural orthostatic tachycardia syndrome group during the first visit(all P >0.05).Conclusions ORS[Ⅰ]treatment can obviously increase the 24 -hour urine sodium,24 -hour urine chloride in children with NMS.ORS[Ⅰ]is an effective therapy for NMS.

Correlation of Spot Urine Protein:Creatinine Ratio with 24-hour Urinary Protein in Preeclampsia: A Cross Sectional Study.

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.

Alto rendimiento clínico entre albuminuria semicuantitativa y proteinuria de 24 horas en pacientes con sospecha de síndrome hipertensivo del embarazo / High clinical performance between semiquantitative albuminuria and 24-hour proteinuria in patients with suspected hypertensive syndrome of pregnancy

ANTECEDENTES: La evaluación precisa de la proteinuria constituye un pilar importante para el diagnóstico del síndrome hipertensivo del embarazo (SHE). El estándar dorado para esta medición es la recolección de orina en 24 horas, pero debido a la duración de la toma de la muestra, alternativas como la albuminuria semicuantitativa se utiliza con mayor frecuencia en los servicios de urgencia de nuestro país. OBJETIVO: Evaluar el rendimiento diagnóstico de la albuminuria semicuantitativa y su asociación con proteinuria de 24 horas en pacientes con SHE. MÉTODOS: Estudio retrospectivo de 145 pacientes con sospecha de SHE atendidas en el Hospital Padre Hurtado, Chile. A todas las pacientes se le realizó albuminuria semicuantitativa (categorizada entre 0+ y 4+) y proteinuria de 24 horas (positivo si >0,3 gramos/24 horas). Se realizó análisis por grupos compuestos de albuminuria semicuantitativa y resultado positivo en proteinuria de 24 horas. RESULTADOS: Se evidenció una sensibilidad de 50%, especificidad de 100%, VPP de 100%, VPN de 65,7%, LR+ de 50 y un LR- de 0,5. CONCLUSIÓN: La albuminuria semicuantitativa ≥2+ muestra una fuerte asociación con proteinuria ≥0,3 g/24 horas y es un método rápido para evaluar SHE.

BACKGROUND: One of the basis for the diagnosis of pregnancy induced hypertension syndrome (PIHS), includes the precise evaluation of proteinuria. The gold standard for its evaluation is the collection of a 24-hour urine specimen, but because it is a slow method, other alternatives, such as semi-quantitative albuminuria have been used more frequently on our emergency rooms. OBJECTIVE: To assess the diagnostic performance of semi-quantitative albuminuria and its association with proteinuria measured in a 24-hour urine specimen collection, in patients with PIHS. METHODS: Retrospective study of 145 patients with clinical suspicion of PIHS who assisted to Hospital Padre Hurtado, Chile. Semi-quantitative albuminuria (categorized as 0 to 4+) and proteinuria measured in a 24-hour urine specimen collection was measured on every patient. Abnormal values of proteinuria were considered when values exceeded 0.3 g/24 hours. Composite outcomes analysis was done between albuminuria groups and positive proteinuria in 24 hrs. RESULTS: Sensibility and specificity of semi-quantitative albuminuria was of 50% and 100%, respectively, with a PPV: 100%, NPV: 65.7%, LR+: 50 and a LR-: 0.5. CONCLUSION: semi-quantitative albuminuria ≥2+ shows a strong association with proteinuria ≥0.3 g/24 hours and it could be used as a fast method to assess PIHS.

Associations between 24-hour Urine Sodium Excretion Level and Obesity-related Metabolic Risk Factors / 대한지역사회영양학회지

OBJECTIVES: Excess sodium intake has been linked to obesity and obesity-related indices. However, the scientific evidence for this association is inadequate. The purpose of this study was to investigate the association between urinary sodium excretion and obesity-related indices among Korean adults. METHODS: A convenience sample of 120 subjects (60 obese and 60 non-obese subjects) were recruited applying frequency matching for sex and age between two groups. Sodium intake level was assessed through 24-hour urine collection. Obesity-related metabolic risk factors, including fasting blood lipid indices, subcutaneous and visceral fat through computed tomography (CT), insulin resistance indices, blood pressure and liver enzymes were measured in all subjects. These obesity-related metabolic risk factors were compared between obese and non-obese group according to sodium excretion levels (180 mEq/day). RESULTS: After adjusting for age, gender, health behaviors (smoking, exercise, drinking), and energy intake, several obesity-related metabolic risk factors, including abdominal circumference, body fat percentage, subcutaneous and visceral fat, triglyceride, and systolic blood pressure were found to be significantly deteriorated as the sodium excretion level increases. In addition, multivariate adjusted-odds ratios of abdominal obesity, high blood triglyceride, and high blood pressure were found significantly higher in the highest sodium excretion group compared to the lowest group. The mean number of metabolic syndrome risk factors was also significantly greater in the highest sodium excretion group than in the lowest group. CONCLUSIONS: The current study findings suggested that high sodium intake can affect obesity and metabolic syndrome risk negatively, implying the necessity of future research on low-sodium diet intervention in relation to obesity and related health problems.

Sodium and Potassium Intake of Urban Dwellers: Nothing Changed in Yazd, Iran.

To assess the daily salt intake of people aged 20-74 years based on the 24-hour urinary sodium excretion in urban population of Yazd, a population-based cross-sectional study was conducted. This is a substudy of Yazd Healthy Heart Project in Iran. From 2004 to 2005, two thousand people of the urban population of Yazd city, aged 20-74 years, were enrolled in the main study. Overall, 219 volunteer participants of 20-70 years were enrolled in this substudy. Sample frame was the household numbers according to the database of Yazd City Health Services. Calcium, phosphorus, sodium, potassium, and creatinine were measured in the urine samples collected from the participants over a 24-hour period. Sodium content in urine over 24 hours was 171.7±82.9 mmol/day in males and 127.8±56.1 mmol/day in females (p<0.0001) while potassium content was 49.4±23.2 mmol/day in males and 41.5±25.1 mmol/day in females (p=0.2). Estimated average daily salt (NaCl) intake was 10.0±4.8 g/day in males and 7.5±3.3 g/day in females (p<0.0001). Only one participant had the ideal Na/K ratio of less than one. Na/K ratios greater than one and less than two were seen in 11.3% (n=24), and a ratio equal to or greater than 2 was observed in 82.3% (n=118) of the participants. The average Na/K ratio was 3.69±1.58. Unlike many developed countries where sodium intake declined over the past few decades, the daily sodium intake in Yazd is high, and daily potassium intake is low. This is similar to what was observed four decades ago in an area not far from Yazd. Efforts must be directed towards health promotion interventions to increase public awareness to reduce sodium intake and increase potassium intake.

Impact of Quantitative 24-hour Urine Protein on Thyroid Hormone Levels in Patients with Severe Preeclampsia / 中国医科大学学报

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.

Estimated Amount of 24-Hour Urine Sodium Excretion Is Positively Correlated with Stomach and Breast Cancer Prevalence in Korea

Stomach cancer is one of the most common cancers in Korea. The aim of this study was to identify the association between the prevalence of cancer, particularly stomach cancer, and the amount of 24-hr urine sodium excretion estimated from spot urine specimens. The study included 19,083 subjects who took part in the Korean National Health and Nutritional Examination Survey between 2009 and 2011. The total amount of urine sodium excreted in a 24-hr period was estimated by using two equations based on the values for spot urine sodium and creatinine. In subjects who had an estimated 24-hr urine sodium excretion of more than two standard deviations above the mean (group 2), the prevalence of stomach cancer was higher than in subjects with lower 24-hr sodium excretion (group 1). By using the Tanaka equation to estimate it, the prevalence of stomach cancer was 0.6% (114/18,331) in group 1, whereas it was 1.6% (9/568) in group 2 (P=0.006). By using the Korean equation, the prevalence was 0.6% (115/18,392) in group 1, and 1.6% in group 2 (8/507) (P=0.010). By using the Tanaka equation, breast cancer in women is more prevalent in group 2 (1.9%, 6/324) than group 1 (0.8%, 78/9,985, P=0.039). Higher salt intake, as defined by the estimated amount of 24-hr urine sodium excretion, is positively correlated with a higher prevalence of stomach or breast cancer in the Korean population.

Random urine protein/creatinine ratio readily predicts proteinuria in preeclampsia

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.

Alprostadil combined with Irbesartan in treatment of early diabetic nephropathy / 中国综合临床

ObjectiveTo observe the clinical efficacy of combined irbesartan and alprostadil treatment of early diabetic nephropathy (DN).Methods A total of 120 patients with early type 2 diabetes of hospitalization were randomly divided into 3 groups: irbesartan group of 40 patients (150 mg, once per day)(group irbesartan),40 patients treated with alprostadil (physiological saline and alprostadi 10 μg))(group alprostadi) ,40 patients treated with alprostadil combined irbesartan (dose same as the other two groups)(combined group).All cases were observed for 4 weeks.Comparison of serum creatinine (Cr), blood urea nitrogen(BUN) ,24 hour urinary albumin(24hUAE) changes after treatment.ResultsAfter treatment 4 weeks 24hUAE of the three groups were significantly decreased (t = 2.07, t = 2.01 and t = 3.15, Ps ＜ 0.05) .The decrease of 24hUAE in the combined treatment group ([252.69 ± 33.56]mg/24h) was better than that in the irbesartan group([268.75 ± 34.42)](t = 2.11, P ＜ 0.05)and in the alprostadil group ([267.95 ± 30.75])mg/24h (t = 1.998, P ＜ 0.05) .No significant difference were observed between the Irbesartan and alprostadil group.During treatment, several patients affected by swell, uncomfortable in the alprostadil group, but improved after treatment.No other adverse effect was observed.Conclusion Alprostadil combined with irbesartan treatment of early diabetic nephropathy is an effective way.