Impact of random urine proteinuria on maternal and fetal outcomes of pregnancy: a retrospective case-control study

BACKGROUND/AIMS: Proteinuria is associated with hypertension and preeclampsia in pregnancy. However, the impact of random urine proteinuria on fetal and maternal outcomes has not been established. We investigated the influence of random urine proteinuria on the clinical outcomes of pregnancy. METHODS: From January 2008 to December 2010, 2,822 patients were retrospectively studied. A total of 536 pregnant women with proteinuria in random urine and matched controls without proteinuria via propensity score matching were analyzed. Proteinuria was checked by the dipstick method. RESULTS: The patients’ mean age was 33.0 ± 4.7 years, and the mean gestational age was 235.6 ± 50.6 days on admission. The prevalence of hypertension and chronic kidney disease was 2.4% (n = 67) and 1.0% (n = 29), respectively. Women with random urine proteinuria showed higher blood urea nitrogen levels and a higher incidence of hematuria. These women also had a higher incidence of preeclampsia, preterm labor, premature rupture of membranes, and intrauterine growth restriction. Proteinuria was strongly correlated with preeclampsia in both propensity score matching (p < 0.001, r = 0.783) and unmatched whole samples (p < 0.001, r = 0.851). CONCLUSIONS: These findings suggest that random urine proteinuria is associated with preeclampsia, preterm labor, premature rupture of membrane, and intrauterine growth restriction.

Diagnostic Utility of the URiSCAN 2 ACR Strip as a Point-of-care Test for Estimating Urine Albumin-Creatinine Ratios

BACKGROUND: Diagnosing albuminuria by measuring the urinary albumin-creatinine ratios (UACR) is important for the early detection of kidney diseases in patients with diabetes or hypertension. Currently, a few point-of-care testing (POCT) systems exist for estimating the UACR. Here, we evaluated the performance characteristics of two semi-quantitative UACR POCT assays. METHODS: Albumin and creatinine levels were quantified for 219 randomly acquired urine samples with the Toshiba TBA-200FR NEO analyzer, and the UACR were calculated. The results were compared to UACR measured using the CLINITEK Microalbumin 2 Strip (Siemens, USA) and URiSCAN 2 ACR Strip (YD diagnostics, Korea) POCT assays. RESULTS: Semi-quantitative results from the CLINITEK and URiSCAN UACR assays showed that the sensitivity and specificity of each test were, respectively, 96.7% and 62.7%, and 45.9% and 84.8%. Positive and negative predictive values of the CLINITEK and URiSCAN tests were, respectively, 50.0% and 98.0%, and 53.8% and 80.2%. The rate of agreement between URiSCAN test and CLINITEK test was 91.1% in the normal UACR range ( or =30 mg/g). CONCLUSIONS: The URiSCAN test showed higher specificity than did the CLINITEK test owing to the lower false positive results. However, the high rate of false negatives for the URiSCAN test significantly lowered its sensitivity and negative predictive values. Therefore, the sensitivity of the URiSCAN device in detecting urine albumin needs to be improved before its adoption as a reliable rule-out testing system.

Application of the ratio of urine albumin to creatinine (ACR) in the urine samples at different time points in monitoring the early renal injury in patients with type 2 diabetes / 实用医学杂志

Objective To investigate the application of using urine ACR at different time points instead of 24-hour urinary albumin (24 h UA) for screening of early renal injury in patients with type 2 diabetes. Methods The 24-h urine samples at different time pointsfrom 89 hospitalized patients were collected. The correlations of the ACR of urine samples at different time points were compared with the 24-h UA. When the 24-h UA was taken as the standard,the receiver operating characteristic (ROC) curves of urine ACR at different time points were established and analized. Results No significant differences in urine ACR between the morning urine group [ACR 9.02 (5.69~ 11.64)mg/mmol] and the random urine group [ACR 8.65 (5.80 ~ 11.83) mg/mmol] (P > 0.05). A positive correlation was observed between the morning urine ACR and the random urine ACR (r = 0.951,P < 0.01), however, the ACR of the morning and the random urine group were all positively correlated with the 24-h UA (r=0.886, 0.859, P<0.01). There were no significant differences in the sensitivities and the specificities between the morning and the random urine specimens in screening for albuminuria (92.6%vs 90.1%, and 87.5%vs 87.5%, respectively). When the 24-h UA was taken as the standard,the area under the ROC curves of the ACR in the random urine specimens and the morning urine specimens were 0.954 ± 0.022 and 0.960 ± 0.021 , respectively. There were no statistical differences between these two groups. Conclusions The morning urine and the random urine ACR , instead of the 24-h UA , could be used for both the early screening and monitoring of the renal injury , and the random urine ACR detection is simple ,convenient and accurate for patients.

Factors Affecting Accurate Quantitation of Proteinuria Using Protein/Creatinine Ratio in Random Urine Specimen / 대한신장학회잡지

It's well known that protein/creatinine ratio(P/C ratio) in random urine samples reflects 24-hour urine protein. However, the factors affecting accurate quantitation of proteinuria using random urine P/C ratio are not fully evaluated. The aim of this study is to evaluate factors affecting accurate quantitaion of proteinuria using random urine P/C ratio. 118 patients admitted in Yonsei university medical center during June 1998 and Dec. 1998 were assessed for the measurement of random urine protein/creatinine ratio from second voided urine. 118 patients(mean age 41.5year, male: female 2.36: 1) had mean creati-nine level 1.83+/-1.78mg/dL, 24-hour pmteinuria 6.06+/-7.64g/day and P/C ratio 4.80+/-4.48, All the patiient.s were divided into A, B, C, I, II, K, IV according to serum creatinine level and 24-hour proteinurim amount. The correlation coefficient(R value) between proteinuria and P/C ratio are shown that in all pa- tients is 0.875, group A(Cr*

The validity of random urine specimen albumin measurement as a screening test for diabetic nephropathy

To assess the validity of urine albumin concentration (UAC) and the urine albumin:creatine ratio (UACR) in a random urine specimen (RUS) for screening diabetic nephropathy in Korea, a total of 105 ambulatory diabetes mellitus patients (male:female, 52:53), ages 40-75 years (median 59 years) collected 105 RUSs after completing a timed 24 hour urine collection. Albumin was measured by immunonephelometry. According to the timed urinary albumin excretion rate (UAER) measured in the 24 hour collection (criterion standard), samples were classified normoalbuminuric (UAER 200 micrograms/min; n = 25). The receiver operating characteristics (ROC) curve of UAC and UACR in a RUS for screening of microalbuminuria (normo- and microalbuminuric samples; n = 80) and macroalbuminuria (micro- and macroalbuminuric samples; n = 55) were plotted. Pearson's coefficients of correlation of 24 hour UAER vs. UAC and UACR were 0.81 and 0.75, respectively (P < 0.001). The point of intersection with a 100%-to-100% diagonal for microalbuminuria were as follows: 31.0 mg/l for UAC and 32.5 mg/g for UACR; for macroalbuminuria 181 mg/l for UAC and 287.3 mg/g for UACR. The sensitivity and specificity of the cut-off points for microalbuminuria were 77% and 82% for UAC and 77% and 92% for UACR. The sensitivity and specificity of the cut-off points for macroalbuminuria were 84% and 90% for UAC and 88% and 90% for UACR. In present study, no difference was observed when comparing the performance of UAC and UACR based on a statistical comparison by McNemar test. The repeated measurements of UAC and UACR in the same individual were statistically similar and were correlated with each other. Based on these results, albumin measurements (UAC and UACR) in a RUS were considered as a valid test for screening diabetic nephropathy.

Random Urine Ca/Cr Ratio in Healthy Neonates

PURPOSE: Recently, in high risk preterm infants, we experienced high incidence of hypercalciuria, nephrolithiasis & nephrocalcinosis. To screen hypercalciuria, we need the normal value of random urine Ca/Cr ratio in healthy neonates according to gestational age, postnatal age, milk and calcium intake. METHODS: Random urine Ca/Cr ratio was checked in 260 healthy full-term infants at the 2-7th day, and in 40 preterm infants at the 3-16th day when they started formula feeding at Ewha Universaity Mok-dong Hospital from March 1995 to October 1995. We calculated calcium amount in formulas and we excluded the neonates who needed extra calcium supplement. RESULTS: There were no significant relationships between random urine Ca/Cr ratio and body weight or gestational age. There were significant logistic positive relationships between random urine Ca/Cr ratio and postnatal age (r=0.47, P<0.05) or calcium intake (r=0.52, P<0.05). The velocity of increase in random urine Ca/Cr ratio in term and preterm infants is not significantly different. The normal values of random urine Ca/Cr ratio in healthy term and preterm infants were 0.026 0.013 (Max. 0.052) at the early neonatal period with low calcium intake, and 0.075 0.0310 (Max. 0.137) at the late neonatal period with adequate calcium intake. CONCLUSION: Random urine Ca/Cr ratio was very low in healthy neonates and increase in a logistic line according to calcium (milk) intake. New normal value of random urine Ca/Cr ratio in neonates according to calcium (milk) intake is suggested to screen hypercalciuria.