Feasibility and accuracy of Tanaka and SH2 methods used to estimate the 24-hour urinary sodium excretion of hypertension patients in Shanghai / 解放军医学杂志

Objective To validate and evaluate the feasibility and accuracy of Tanaka (T method) and SH2 (S method) used to estimate the 24-hour urinary sodium excretion of patients in Shanghai with hypertension. Methods A hundred and eighty hypertensive patients, hospitalized in the Internal Medicine Ward of Changhai Hospital affiliated to Navy Medical University from January 2017 to January 2018, were enrolled in present study. The specimens were collected of morning urine, afternoon urine, evening urine and the completed 24h urine, and the levels of sodium, potassium and creatinine in urine specimens were detected. The differences of estimation value calculated by T method and S method were compared, and the consistency of estimated value and actual urinary sodium excretion were compared by Bland-Altman plots respectively. Results There were 122 patients were enrolled in the final statistical analysis. The average urinary sodium excretion was 151.02mmol (about 8.83g salt). The average deviation values estimated by T method at 3 time points were 34.99, 22.72 and 48.76mmol, and estimated by S method were –6.83, –6.82, –6.31mmol. The intra-group correlation coefficient (ICC) was higher of T method in morning urine specimen and of S method in three time spots urine specimens. Bland-Altman plots showed that the higher the level of 24h urine sodium excretion, the greater the bias of S method with a linear trend. Conclusion Because of the varying degrees of limitation, both T and S methods are not suitable for estimating the individual 24h urinary sodium excretion. The two methods are suitable for estimating the average 24h urinary sodium level of population, while S method is more accurate than T method.

Estimating 24-Hour Urine Sodium Level with Spot Urine Sodium and Creatinine

The 24-hr urine sodium excretion level was estimated based on the spot urine sodium, and the efficacy of the formula was validated to determine the status of low salt intake or =100 mEq/day using the estimated amount> or =100 mEq/day was 84.3%, 87.6%, and 84.8%, respectively. In conclusion, the three equations used to estimate the 24-hr urine sodium content were useful to determine the status of low salt intake.

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.

Valores basales de creatinina en orina puntual en escolares del Municipio San Diego: Carabobo-Venezuela / Spot urine creatinine referential levels in school children from San Diego county: Carabobo-Venezuela

Los valores referenciales de creatinina, están establecidos solo para adultos. Pocos países y organismos internacionales han adoptado niveles referenciales de creatinina en orina puntual en una población infantil. en ausencia de reglamentación para estos niveles en niños, son utilizados como referencia los establecidos por países con características diferentes a la de niños venezolanos. Esto motivó a los autores a determinar valores basales de creatinina en orina puntual en escolares, del municipio San Diego del Estado Carabobo, en el 2006. El estudio fue descriptivo de corte transversal, se determinaron niveles de creatinina en orina puntual a 123 niños entre 6-12 años de edad de ambos géneros. El método utilizado fue el de Jaffe modificado. La media del Valor basal fue de 0,96 ± 0,44 g/L. Sin diferencias estadísticas significativas, al compararlas por género y edad. El 98,4% de la población presentó concentraciones de valores basales entre 0,3-3,0 g/L. Estos resultados de valores medios de creatinina en orina en escolares, proponen hacer un aporte preliminar que sirva como base a proximos estudios que puedan establecer rangos referenciales del valor basal puntual en niños

The reference values of urinary creatinine found in the literature are for adults. Few countries and international organisms have adopted spot urine creatinine referential levels in children. In obsence of a specific regulation established to these levels in children population, the urinary creatinine values used like reference have been established in countries with geographical and culture characteristics, body composition and diet habits different from Venezuela children. This approach motivated to the autors of this study determine baseline values of spot urinary creatinine in schoolchildren related to age and gender in San Diego county in the years 2006. The study was a descriptive cross-sectional, where we determined the baseline levels in 123 children in age range between 6 to 12 years old of both genders. The analysis was realized by the Jaffé modified method. The baseline average was 0,96 ± 0,44 g/L. There was not significant statistical difference between the values of different and gender. The 98.4% of the studied population showed baseline concentrations between 0.3-3.0 g/L. Results will become a base for future studies that will set spot baseline reference ranges for children

Spot urine porphyrins/creatinine ratio profile of healthy Brazilian individuals adjusted for personal habits

Changes in urinary porphyrin excretion may be the result of hereditary causes and/or from environmental or occupational exposure. The objective of this study was to measure the amount of some porphyrins in spot urine samples obtained from volunteers randomly selected from a healthy adult population of São Paulo with a sensitive HPLC method and to estimate normal ranges for a non-exposed population. Spot urine samples were collected from 126 subjects (both genders, 18 to 65 years old) not occupationally exposed to porphyrinogenic agents. Porphyrin fractions were separated on RP-18 HPLC column eluted with a methanol/ammonium acetate buffer gradient, pH 4.0, and measured fluorometrically (excitation 405 nm/emission 620 nm). The amount of porphyrins was corrected for urinary creatinine excretion. Only 8-carboxyl (uro) and 4-carboxyl (copro) porphyrins were quantified as µg/g creatinine. Data regarding age, gender, occupational activities, smoking and drinking habits were analyzed by Mann-Whitney and Kruskal-Wallis tests. Uroporphyrin results did not differ significantly between the subgroups studied. Copro and uro + copro porphyrins were significantly different for smokers (P = 0.008) and occupational activities (P = 0.004). With respect to alcohol consumption, only men drinking >20 g/week showed significant differences in the levels of copro (P = 0.022) and uro + copro porphyrins (P = 0.012). The 2.5-97.5th percentile limit values, excluding those for subjects with an alcohol drinking habit >20 g/week, were 0-20.8, 11.7-93.1, and 15.9-102.9 µg/g creatinine for uro, copro and uro + copro porphyrins, respectively. These percentile limit values can be proposed as a first attempt to provide urinary porphyrin reference values for our population, serving for an early diagnosis of porphyrinopathies or as biomarkers of exposure to porphyrinogenic agents.

Diagnosis and screening of chronic kidney disease / 대한내과학회지

A simple definition of chronic kidney disease (CKD) is necessary to establish clinical practical guidelines. The Kidney Disease Outcomes Quality Initiative (K/DOQI) defined CKD as kidney damage or a glomerular filtration rate (GFR) 30 mg/g in two of three spot urine collections. With the CKD guidelines of K/DOQI and KDIGO, the diagnosis and early detection of CKD, which may need a Korean estimation equation, are improving and should help to reduce the prevalence and incidence of end-stage renal disease in Korea.

Assessing albuminuria in spot morning samples from diabetic patients / Avaliação de albuminúria em amostra matinal em pacientes diabéticos

Microalbuminuria assessment is essential for diagnosing incipient nephropathy in diabetic patients. The present study aim to evaluate whether urinary albumin concentration (UAC) and urinary albumin-to-creatinine ratio (UACR) agree with 24 h urine collection in screening for albuminuria > 30 mg/24 h in type 1 and 2 diabetics. In this cross-sectional study were evaluated 293 diabetic patients (117 type 1 and 176 type 2). Albuminuria was determinated by turbidimetric immunoassay. The best discriminator value was 22 mg/l (sensitivity 82.5 percent, specificity 74.0 percent) for UAC and 27.3 mg/g creatinine (sensitivity 83.3 percent, specificity 80.9 percent) for UACR. Areas under ROC curves were 0.868 and 0.878, respectively (p = 0.53). Lower discriminators as 10 mg/l (sensitivity 94.2 percent, specificity 48.6 percent) and 10 mg/g creatinine (sensitivity 96.7 percent, specificity 49.1 percent) attained high sensitivities. UAC and UACR from spot morning urine had similar accuracy in screening microalbuminuria. The simplicity and lower cost of UAC justifies its preferential clinical use.

Pesquisar microalbuminúria é essencial para o diagnóstico de nefropatia incipiente diabética. Este estudo objetiva avaliar concordância entre concentração de albumina urinária (CAU) e relação albuminúria-creatinúria (RAC) com coleta urinária de 24 h para pesquisa de albuminúria > 30 mg/24 h em diabéticos tipos 1 e 2. Estudou-se transversalmente 293 pacientes diabéticos (117 tipo 1 e 176 tipo 2). A albuminúria foi determinada por imunoensaio turbidimétrico. O melhor discriminador para CAU foi 22 mg/l (sensibilidade 82,5 por cento, especificidade 74 por cento) e para RAC 27,3 mg/g de creatinina (sensibilidade 83,3 por cento, especificidade 80,9 por cento). Áreas sob as curvas ROC foram 0,868 e 0,878, respectivamente (p = 0,53). Menores discriminadores como 10 mg/l (sensibilidade 94,2 por cento, especificidade 48,6 por cento) e 10 mg/g de creatinina (sensibilidade 96,7 por cento, especificidade 49,1 por cento) resultaram sensibilidades maiores. CAU e RAC de amostras urinárias isoladas matinais apresentaram acurácia semelhante para pesquisa de microalbuminúria. Simplicidade e baixo custo da CAU justificam seu uso clínico preferencial.

The Factors Affecting Accurate Quantitaion of Proteinuria Using Spot Urine Protein/Creatinine Ratio in Children

PURPOSE: Many results have reported a correlation between the spot urine protein/creatinine ratio(P/C ratio) and 24-hour urinary protein(24UP) amount. This study was designed to evaluated correlation between 24UP amounts and P/C ratio in children and to find the factors that affect this correlation. METHODS: 210 patients who visited the Department of Pediatrics in Busan Paik Hospital from september 2003 to december 2007 were included in this study. All the patients were divided into I, II, III/A, B, C group[I:24UP(mg/m2/day)] or =1,000, A: Cr excretion(mg/kg) or =25)]. Pearson correlation analysis was performed between 24UP and P/C ratio to evaluate the relationship. We defined fractional difference between 24UP and P/C ratio, and then performed multiple regression analysis. RESULTS: There was a strong positive linear correlation between 24UP and P/C ratio in all patients, and the correlation was also good in each group. The factors affecting accurate quantitation of proteinuria using spot urine P/C ratio was creatinine excretion. CONCLUSION: Spot urine P/C ratio is a useful test to predict proteinuria roughly. Therefore, we expect that urine P/C ratio can be used as parameter instead of 24UP, if we set cutoff value of P/C ratio considered to creatinine excretion according to age and sex in large pediatric population.

The Usefulness of Spot Urine Protein/Creatinine Ratio in Evaluating Proteinuria in Children and the Correlation between 24-hour Urinary Protein Amount and Spot Urine Protein/Creatinine Ratio

PURPOSE: Recently, different results about factors affecting accurate quantitation of 24-hr urinary protein(24UP) amount using spot urine protein/creatinine ratio(PCR) have been reported. The current study was designed to evaluate correlation between 24UP amounts and PCR in children, and the effect of 24UP amounts, age, sex, and glomerular filtration rate(GFR) on this correlation. METHODS: Among 94 patients who visited the department of pediatrics in Busan Paik Hospital from March 2002 to August 2002, 68 patients whose urinary creatinine excretion was > or = 15 mg/kg/day were included in this study. All the patients were divided into I, II/A, B group(I : 24UP or = 500 mg/day, A : or = 10 years of age). Pearson correlation analysis was performed between 24UP and PCR to evaluate the relationship. We defined fractional difference between 24UP and PCR, and then performed multiple regression analysis with 24UP amount, age, GFR and fractional difference. RESULTS: There was a strong positive linear correlation between 24UP and PCR(R=0.936, P or = 500 mg. The factors affecting accurate quantitation of proteinuria using spot urine PCR was age, not 24UP amount, GFR or sex. CONCLUSION: Spot urine PCR is a useful test but has limitations in predicting 24UP amount. Therefore, it should be used only as screening method. Age-adjusted PCR cutoff values may be necessary to predict 24UP amount in children with proteinuria.

The Usefulness of Monitoring of Transtubular Potassium Gradient and Spot Urine Na/K Ratio in the management of Cirrhotic Ascites / 대한간학회지

BACKGROUND/AIMS: Transtubular potassium gradient(TTKG) is known as the most accurate indicator of aldosterone activity. TTKG may be used to monitor the effectiveness of aldosterone antagonist which is prescribed generally for the management of cirrhotic ascites. Spot urine [Na]/[K] ratio may also be used for the same purpose. METHODS: After measuring TTKG, spot urine [Na]/[K] ratio, and plasma aldosterone concentration in each of the 23 patients all who had cirrhotic ascites, 100 mg of spiron-olactone was prescribed to be taken daily for 5 days. When no diuretic response occurred and TTKG was more than 3.5 at the end of 5 days, the dose of spironolactone was increased by 100 mg/day at the interval of 5 days until TTKG decreased to below 3.5. Furosemide was added to the non-responders if their TTKG had dropped to below 3.5. RESULTS: Basal plasma concentration of aldosterone was higher than upper normal limit in 13(57%) patients, and correlated with TTKG significantly(r=0.60, p=0.002). TTKG was calculated to be 3.5+/-0.67 when assuming the aldosterone activity has been completely blocked. Spot urine [Na]/[K] ratio had significant negative correlation with TTKG before and after the administration of spironolactone. In most patients, diuretic response appeared with the fall of TTKG (especially below 3.5) and with the rise of spot urine [Na]/[K] ratio. In patients who did not respond to a low dose spironolactone, further treatment plan (to increase dose of spironolactone or to add furosemide) was guided by TTKG, and all were successful. CONCLUSIONS: TTKG and spot urine [Na]/[K] ratio are good indicators of aldosterone activity, and might be used as useful guidelines in the diuretic management of cirrhotic ascites.

Analysis of Hypokalemia in Emergency Patients / 대한신장학회잡지

OBJECTIVES: Hypokalemia is one of the most common electrolyte disorders encountered in clinical medicine. It is important electrolyte disorder because it is account for neuromuscular, cardiovascular and renal disturbance. But there are few studies to evaluate the incidence and cause of hypokalemia in emergency patients. Present study was performed to evaluate the incidence and cause of hypokalemia and coincidental changes of other electrolyte and chemical parameters of blood and urine. METHODS: Hypokalemia was defined as a serum potassium concentration less than 3.5mEq/L. A total 80 medical patient without renal failure were prospectively studied for 62 days. Electrolytes and chemical parameters of the blood and urine were determined at emergency room. RESULTS: 1) Of medical inpatients through emergency room, hypokalemia was detected in high frequency(32%) and mild degree(mean; 3.1+/-0.1mEq/L). 2) The most common cause of hypokalemia was diuretics(23%), other causes were vomiting, SIADH, diarrhea, alkalemia, and unidentified cause(each; 15.4%). 3) Compared to the normokalemic group, the hypokalemic group showed significant decrease in urinary anion gap(P=0.003). 4) There was no significant difference of spot urine potassium concentrations between renal and extrarenal origin of hypokalemia. CONCLUSION: The hypokalemia in emergency patients was detected in high frequency and mild degree. Urine anion gap was significantly decreased in hypokalemic group than normokalemic group. Spot urine potassium concentration was less effective in differentiation of renal and extrarenal origin of hypokalemia.

Evaluation of Mercury Concentration in Spot Urine for Biological Monitoring Among Metallic Mercury Exposed Workers / 대한산업의학회지

Biological monitoring for exposures permits estimation of organ doses or body burdens from exposures through all relevant portals of entry. Biological monitoring data may be used to estimate environmental concentrations when the latter cannot be measured directly. Biological indices are usually surrogates for the concentration of a chemical or its metabolites or its effect at the true receptors. Mercury concentration in urine has-been most-coinmoialy-recommended as a biological exposure index of mercury. For data based on urine analysis, variation in urine volume is the most significant. The urinary concentration related to excretion of the solute provides some correction for fluctuation of urine output. Sampling time must be carefully observed because distribution and elimination of a chemical are kinetic events. This study has evaluated mercury concentration in spot urine compared to the results of 24 hour collected urine by the adjustment methods (specif ic gravity, creatinine) and sampling time. The subjects were 43 workers who had been exposed to the metallic mercury. The results were as follows: 1. The correlation coefficients between mercury concentration in 24 hour urine and that in spot urine were 0.639-0.715 and were not different by adjustment methods. 2. In the high exposure group who were over lOOug/1 of urinary mercury, the correlation coefficients between mercury concentration in 24 hour urine and that in spot urine were 0. 687-0.824 and were not different by adjustment methods. 3. Mercury concentration in spot urine were very variable by sampling time or exposure time. The correlation coefficients between mercury concentration in 24 hour urine and that in spot urine were most highest as 0.85-0.91 at first voiding urine in the morning, and were 0. 77-0.86 at urine collected within four hours before end of shift. In the biological monitoring to exposure of mercury, sampling of spot urine were most proper at first voiding urine in the morning, and then at urine collected within four hours before end of shift. But the adjustment methods of specific gravity and creatinine were no difference of the results.

A study for mass screening of galactosemia using galactitol level by spot urine method among Korean infants

No abstract available.