Rodby RA, Rohde RD, Sharon Z, Pohl MA, Bain RP, Lewis EJ, for
the Collaborative Study Group
The urine protein to creatinine ratio as a predictor of 24-hour
urine protein excretion in type 1 diabetic patients with
nephropathy
Am J Kidney Dis
(Dec) 26:904-909 1995
The protein to creatinine (P/C) ratio measured in a random urine specimen
has
become a popular substitute for 24-hour protein measurements because it is
easier to obtain. However, the utility of this test in clinical practice
remains unclear. 229 diabetic patients enrolled in the ACE Inhibition in
Type I Diabetic Nephropathy Collaborative Study provided specimens for
analysis; 33 patients provided two 24-hr and two random specimens separated
by at least a 3-month period. Proteinuria ranged from 0.05 to 13.3 g/d.
The
log random urine P/C ratio was strongly correlated with log 24 hr urine
protein (r=0.90), indicating that the 24 hr value can be predicted from the
random specimen. For instance, if it is assumed that the patient is
excreting 1.0 g of creatinine daily, a P/C ratio of 0.5 would indicated 0.5
g
daily of proteinuria. However, the correlation between P/C ratio and 24 hr
values was not as tight when proteinuria was in the nephrotic range.
Indeed,
among the 33 patients providing two specimens separated in time, the
direction in change of the P/C ratio was opposite that of the 24-hr value in
almost half of specimens. The authors conclude that although a random P/C
ratio is useful in predicting a range of proteinuria in type I diabetic
patients, this technique is not recommended for longitudinal patient
analysis.
(Leehey)
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