【进展】Annals of Clinical Biochemistry：尿蛋白/肌酐比值可以反映24小时尿蛋白丢失状况？

Protein and albumin-to-creatinine ratios in random urines accurately predict 24 h protein and albumin loss in patients with kidney disease
Annals of Clinical Biochemistry，2009，46（6）：468-476


Background: Random urine protein-to-creatinine (PCR) and albumin-to-creatinine (ACR) ratios have been proposed as alternatives to 24 h urine measurements to simplify sample collection and overcome errors. The aim of this study was to examine the ability of PCR and ACR to predict urinary 24 h protein and albumin loss, respectively, in patients with kidney disease, and determine the most appropriate time of collection.

Methods: Eighty-three patients were recruited from a renal outpatient clinic. In a 24 h period, each collected an early-morning urine (EMU), second and third voids, and the remaining urine passed that day. PCR and ACR were determined in random urines and compared with the 24 h loss of protein and albumin, respectively.

Results: For all patients, median (range) 24 h urine protein and albumin losses were 220 (30–15600) and 60 ( 0.87, P < 0.0001). Receiver operator characteristic (ROC) curve analysis showed PCR accurately predicted both an abnormal 24 h urine protein 150 mg/24 h (areas under curves [AUC] 0.90–0.92) and significant proteinuria above 300 mg/24 h (AUC between 0.97 and 1.00). ACR accurately predicted both an abnormal 24 h urine albumin 30 mg/24 h (AUC 0.98 to 0.99) and frank albuminuria at 300 mg/24 h or 700 mg/24 h (AUC between 0.99 and 1.00). EMU and random urines performed equally well in predicting proteinuria and albuminuria from PCR and ACR, respectively.

Conclusions: By careful choice of cut-offs, both PCR and ACR can be used in patients with kidney disease to rule in or rule out abnormal 24 h losses of protein and albumin. EMU and, importantly, random samples can be used as surrogates for 24 h urine collections.

http://acb.rsmjournals.com/cgi/content/abstract/46/6/468