A single urine protein-to-creatinine ratio measurement (AUC 0.826) was significantly more useful than three consecutive urine dipstick measurements (AUC 0.702) for detecting microalbuminuria.
Observational (n=444)
No
Does the urine protein-to-creatinine ratio accurately predict microalbuminuria in patients with non-diabetic lifestyle-related diseases compared to urine dipstick?
The urine protein-to-creatinine ratio is a useful tool for the early detection of microalbuminuria in patients with non-diabetic lifestyle-related diseases, even when dipstick proteinuria is negative.
Absolute Event Rate: 0.826% vs 0.702%
p-value: p=<0.0001
BACKGROUND: The utility of dipstick proteinuria for predicting microalbuminuria in non-diabetic lifestyle-related diseases compared with the urine protein-to-creatinine ratio (uPCR) and the effect of dipstick proteinuria on the cut-off value (CO) and accuracy of uPCR are unclear. METHODS: and uPCR of < 0.5 g/gCr at initiation. Urine dipstick, uPCR and urine albumin-to-creatinine ratio (uACR) were measured three times per case. Microalbuminuria was defined as uACR of 30-299 mg/gCr for at least 2 of 3 measurements. Youden's Index was used as the optimal CO. Factors associated with microalbuminuria were analyzed using a logistic regression model. RESULTS: In 313 non-diabetic cases (median 70.8 years old), 3 dipstick proteinuria measurements were independently useful for detecting microalbuminuria, and the CO was set when a trace finding was obtained at least 1 of 3 times (sensitivity 0.56, specificity 0.80, positive predictive value PPV 0.73, negative predictive value NPV 0.65). A single uPCR measurement was more useful than 3 dipstick measurements, and was useful for detecting microalbuminuria even in cases with three consecutive negative proteinuria findings, indicating that the CO of the second uPCR with G1-3a (n = 136) was 0.06 g/gCr (sensitivity 0.76, specificity 0.84. PPV 0.68, NPV 0.89), while that with G3-b4 (n = 59) was 0.10 g/gCr (sensitivity 0.56, specificity 0.91. PPV 0.83, NPV 0.71). The sum of 3 uPCRs was useful for detecting microalbuminuria in cases with G1-3a (sensitivity 0.67, specificity 0.94, PPV 0.82, NPV 0.86) and G3b-4 (sensitivity 0.78, specificity 0.94, PPV 0.91 NPV 0.83), with both COs being 0.23 g/gCr. These COs of microalbuminuria did not change when trace or more proteinuria was included, although the sensitivity increased. A high uPCR and low urine specific gravity or creatinine level were independent factors for uACR ≥ 30 mg/gCr in cases with negative proteinuria, although the uPCR was a major predictive factor of a uACR ≥ 30 mg/gCr. CONCLUSIONS: The uPCR (preferably determined using early-morning urine), including in dipstick-negative proteinuria cases with non-diabetic lifestyle-related diseases, can aid in the early detection of microalbuminuria. TRIAL REGISTRATION: Retrospectively registered.
Ogi et al. (Thu,) conducted a observational in Non-diabetic lifestyle-related diseases and diabetes (n=444). Urine protein-to-creatinine ratio (uPCR) vs. Urine dipstick was evaluated on Area under the curve (AUC) for predicting microalbuminuria (p=<0.0001). A single urine protein-to-creatinine ratio measurement (AUC 0.826) was significantly more useful than three consecutive urine dipstick measurements (AUC 0.702) for detecting microalbuminuria.