A-061 Usefulness of a random spot urine proteins-to-creatinine ratio to screen for increased albuminuria in patients with type 1 diabetes

Abstract Background Moderately increased albuminuria is a biomarker for early onset diabetic nephropathy. One recommendation is to use proteinuria-to-creatininuria ratio (UPCR) to screen for increased albuminuria in countries with limited financial resources. The aim of this study was to evaluate the performance of UPCR at different cut-off to screen for increased albuminuria using albuminuria-to-creatininuria ratio (UACR) as a gold standard. Methods This was a cross-sectional study. A random spot urine sample was collected from patients with type 1 diabetes to measure albuminuria and total proteinuria using respectively an immunoturbidimetric and a colorimetric assays. Albuminuria was expressed as UACR and proteinuria as UPCR. The area under the curve (AUC) method and the kappa coefficient were used to compare UPCR and UACR. Results A total of 150 patients with a mean age of 15±4.42 years and a male frequency of 51.33% were included in this study. The frequency of moderately increased albuminuria according to UACR was 33.33% (n=50). The frequency of moderately increased albuminuria according to UPCR at the thresholds of 130, 150, 180 and 200 mg/g were all higher than that obtained with UACR whereas the frequency of moderately increased albuminuria according to the UPCR at the threshold of 272 mg/g was 35.33% (n = 53). For the five (5) UPCR cut-off values, the areas under the receiver operating curves (AUC) were all low i.e. 70%. The highest kappa coefficient of the series was observed with the UPCR cut-off value of 272 mg/g. However, the level of agreement between UPCR 272 mg/g and UACR results was mild with a kappa coefficient of 0.276 95%CI: 0.116 – 0.436 i.e. 0.40. Conclusion The level of agreement between UPCR and UACR was moderate. It is not sufficient enough for UPCR to replace UACR to screen for increased albuminuria in patient with type 1 diabetes.