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Use of urinary protein:creatinine ratio in advanced stages of chronic kidney disease in diabetes

Background: Albumin:creatinine ratio (ACR) is the recommended method for the detection of incipient kidney disease in diabetic patients. However, protein daily excretion rate is used for the quantification and monitoring of proteinuria in more-advanced stages of chronic kidney disese. We wanted to determine whether measurement of protein:creatinine ratio (PCR) can be used as an alternative to protein excretion rate in detecting clinically significant proteinuria in diabetic patients. Materials and methods: 48 diabetic patients were included in the study. We measured ACR and PCR in random urine samples and protein contents in 24-h urine samples. All measurements were made on Olympus AU600. Urinary albumin was measured by immunoturbidimetric method, while urinary creatinine and protein were measured by the spectrophotometric Jaffe and pyrogallol red method, respectively. Clinically significant proteinuria was considered to be present with the ACR ≥ 30 mg/mmol which is approximately equivalent to PCR 50 mg/mmol. All results were analyzed with MedCalc 9.4.2.0. statistical software (MedCalc Software bvba, Mariakerke, Belgium). Results: ACR was ≥ 30 mg/mmol in 28/48 diabetic patients. Sensitivity was 100% and specificity was 95.0% for PCR as an indicator of clinically significant proteinuria at a cut-off value of 50 mg/mmol. Protein daily excretion rate as an indicator of clinically significant proteinuria gave lower values for sensitivity and specificity at the cut-off value of > 0.5g/24h ; they were 78, 6% and 85, 0% respectively. Conclusions: The protein:creatinine ratio performed better as an indicator of clinically significant proteinuria than the 24-urine collection method in diabetic patients.

protein; creatinine; urine; diabetic nephropathy

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