各种肾小球疾病的定点尿蛋白与肌酐比值与 24 小时尿蛋白排泄量的相关性

Amber Raza, S. Nawaz, Rahma Rashid, Ejaz Ahmed, Muhammed Mubarak
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引用次数: 0

摘要

背景 蛋白尿是许多形式肾损伤的重要且众所周知的生物标志物。蛋白尿的定量对于肾小球疾病的诊断和治疗尤为重要。蛋白尿的定量有多种方法。其中,测量 24 小时尿蛋白排泄量是金标准方法。然而,这种方法繁琐、耗时,给患者带来不便,而且并非完全万无一失。随着时间的推移,人们对许多替代方法进行了测试,尽管结果不尽相同。其中,在单排尿样本中测量尿蛋白与肌酐比值(uPCR)被广泛使用。大多数研究发现,单次尿液样本中的尿蛋白-肌酐比值与 24 小时尿蛋白估计值之间具有良好的相关性,而其他研究则没有发现。目的 研究巴基斯坦一家大型肾病中心对不同形式肾小球疾病患者进行的定点 uPCR 与 24 小时尿蛋白估测值之间的相关性。方法 这项横断面观察性研究于 2017 年 9 月至 2018 年 3 月在巴基斯坦卡拉奇信德泌尿外科和移植研究所肾脏内科进行。所有因疑似肾小球肾炎和持续性蛋白尿而接受检查的新发蛋白尿成年患者均被纳入研究范围,年龄在 18 岁至 60 岁之间。所有患者都得到了关于从早上 7:00 开始收集 24 小时尿液以估算总蛋白和肌酐排泄量的详细建议。第二天,在提交 24 小时尿样以测量 uPCR 时,收集点滴尿样和血液样本。患者的数据以表格形式收集。使用 SPSS 20.0 版进行统计分析。结果 共纳入 157 名患者。他们的平均年龄为(30.45 ± 12.11)岁。男性 94 人(59.8%),女性 63 人(40.2%)。所有患者的 24 小时尿蛋白平均排泄量为 3192.78 ± 1959.79 毫克,尿蛋白定点定量平均值为 3.16 ± 1.52。在所有患者中,定点 uPCR 与 24 小时尿蛋白排泄量之间存在微弱但明显的相关性(r = 0.342,P = 0.01)。在亚组分析中,年龄大于 47 岁的患者(r = 0.78)和体重指数大于 25 kg/m2 的患者(r = 0.45)的相关性稍好。布兰德和阿尔特曼图谱分析比较了定点 uPCR 和 24 小时蛋白质测量之间的差异,结果显示两种方法之间的一致性范围很广。结论 总体而言,本研究结果表明,在不同形式的肾小球疾病中,定点 uPCR 和 24 小时尿蛋白估计值之间存在显著的弱正相关。两种方法之间的一致性也很差。因此,有必要在未经选择的肾病患者群体中仔细解释该比率。
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The correlation of spot urinary protein-to-creatinine ratio with 24-h urinary protein excretion in various glomerulopathies
BACKGROUND Proteinuria is an important and well-known biomarker of many forms of kidney injury. Its quantitation is of particular importance in the diagnosis and management of glomerular diseases. Its quantification can be done by several methods. Among these, the measurement of 24-h urinary protein excretion is the gold standard method. However, it is cumbersome, time-consuming, and inconvenient for patients and is not completely foolproof. Many alternative methods have been tested over time albeit with conflicting results. Among the latter, the measurement of urine protein-to-creatinine ratio (uPCR) in single-voided urinary samples is widely used. The majority of studies found a good correlation between uPCR in single urine samples with 24-h urinary protein estimation, whereas others did not. AIM To investigate the correlation of spot uPCR with 24-h urinary protein estimation in patients suffering from different forms of glomerulopathies at a single large-volume nephrological center in Pakistan. METHODS This cross-sectional, observational study was conducted at the Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan from September 2017 to March 2018. All newly presenting adult patients with proteinuria who were being investigated for suspected glomerulonephritis and persistent proteinuria with ages between 18 to 60 years were enrolled. All patients were given detailed advice regarding 24-h urine collection starting at 7:00 AM for total protein and creatinine excretion estimations. A spot urine sample was collected the next day at the time of submission of a 24-h urine sample for measuring uPCR along with a blood sample. The data of patients were collected in a proforma. SPSS version 20.0 was used for statistical analysis. RESULTS A total of 157 patients were included. Their mean age was 30.45 ± 12.11 years. There were 94 (59.8%) males and 63 (40.2%) females. The mean 24-h urinary protein excretion was 3192.78 ± 1959.79 mg and the mean spot uPCR was 3.16 ± 1.52 in all patients. A weak but significant correlation was observed between spot uPCR and 24-h urinary protein excretion (r = 0.342, P = 0.01) among all patients. On subgroup analysis, a slightly better correlation was found in patients older than 47 years (r = 0.78), and those with body mass index > 25 kg/m2 (r = 0.45). The Bland and Altman's plot analysis comparing the differences between spot uPCR and 24-h protein measurement also showed a wide range of the limits of agreement between the two methods. CONCLUSION Overall, the results from this study showed a significant and weakly positive correlation between spot uPCR and 24-h urinary protein estimation in different forms of glomerulopathies. The agreement between the two methods was also poor. Hence, there is a need for careful interpretation of the ratio in an unselected group of patients with kidney disease.
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