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Correlation of urine protein/creatinine ratios to 24-h urinary protein for quantitating proteinuria in children

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Abstract

Background

The purpose of this study was to evaluate the correlation and consistency between urine protein/creatinine ratio (UPCR) and 24-h urine protein (24HUPr) in children, and to determine cutoff values of UPCR relative to 24HUPr at 100 mg/m2/d (≥ 100 mg/m2/d as pathological proteinuria) and 1000 mg/m2/d (≥ 1000 mg/m2/d as nephrotic-range proteinuria).

Methods

Three hundred sixty-six children were enrolled, including 81 controls, 109 with Henoch-Schönlein purpura nephritis, 167 with nephrotic syndrome, 5 with IgA nephropathy, and 4 with lupus nephritis. Patients were divided into three groups: normal group; non-nephrotic-range proteinuria group; nephrotic-range proteinuria group. The cutoff values of UPCR in predicting the different levels of proteinuria were determined using ROC curve analysis.

Results

UPCR was positively correlated with 24HUPr (r = 0.915, p < 0.01). Bland-Altman diagrams showed that UPCR and 24HUPr had good consistency, and > 95% spots of UPCR and 24HUPr were within 95% confidence intervals. Relative to 24HUPr at 100 mg/m2/d, the cutoff value of UPCR (0.18 g/g Cr) had the highest sensitivity (94%) and specificity (98.8%) which is close to 0.2 g/g Cr as proposed by the American College of Rheumatology. Relative to 24HUPr at 1000 mg/m2/d, the cutoff value of UPCR (2.09 g/g Cr) had the highest sensitivity (92.1%) and specificity (92.1%) which is close to the 2.0 g/g Cr proposed in KDIGO guidelines.

Conclusions

UPCR showed strong correlation and consistency with 24HUPr for evaluating levels of proteinuria in children. UPCR < 0.2 g/g Cr can be considered a criterion for normal-range proteinuria. Instead of 24HUPr ≥ 1000 mg/m2/d, UPCR ≥ 2.0 g/g Cr can be considered a criterion for nephrotic-range proteinuria or nephrotic syndrome in children.

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Funding

This study was funded by Special project of traditional Chinese medicine research in Henan province (No. 2018ZYZD05) and Innovation team on diagnosis and treatment of Henoch-Schönlein Purpura nephritis in children by integrated Chinese and Western medicine (No. 18IRTSTHNO28).

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Author notes

  1. Yanjie Huang and Xiaoqing Yang have contributed equally to the work and are both to be considered as first authors.

Authors and Affiliations

  1. Department of Pediatrics, Henan University of Chinese Medicine, 156 Jinshui East Road, Zhengzhou, Henan, 450046, China

    Yanjie Huang, Yanan Zhang, Shangsai Yue, Wensheng Zhai, Xianqing Ren & Ying Ding

  2. Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China

    Xiaoqing Yang, Xiaofeng Mei & Liangliang Bi

  3. College of chemistry and Molecular Engineer, Zhengzhou University, Zhengzhou, Henan, China

    Shusheng Zhang & Zhifen Deng

  4. Department of Anesthesia, Stanford University School of Medicine, Palo Alto Veterans Institute for Research, Stanford, CA, USA

    Yuan Sun

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  1. Yanjie Huang
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Correspondence to Yanjie Huang or Ying Ding.

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Huang, Y., Yang, X., Zhang, Y. et al. Correlation of urine protein/creatinine ratios to 24-h urinary protein for quantitating proteinuria in children. Pediatr Nephrol 35, 463–468 (2020). https://doi.org/10.1007/s00467-019-04405-5

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  • DOI: https://doi.org/10.1007/s00467-019-04405-5

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