Valor de corte del cociente proteinuria/creatininuria predictor de proteinuria = 150 mg/24h en una muestra de estudiantes argentinos. Utilidad de su aplicación para categorización de la proteinuria.

Cecilia María Brissón, Verónica Cuestas, Priscila Prono Minella, Susana Denner, Verónica Fernández, Rosina Bonifacino Belzarena, Silvia Marsili, María Eugenia Brissón

Resumen


La proteinuria es marcador clásico de daño renal. KDIGO 2012 categoriza proteinuria de 24h (PER), mg/24h, o relación proteinuria/creatininuria en muestra aislada (PCR), mg/g, en: A1, normal-levemente aumentada: <150; A2, moderadamente aumentada: 150-500; A3, severamente aumentada: >500. PER es el gold estándar, PCR fue incorporada para evitar recolección de 24h perolaequivalencia numéricaentre ambas es controvertida. El valor 150 mg/24h, tiene relevancia diagnóstica/pronóstica en Enfermedad Renal Crónica. Objetivos: determinar en una muestra de estudiantes: a) correlación de PCR en primera orina matutina con PER, b) valor de corte (VdC) de PCR predictor de PER=150 mg/24h, c) concordancia entre ambas metodologías para la categorización A según valores de PCR de KDIGO 2012 y del VdC hallado.

Metodología: Estudio descriptivo, analítico, transversal. Muestra: 51 estudiantes. Determinaciones en orina de 24h y en la primera matutina. Proteínas: método Rojo de Pirogalol-Molibdato; creatinina: Jaffé cinético. Correlación: coeficiente de Spearman; concordancia: Bland-Altman y kappa.VdC: análisis ROC (receiver operating curve). Programas: Excel yMedcalc. IC95%, p<0,05.

Resultados. Proteinuria (mediana/rango intercuartil), PER (mg/24h): 106,00/83,64-137,82; PCR(mg/g): 58,00/50,50-87,00; p=0,025; coeficiente Spearman: 0,5540; Bland-Altman media de las diferencias (PER-PCR): 31,4. ABC=0,883 (IC95% 0,762-0,956), VdC=82 mg/g, S=90%, E=82,9%, RP+=5,27, RP-=0,12. Concordancia en categorización A: kappa empleando PCR 150 mg/g: 0,106 (IC95% -0,134-0,347), pobre-leve; kappaempleandoVdC hallado: 0,4568 (IC95% 0,2063-0,6505), leve-considerable.

Conclusiones. La concordancia en categorización A mejora utilizando el VdC.Destaca la importancia de no usar como equivalentes PCR=150 mg/g y PER=150 mg/24h para diferenciar proteinuria normal de aumentada sino establecer en cada laboratorio los VdC correspondientes.


Palabras clave


Proteinuria, proteinuria clasificación, proteinuria diagnóstico– enfermedad renal crónica, técnicas de laboratorio clínico, creatinina orina

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DOI: 10.22265/acnef.0.0.309

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