Cut-off value of proteinuria/creatininuria ratio predictor of proteinuria= 150 mg/24h in a sample of argentinean students. Its utility in proteinuria categorization
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chronic kidney disease
clinical laboratory techniques

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Brissón CM, Cuestas V, Prono-Minella P, Denner S, Fernández V, Bonifacino-Belzarena R, Marsili S, Brissón ME. Cut-off value of proteinuria/creatininuria ratio predictor of proteinuria= 150 mg/24h in a sample of argentinean students. Its utility in proteinuria categorization. Rev. Colomb. Nefrol. [Internet]. 2018 Sep. 4 [cited 2022 Jun. 26];5(2):179-8. Available from:


Introduction: Proteinuria is a kidney damage marker. KDIGO 2012 categorizes 24h proteinuria (PER), mg/ 24h, or proteinuria / creatininuria ratio in isolated sample (PCR), mg / g, in: A1, normal-slightly increased: <150; A2, moderately increased: 150-500; A3, severely increased:> 500. PER is the gold standard, PCR was incorporated to avoid 24h collection but the numerical equivalence between both is controversial. The maximum normal value, 150 mg / 24h, has diagnostic / prognostic relevance in Chronic Kidney Disease.

Objectives: to determine in a sample of students: a) correlation of PCR in first morning urine with PER, b) cut-off value (VdC) of PCR predictor of PER = 150 mg / 24h, c) concordance between both methodologies for categorization A according to the PCR values of KDIGO 2012 and the VdC found.

Methodology: Descriptive, analytical, cross-sectional study. Sample: 51 students. Determinations in 24h urine and first morning. Proteins: Red Pirogalol-Molybdate method; creatinine: Jaffé kinetic. Correlation: Spearman coefficient; Concordance: Bland-Altman and kappa. VdC: ROC analysis (receiver operating curve). Programs: Excel and Medcalc. 95% CI, p <0.05.

Results: Proteinuria (median / interquartile range), PER (mg / 24h): 106.00 / 83.64-137.82; PCR (mg / g): 58.00 / 50.50-87.00; p = 0.025; Spearman coefficient: 0.5540; Bland-Altman mean of the differences (PER-PCR): 31.4. ABC = 0.883 (95% CI 0.762-0.956), VdC = 82 mg /g, S=90 %, E=82.9 %, RP + = 5.27, RP- = 0.12. Concordance in categorization A: kappa using PCR 150 mg / g: 0.106 (IC95% -0.134-0.347), poor-mild; kappa using VdeC found: 0.4568 (IC95% 0.2063-0.6505), mild-considerable.

Conclusions: The concordance in categorization A improves using the VdC. It emphasizes the importance of not using as equivalent PCR = 150 mg / g and PER = 150 mg / 24h to differentiate normal from increased proteinuria but to establish in each laboratory the corresponding VdeC.
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1. Koopman MG, Krediet RT, Koomen GCM, Strackee J, Arisz L. Circadian rhythm of proteinuria: consequences of the use of protein: creatinine ratios. Nephrol Dial Transplant. 1989;4(1):9-14.

2. Kosmadakis G, Filiopoulos V, Georgoulias C, Smirloglou D, Draganis T, Michail S. Quantitative Evaluation of Proteinuria by Estimation of the Protein/Creatinine Ratio in a Random Urine Sample. RenFail.2010;32(2):153-6. Available from:

3. Montagna G, Buzio C, Calderini C, Quaretti P,Migone L. Relationship of proteinuria and alburninuria to posture and to urine collection period. Nephron.1983;35(2):143-4. Available from:

4. Ginsberg JM, Chang BS, Matarese RA, Garella S. Use of single voided urine samples to estimate quantitative proteinuria. New Engl J Med. 1983;309(25):1543-6. Available from: 10.1056/NEJM198312223092503

5. Burden R, Tomson C. Identification, management and referral of adults with chronic kidney disease: concise guidelines. ClinMed (Lond). 2005;5(6):635-42. Available from:

6. Johnson DW1, Atai E, Chan M, Phoon RK, Scott C, Toussaint ND, et al. KHA-CARI Guideline: Early chronic kidney disease: Detection, prevention and management. Nephrology (Carlton). 2013;18(5):340-50. Available from:

7. National Clinical Guideline Centre. Chronic kidney disease (partial update). Early identification and management of chronic kidney disease in adults in primary and secondary care. 2014. Available from:

8. KeaneWF, EknoyanG.Proteinuria, albuminuria, risk, assessment, detection, elimination (PARADE): a position paper of the National Kidney Foundation. Am J KidneyDis.1999;33(5):1004-10.

9. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J KidneyDis. 2002;39(2 Suppl 1):S1-266.

10. Kidney Disease: Improving Global Outcomes. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Supplements. 2013;3(1):1-150.

11. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-74.

12. Jaeschke R, Guyatt GH, Sackett DL. Users´ guides to the medical literature. III. How to use an article about a diagnostic diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA. 1994;271(9):703-7. Available from:

13. Price CP, Newall RG, Boyd JC. Use of Protein: Creatinine Ratio Measurements on Random Urine Samples for Prediction of Significant Proteinuria: A Systematic Review. Clin Chem. 2005;51(9):1577-86. Available from:

14. Côté AM, Brown MA, Lam EM, von Dadelszen P, Firoz T, Liston RM, et al. Diagnostic accuracy of urinary spot protein: creatinine ratio for proteinuria in hypertensive pregnant women: systematic review. BMJ. 2008;336(7651):1003-6. Available from:

15. Morris RK, Riley RD, Doug M, Deeks JJ, Kilby MD. Diagnostic accuracy of spot urinary protein and albumin to creatinine ratios for detection of significant proteinuria or adverse pregnancy outcome in patients with suspected pre-eclampsia: systematic review and meta-analysis. BMJ. 2012;345:e4342. Available from:

16. Gai M, Motta D, Giunti S, Fop F, Masini S, Mezza E, et al. Comparison between 24-h proteinuria, urinary protein/creatinine ratio and dipstick test in patients with nephropathy: patterns of proteinuria in dipstick-negative patients. Scand J Clin Lab Invest. 2006;66(4):299-307. Available from:

17. Guy M, Borzomato JK, Newall RG, Kalra PA, Price CP. Protein and albumin-to-creatinine ratios in random urines accurately predict 24 h protein and albumin loss in patients with kidney disease. Ann Clin Biochem. 2009;46(Pt 6):468-76. Available from:

18. Farías R, Páez N, Acosta-García E, Marino A, Herrera B, Padilla E. orrelación entre cociente proteína/creatinina y proteinuria de 24 horas en pacientes con enfermedad renal. Acta Bioquím Clín Latinoam. 2015:49(2):215-20.

19. Patil P, Shah V, Shah B. Comparison of Spot Urine Protein Creatinine Ratio with 24 Hour Urine Protein for Estimation of Proteinuria. J Assoc Physicians India. 2014;62(5):406-10.

20. Lemann J Jr, Doumas BT. Proteinuriain Health and Disease Assessed y Measuringthe Urinary Protein/Creatinine Ratio. Clin Chem. 1987;33(2 Pt 1):297-9.

21. Leung YY, Szeto CC, Tam LS, Lam CW, Li EK, Wong KC, et al. Urine protein-to-creatinine ratio in an untimed urine collection is a reliable measure of proteinuria in lupus nephritis. Rheumatology (Oxford). 2007,46(4):649-52. Available from:

22. Wahbeh AM, Ewais MH, Elsharif ME. Comparison of 24-hour Urinary Protein and Protein-to-Creatinine Ratio in the Assessment of Proteinuria. Saudi J Kidney Dis Transpl. 2009;20(3):443-7.

23. Montero N, Soler MJ, Pascual MJ, Barrios C, Márquez E, Rodríguez E, et al. Correlación entre el cociente proteína/creatinina en orina esporádica y las proteínas en orina de 24 horas. Nefrología (Madr.). 2012;32(4):494-501. Available from:
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