The value of simultaneous measurements of urinary albumin and total protein in proteinuric patients

Proteinuria is a common pathological finding in renal disease. Examining the urinary protein electrophoretic pattern gives clues to the site of origin of the protein. We hypothesized that the type of proteinuria, classified by urine protein electrophoresis and immunofixation (uPEI), may be predicted...

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Published in:Nephrology, dialysis, transplantation dialysis, transplantation, 2012-04, Vol.27 (4), p.1534-1541
Main Authors: SMITH, Edward R, CAI, Michael M. X, MCMAHON, Lawrence P, WRIGHT, David A, HOLT, Stephen G
Format: Article
Language:English
Subjects:
Albuminuria - urine
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Biomarkers - urine
Cohort Studies
Creatinine - urine
Emergency and intensive care: renal failure. Dialysis management
Glomerulonephritis
Humans
Intensive care medicine
Kidney Diseases - complications
Kidney Diseases - pathology
Kidney Diseases - urine
Medical sciences
Nephrology. Urinary tract diseases
Nephropathies. Renovascular diseases. Renal failure
Proteinuria - etiology
Proteinuria - urine
ROC Curve
Urinalysis
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Summary:Proteinuria is a common pathological finding in renal disease. Examining the urinary protein electrophoretic pattern gives clues to the site of origin of the protein. We hypothesized that the type of proteinuria, classified by urine protein electrophoresis and immunofixation (uPEI), may be predicted by simply examining the proportion of higher molecular weight protein (e.g. albumin) in urine total protein content. One thousand and eleven patients, whose urine had been sent to the pathology department for uPEI, were analysed for total protein and albumin to creatinine ratio (uPCR and uACR) and the ratio reported as the albumin to total protein ratio (uAPR). In a group of renal outpatients (n=248), we also specifically measured tubular proteins (N-acetyl-β-D-glucosaminidase, NAG, and β2-microglobulin) and expressed these as ratios to creatinine (uNCR and uβ2CR). To validate these findings, we correlated these measurements with 68 patients in whom we also had renal biopsy data. In receiver operating characteristic (ROC) curve analysis, the AUC for uAPR was 0.84 for predicting tubular proteinuria pattern on uPEI. In the renal outpatient subgroup, uAPR predicted a tubular pattern of urinary protein equally as well as testing for specific tubular protein markers (uNCR and uβ2CR). In the validation cohort, a uAPR cut-off of
ISSN:0931-0509
1460-2385
DOI:10.1093/ndt/gfr708