Comparison of three spot proteinuria measurements for pediatric nephrotic syndrome: based on the International pediatric Nephrology Association 2022 Guidelines.

Autor: Ambarsari CG; Department of Child Health, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.; School of Medicine, University of Nottingham, Nottingham, United Kingdom.; Medical Technology Cluster, Indonesian Medical Education and Research Institute (IMERI), Universitas Indonesia, Jakarta, Indonesia., Utami DAP; Department of Child Health, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.; Bina Husada Hospital (Member of Mitra Keluarga), Bogor, Indonesia., Tandri CC; Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia., Satari HI; Department of Child Health, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Jazyk: angličtina
Zdroj: Renal failure [Ren Fail] 2023; Vol. 45 (2), pp. 2253324. Date of Electronic Publication: 2023 Sep 19.
DOI: 10.1080/0886022X.2023.2253324
Abstrakt: Background: Pediatric nephrotic syndrome (NS) requires routine proteinuria monitoring, which is costly and affects patients' quality of life. The gold-standard 24-h urine protein (UP) measurement is challenging in children, and first-morning urine collection requires specific conditions, making it difficult in outpatient settings. Studies have reported comparability of second or random morning urine sample to the first-morning specimen. This study aimed to compare outcomes of random morning proteinuria measurements to 24-h UP and the roles of the urinary protein creatinine ratio (UPCR) and dipstick tests in pediatric NS, based on International Pediatric Nephrology Association (IPNA) 2022 Guidelines.
Method: Twenty-four-hour and morning urine samples were collected from 92 pediatric NS patients. These were subjected to automated analyses for 24-h UP, UPCR, and semi-automated dipstick analysis. A blinded doctor performed manual dipstick analysis.
Results: UPCR had a stronger correlation with 24-h UP than with automated and manual urine dipstick tests. UPCR had the highest sensitivity and specificity for predicting no remission/relapse and high sensitivity but low specificity for complete remission. The optimal UPCR cutoff for remission was 0.44 mg/mg and for no remission/relapse was 2.08 mg/mg. Automated and manual dipstick tests demonstrated limited sensitivity but high specificity and similar AUC values for remission/relapse.
Conclusion: UPCR was sensitive and specific for diagnosing no remission/relapse and sensitive but not specific for detecting remission. Manual and automated urine dipstick tests were comparable for remission and no remission/relapse detection. This study supports the IPNA 2022 Guidelines, as 2 mg/mg was the optimal UPCR cutoff for no remission/relapse, while for remission the optimal cutoff was 0.4 mg/mg.
Databáze: MEDLINE
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