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Urine Protein/Creatinine Ratios during Labor: A Prospective Observational Study.

ABSTRACT: To evaluate the utility of urine protein/creatinine ratio (uPCR) measurements among healthy parturients at term we performed a prospective cohort study at a community teaching hospital.Serial urine samples were collected. Ninety-three women contributed 284 urine samples. uPCRs were determined. Multiple imputation and paired sampled analysis was performed when appropriate.Two-thirds (63/93) of women had at least one measured uPCR ? 0.3. One-third (31/93) had a uPCR ? 0.3 at admission, including 39.1% (9/23) of women not in labor. Median (IQR) uPCRs increased during labor and after delivery: latent phase/no labor, 0.15 (0.06-0.32); active phase, 0.29 (0.10-0.58); early postpartum, 0.45 (0.18-1.36) (all p < 0.04). Median uPCRs were significantly < 0.3 in the latent phase and significantly > 0.3 in the immediate postpartum period (p < 0.01). Women who labored before cesarean delivery had the highest early postpartum uPCRs: median (IQR) 1.16 (0.39-1.80). A negative urine dipstick protein result did not exclude uPCR ? 0.3. uPCRs were similar when compared by method of urine collection.uPCR ? 0.3 is common among healthy women with uncomplicated pregnancies at term. uPCR increases during labor and is not a reliable measure of pathologic proteinuria at term or during the peripartum period.

SUBMITTER: Tanamai VW

PROVIDER: S-EPMC4968820 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Urine Protein/Creatinine Ratios during Labor: A Prospective Observational Study.

Tanamai Vaya W VW Seagle Brandon-Luke L BL Yeh Judy Y JY Brady Bethany B Miller Corrie B CB Sena Salvador S Dodge Jessica J Shahabi Shohreh S Samuelson Robert R Norwitz Errol R ER Luo Guoyang G

PloS one 20160801 8

<h4>Purpose</h4>To evaluate the utility of urine protein/creatinine ratio (uPCR) measurements among healthy parturients at term we performed a prospective cohort study at a community teaching hospital.<h4>Methods</h4>Serial urine samples were collected. Ninety-three women contributed 284 urine samples. uPCRs were determined. Multiple imputation and paired sampled analysis was performed when appropriate.<h4>Results</h4>Two-thirds (63/93) of women had at least one measured uPCR ≥ 0.3. One-third (3 ...[more]

PMID: 27479123

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Project description:BackgroundAlthough measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), total urine protein or dipstick protein is often measured instead.ObjectiveTo develop equations for converting urine protein-creatinine ratio (PCR) and dipstick protein to urine albumin-creatinine ratio (ACR) and to test their diagnostic accuracy in CKD screening and staging.DesignIndividual participant-based meta-analysis.Setting12 research and 21 clinical cohorts.Participants919 383 adults with same-day measures of ACR and PCR or dipstick protein.MeasurementsEquations to convert urine PCR and dipstick protein to ACR were developed and tested for purposes of CKD screening (ACR ≥30 mg/g) and staging (stage A2: ACR of 30 to 299 mg/g; stage A3: ACR ≥300 mg/g).ResultsMedian ACR was 14 mg/g (25th to 75th percentile of cohorts, 5 to 25 mg/g). The association between PCR and ACR was inconsistent for PCR values less than 50 mg/g. For higher PCR values, the PCR conversion equations demonstrated moderate sensitivity (91%, 75%, and 87%) and specificity (87%, 89%, and 98%) for screening (ACR >30 mg/g) and classification into stages A2 and A3, respectively. Urine dipstick categories of trace or greater, trace to +, and ++ for screening for ACR values greater than 30 mg/g and classification into stages A2 and A3, respectively, had moderate sensitivity (62%, 36%, and 78%) and high specificity (88%, 88%, and 98%). For individual risk prediction, the estimated 2-year 4-variable kidney failure risk equation using predicted ACR from PCR had discrimination similar to that of using observed ACR.LimitationDiverse methods of ACR and PCR quantification were used; measurements were not always performed in the same urine sample.ConclusionUrine ACR is the preferred measure of albuminuria; however, if ACR is not available, predicted ACR from PCR or urine dipstick protein may help in CKD screening, staging, and prognosis.Primary funding sourceNational Institute of Diabetes and Digestive and Kidney Diseases and National Kidney Foundation.

Project description:Urine albumin-creatinine ratio (ACR) and protein-creatinine ratio (PCR) are important markers of kidney damage and are used for prognosis in persons with chronic kidney disease (CKD). Despite how commonly these measurements are done in clinical practice, relatively few studies have directly compared the performance of these 2 measures with regard to associations with clinical outcomes, which may inform clinicians about which measure of urinary protein excretion is best. We studied the association of ACR and PCR with common complications of CKD.Cross-sectional study.3,481 participants with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study.ACR and PCR.We examined the association between ACR and PCR with measures of common CKD complications: serum hemoglobin, bicarbonate, parathyroid hormone, phosphorus, potassium, and albumin.Restricted cubic spline analyses adjusted for estimated glomerular filtration rate (eGFR; calculated by the MDRD [Modification of Diet in Renal Disease] Study equation) were performed to study the continuous association with our predictors with each outcome.Mean eGFR was 43±13 (SD)mL/min/1.73 m2 and median values for PCR and ACR were 140 and 46 mg/g, respectively. In continuous analyses adjusted for eGFR, higher ACRs and PCRs were similar and both were associated with lower serum hemoglobin, bicarbonate, and albumin levels and higher parathyroid hormone, phosphorus, and potassium levels. Across all outcomes, the associations of ACR and PCR were similar, with only small absolute differences in the outcome measure. Similar associations were seen in patients with diabetes mellitus.Participants largely had moderate CKD with low values for ACR and PCR, so results may not be generalizable to all CKD populations.In persons with CKD, ACR and PCR are relatively similar in their associations with common complications of CKD. Thus, routine measurement of PCR may provide similar information as ACR in managing immediate complications of CKD.

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Urine Protein/Creatinine Ratios during Labor: A Prospective Observational Study.

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Urine Protein/Creatinine Ratios during Labor: A Prospective Observational Study.

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