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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:BackgroundMonitoring proteinuria is important for the management of patients with cancer treated with anti-vascular endothelial growth factor (VEGF) or anti-VEGF receptor (VEGFR) inhibitors (VEGF/Ri). Here we investigated the difference between the urine protein/creatinine ratio (UPCR) and a qualitative value test (QV) on the decision making of treatment continuation and the usefulness of UPCR testing in patients with gastrointestinal cancer treated with anti-VEGF/Ri.MethodsFrom January 2017 to December 2018, a survey was conducted based on the medical records of patients with gastrointestinal cancer with a QV of ≥2+ during the use of anti-VEGF/Ri at seven Japanese institutions participating in the Onco-nephrology Consortium. The primary endpoint was the ratio of the worst UPCR < 2.0 (low UPCR) in cases with a QV2+ at the point of the first proteinuria onset. The secondary endpoints were a comparison of low UPCR and worst UPCR ≥2.0 (high UPCR), the concordance rate between UPCR and QV in the Common Terminology Criteria for Adverse Events (CTCAE) grading, and the differences in the decision making for anti-VEGF/Ri continuation.ResultsAmong the 71 patients enrolled, the proportion of low UPCR in onset QV2+ (n = 53) was 66% (n = 35). In a comparison between low (n = 36) and high UPCR cases (n = 24), body weight (P = 0.036), onset QV status (P = 0.0134), and worst QV status (P < 0.0001) were significantly associated with UPCR levels. The concordance rate for CTCAE Grade 2 of both the QV and UPCR was 83%. Regarding the judgment of anti-VEGF/Ri continuation, treatment was continued in 42.4% of cases when the QV became 3+, whereas only 25% continued treatment when the UPCR value became high.ConclusionUrine dipstick test results may overestimate proteinuria, and the UPCR result tended to be more critical than the QV when deciding the treatment policy.Trial registrationThis study is a multiple institutional retrospectively registered observational trial.Clinical trial numberUniversity Hospital Medical Information Network (UMIN) Clinical Trials Registry (protocol ID UMIN000042545 ).

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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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