Evaluation of the analytical variability of urine protein-to-creatinine ratio in cats

Intravenous iodinated contrast (IVIC) medium is routinely administered to dogs. Scattered information exists regarding the serum biochemical or urinary profiles associated with the administration of IVIC in dogs. The aim of the study was to describe, compare, and discuss from the perspective of previous studies the alterations in serum biochemical and urinary parameters before (T0) and within one week (T1) of the IVIC administration during routine computed tomography (CT) scan evaluation of 22 dogs. Mature dogs presenting for CT scan evaluation for preoperative oncology staging/surgical planning were included. T1 evaluation was performed within one week of IVIC administration. Statistically significant differences in serum total protein, albumin, chloride, calcium, and phosphorus concentrations, urine protein to creatinine ratio, and urine specific gravity were found between T1 and T0. At T1, the serum creatinine concentration was within reference ranges in all dogs but one. An increase in the urine protein to creatinine ratio was observed in four samples, one of which was non-proteinuric at T0. Changes in biochemistry and urine parameters between T0 and T1 were not considered clinically significant.

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The ratio and difference of urine protein-to-creatinine ratio and albumin-to-creatinine ratio facilitate risk prediction of all-cause mortality

Scientific Reports ◽

10.1038/s41598-021-86541-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

David Ray Chang ◽

Hung-Chieh Yeh ◽

I-Wen Ting ◽

Chen-Yuan Lin ◽

Han-Chun Huang ◽

...

Keyword(s):

Daily Practice ◽

Tertiary Hospital ◽

P Value ◽

Urine Specimen ◽

Creatinine Ratio ◽

Urine Protein ◽

Protein Ratio ◽

Discriminative Performance ◽

Prognostic Assessment ◽

All Cause Mortality

AbstractThe role of the difference and ratio of albuminuria (urine albumin-to-creatinine ratio, uACR) and proteinuria (urine protein-to-creatinine ratio, uPCR) has not been systematically evaluated with all-cause mortality. We retrospectively analyzed 2904 patients with concurrently measured uACR and uPCR from the same urine specimen in a tertiary hospital in Taiwan. The urinary albumin-to-protein ratio (uAPR) was derived by dividing uACR by uPCR, whereas urinary non-albumin protein (uNAP) was calculated by subtracting uACR from uPCR. Conventional severity categories of uACR and uPCR were also used to establish a concordance matrix and develop a corresponding risk matrix. The median age at enrollment was 58.6 years (interquartile range 45.4–70.8). During the 12,391 person-years of follow-up, 657 deaths occurred. For each doubling increase in uPCR, uACR, and uNAP, the adjusted hazard ratios (aHRs) of all-cause mortality were 1.29 (95% confidence interval [CI] 1.24–1.35), 1.12 (1.09–1.16), and 1.41 (1.34–1.49), respectively. For each 10% increase in uAPR, it was 1.02 (95% CI 0.98–1.06). The linear dose–response association with all-cause mortality was only observed with uPCR and uNAP. The 3 × 3 risk matrices revealed that patients with severe proteinuria and normal albuminuria had the highest risk of all-cause mortality (aHR 5.25, 95% CI 1.88, 14.63). uNAP significantly improved the discriminative performance compared to that of uPCR (c statistics: 0.834 vs. 0.828, p-value = 0.032). Our study findings advocate for simultaneous measurements of uPCR and uACR in daily practice to derive uAPR and uNAP, which can provide a better mortality prognostic assessment.

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POS0681 VOCLOSPORIN FOR LUPUS NEPHRITIS: INTERIM ANALYSIS OF THE AURORA 2 EXTENSION STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.372 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 585.2-586

Author(s):

A. Saxena ◽

P. Mina-Osorio ◽

C. Mela ◽

V. Berardi

Keyword(s):

Lupus Nephritis ◽

Treatment Period ◽

Interim Analysis ◽

Low Dose ◽

Extension Study ◽

Creatinine Ratio ◽

Urine Protein ◽

Pre Treatment ◽

One Year ◽

Change In Mean

Background:Voclosporin, a novel calcineurin inhibitor (CNI), has been tested successfully in two pivotal trials in adult patients with lupus nephritis.Previously reported results from the Phase 3 AURORA 1 study and the Phase 2 AURA-LV study showed that compared with mycophenolate mofetil (MMF) and low-dose steroids alone, the addition of voclosporin significantly increased the renal response rate and reduced proteinuria, as measured by urine protein creatinine ratio (UPCR), in patients with lupus nephritis (LN) at approximately one year of treatment (48 weeks in AURA-LV and 52 weeks in AURORA 1).Objectives:Patients that completed one year of treatment in the AURORA 1 study were eligible to enroll into the two-year, blinded, controlled extension study, AURORA 2. Here we report the first interim analysis of the ongoing AURORA 2 study.Methods:Patients completing AURORA 1 were eligible to continue the same randomized treatment of voclosporin (23.7 mg BID) or placebo, in combination with MMF (1 g BID) and low-dose oral steroids in the AURORA 2 extension. This interim analysis evaluated UPCR and estimated glomerular filtration rate (eGFR) in patients with up to two years of total treatment: one year from AURORA 1 and up to one year in AURORA 2.Results:116 patients in the voclosporin arm and 100 patients in the control arm enrolled in the extension study, of which 73 patients in the voclosporin arm and 51 patients in the control arm had received two years of treatment at the time of this interim analysis. Mean UPCR at pre-treatment (AURORA 1) baseline was 3.94 mg/mg in the voclosporin arm (n=116) and 3.87 mg/mg in the control arm (n=100). The LS mean change in UPCR from pre-treatment baseline to year two was -3.1 mg/mg for the voclosporin arm (n=73) and -2.1 mg/mg for control arm (n=51; Table 1). Mean eGFR at pre-treatment (AURORA 1) baseline was 79.6 mL/min for the voclosporin arm (n=116) and 78.9 mL/min for the control arm (n=100) and at year two, was 79.0 mL/min for the voclosporin arm (n=73) and 82.9 mL/min for the control arm (n=51). There was a small early decrease in mean eGFR in the first four weeks of treatment (in AURORA 1) after which eGFR remained stable throughout year one and year two. Additionally, there were no unexpected new AEs observed in patients who continued with voclosporin treatment compared to control-treated patients for more than one year.Table 1.UPCRControl (n=100)Voclosporin (n=116)Treatment Comparison of Voclosporin to ControlnUPCR (mg/mg)nUPCR (mg/mg)UPCR (mg/mg)p-valuePre-treatment baseline, mean1003.871163.94NCNCChange from pre-treatment baseline, LS mean Year 1100-2.4116-3.0-0.60.0080 Year 251-2.173-3.1-1.00.0004LS, least squares; NC, not calculated; UPCR, urine protein creatinine ratio.Mixed effects model for repeated measures (MMRM) analysis of LS mean change from pre-treatment baseline for UPCR included terms for baseline covariate, treatment, visit and treatment by visit interaction. Integrated results include data from pre-treatment baseline of AURORA 1, the one-year treatment period in AURORA 1 and up to a one-year treatment period in AURORA 2.Conclusion:Patients in the voclosporin treatment arm maintained meaningful reductions in proteinuria with no change in mean eGFR at two years of treatment. Additional AURORA 2 efficacy and safety data will be provided at the conclusion of the study.Disclosure of Interests:Amit Saxena: None declared, Paola Mina-Osorio Shareholder of: Aurinia Pharmaceuticals Inc., Employee of: Aurinia Pharmaceuticals Inc., Christopher Mela Shareholder of: Aurinia Pharmaceuticals Inc., Employee of: Aurinia Pharmaceuticals Inc., Vanessa Berardi Shareholder of: Aurinia Pharmaceuticals Inc., Employee of: Aurinia Pharmaceuticals Inc.

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Diagnostic efficacy and influence factors of urinary protein/creatinine ratio replacing 24-h urine protein as an evaluator of proteinuria in children

International Urology and Nephrology ◽

10.1007/s11255-021-03021-3 ◽

2021 ◽

Author(s):

Panpan Zhai ◽

Yanjie Huang ◽

Shangsai Yue ◽

Xiaoqing Yang ◽

Jinghui Luo ◽

...

Keyword(s):

Influence Factors ◽

Urinary Protein ◽

Creatinine Ratio ◽

Urine Protein ◽

Diagnostic Efficacy

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Spot urine protein creatinine ratio compared with dipstick proteinuria as a primary screening tool for renal disease in a community setting

10.21203/rs.3.rs-952054/v1 ◽

2021 ◽

Author(s):

Michael Abel Alao ◽

Asinobi OA ◽

Ibrahim OR ◽

Lagunju IA

Keyword(s):

High Risk ◽

Kidney Disease ◽

Renal Disease ◽

Screening Tool ◽

Healthy Children ◽

Creatinine Ratio ◽

Urine Protein ◽

Spot Urine ◽

Primary Screening ◽

Dipstick Urinalysis

Abstract Background Although, the use of manual dipstick urinalysis for proteinuria has been a common practice, the Kidney Disease Improving Global Outcomes (KDIGO) guideline on screening for chronic renal disease least advocate it use. Besides, several studies have assessed the performance of dipstick urinary in screening for proteinuria to be inaccurate, unreliable with a poor predictive values. The goal of this study was to determine and compare the presence of significant proteinuria (SP) in high-risk African children using the spot urine protein creatinine ratio (UPr/UCr) as a primary screening tool besides dipstick proteinuria screening. Methods This cross-sectional study involved 1,316 apparently healthy children recruited through a multi-stage sampling technique in Ogbomoso land, Nigeria. We performed a dipstick urinalysis on early-morning urine samples. Urinary protein content was determined using a turbidimetric method and Jaffe’s reaction to measure the urinary creatinine concentration. Statistical analysis was performed using the IBM Statistical Package for Social Sciences (SPSS)TM, Version 23.0 for Windows. Results The prevalence of SP using spot UPr/UCr (≥ 0.2) and dipstick proteinuria screening (≥1+) were 18% and 0.8%, respectively (p<0.001). Of the 224 subjects determined to have SP using UPr/UCr, the females (140; 20.1%) had a higher proportion compared to males (84; 15.4% -p=0.032). Nephrotic range proteinuria was detected in nine out of 10 subjects (90%) using UPr/UCr but in only three out of ten (30%) using the urinary dipstick method. The biserial correlation coefficient (r= 0.092; p=0.001) and inter-rater-agreement (Cohen’s Kappa = 0.01) were poor, and the McNemar’s test result was (p<0.001). Conclusion The UPr/UCr ratio technique appeared to perform better than dipstick urinalysis as a primary screening tool for renal disease. Hence, it may be adopted for early detection of SP as a kidney disease marker especially among the high risk population.

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Facility-Level Variations in Kidney Disease Care among Veterans with Diabetes and CKD

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.03830318 ◽

2018 ◽

Vol 13 (12) ◽

pp. 1842-1850 ◽

Cited By ~ 5

Author(s):

Sankar D. Navaneethan ◽

Julia M. Akeroyd ◽

David Ramsey ◽

Sarah T. Ahmed ◽

Shiva Raj Mishra ◽

...

Keyword(s):

Veterans Affairs ◽

Creatinine Ratio ◽

Angiotensin Receptor ◽

Urine Protein ◽

Urine Albumin ◽

Patients With Diabetes ◽

Facility Level ◽

Rate Ratios ◽

Core Measures ◽

Median Rate

Background and objectivesFacility-level variation has been reported among veterans receiving care for various diseases. We studied the frequency and facility-level variations of guideline-recommended practices in patients with diabetes and CKD.Design, setting, participants, & measurementsPatients with diabetes and concomitant CKD (eGFR 15–59 ml/min per 1.73 m2, measured twice, 90 days apart) receiving care in 130 facilities across the Veterans Affairs Health Care System were included (n=281,223). We studied the proportions of patients (facility-level) receiving recommended core measures and facility-level variations of these study outcomes using median rate ratios, adjusting for various patient and provider-level factors. Median rate ratio quantifies the degree to which care may vary for similar patients receiving care at two randomly chosen facilities, with <1 being no variation and >1.2 as substantial variation between the facilities. Study outcomes included measurement of urine albumin-to-creatinine ratio/urine protein-to-creatinine ratio and blood hemoglobin concentration, prescription of statins and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, BP<140/90 mm Hg, and referral to a Veterans Affairs nephrologist (only for those with eGFR<30 ml/min per 1.73 m2).ResultsAmong those with eGFR 30–59 ml/min per 1.73 m2, proportion of patients receiving recommended core measures (median and interquartile range across facilities) were 37% (22%–47%) for urine albumin-to-creatinine ratio/urine protein-to-creatinine ratio, 74% (72%–79%) for hemoglobin measurement, 66% (62%–69%) for angiotensin-converting enzyme inhibitor/angiotensin receptor blocker prescription, 85% (74%–87%) for statin prescription, 47% (42%–53%) for achieving BP<140/90 mm Hg, and 13% (7%–16%) for meeting all outcome measures. Adjusted median rate ratios (95% confidence intervals) were 5.2 (4.1 to 6.4), 2.4 (2.1 to 2.6), 1.3 (1.2 to 1.3), 1.2 (1.2 to 1.3), 1.4 (1.3 to 1.4), and 4.1 (3.3 to 5.0), respectively. Median rate ratios were qualitatively similar in an analysis restricted to those with eGFR 15–29 ml/min per 1.73 m2.ConclusionsAmong patients with diabetes and CKD, at facility-level, ordering of laboratory tests, and scheduling of nephrology referrals in eligible patients remains suboptimal, with substantial variations across facilities.

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