TY - JOUR
T1 - Comparison of three spot proteinuria measurements for pediatric nephrotic syndrome
T2 - based on the International pediatric Nephrology Association 2022 Guidelines
AU - Ambarsari, Cahyani Gita
AU - Utami, Dwi Ambar Prihatining
AU - Tandri, Chika Carnation
AU - Satari, Hindra Irawan
N1 - Funding Information:
No specific funding was received by the authors for this study. We would like to express our gratitude to Professor Taralan Tambunan, Professor Partini Pudjiastuti Trihono, Professor Sudung Oloan Pardede, Eka Laksmi Hidayati, MD, and Henny Adriani Puspitasari, MD, for their care of the patients at the Department of Child Health, Cipto Mangunkusumo Hospital. We are also thankful to Darmawan Budi Setyanto, MD, Mulya Rahma Karyanti, MD, and Dina Muktiarti, MD, for their feedback on the development of this manuscript and to Ghafur Rasyid Arifin, MD and Wani Riselia Sirait, MD, for their assistance in data collection. This work was previously presented as a scientific poster at the 55th Annual Meeting European Society for Paediatric Nephrology Congress 2023 in Vilnius, Lithuania.
Publisher Copyright:
© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2023
Y1 - 2023
N2 - 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.
AB - 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.
KW - Creatinine
KW - relapse
KW - steroid-dependent
KW - steroid-resistant
KW - steroid-sensitive
KW - urine
UR - http://www.scopus.com/inward/record.url?scp=85171896430&partnerID=8YFLogxK
U2 - 10.1080/0886022X.2023.2253324
DO - 10.1080/0886022X.2023.2253324
M3 - Article
C2 - 37724557
AN - SCOPUS:85171896430
SN - 0886-022X
VL - 45
JO - Renal Failure
JF - Renal Failure
IS - 2
M1 - 2253324
ER -