Correlación entre el cociente proteinuria/creatininuria en una orina al azar y la proteinuria de 24 horas
Resumen
Introducción: la cuantificación de proteínas en orina es un estudio que evalúa la afectación renal por ciertas enfermedades. Su medición puede realizarse también a través del cociente proteinuria/creatininuria.
Objetivo: determinar la correlación entre el cociente proteinuria/creatininuria y la proteinuria de 24 horas.
Metodología: se realizó un estudio descriptivo observacional, prospectivo con componente analítico de corte transverso, de muestreo no probabilístico. Se incluyó a 60 pacientes con factores de riesgo de padecer enfermedad renal crónica, que acudieron al Hospital Nacional (Itauguá) en el año 2014. Todos se realizaron análisis de orina de 24 horas y de una muestra de orina al azar para estimar el cociente proteinuria/creatininuria.
Resultados: se observó que existe una correlación muy significativa (r= 0,9 p < 0,001) entre los valores del cociente de proteinuria/creatininuria en una orina al azar y la proteinuria de 24 horas, con una sensibilidad 94,1% (IC95% 79-100), especificidad 100% (IC95% 98-100%), valor predictivo positivo 100% (IC95% 96-100) y valor predictivo negativo 97,7% (IC95% 92-100).
Conclusiones: el cociente proteinuria/creatininuria es útil para detectar proteinuria en rango no nefrótico.
Citas
Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, Van Lente F, Levey AS. Prevalence of chronic kidney disease in the United States. JAMA. 2007 Nov 7; 298(17):2038-47.
Alegre JR, Alles A, Angerosa M, Bianchi ME, Dorado E, Etchegoyen MC, et al. Documento de Consenso: Implicancia de la proteinuria en el diagnóstico y seguimiento de la enfermedad renal crónica. Acta Bioquím Clín Latinoam. 2013; 47 (3): 613-25.
Rodrigo Calabia E. Medida de la función renal. Evaluación del cociente microalbuminuria/creatinina. Valor de la tira reactiva y del examen del sedimento urinario. Indicaciones para solicitar ecografía renal. Nefrologia. 2004; 24 Supl.(6): 35-46.
Regeniter A, Freidank H, Dickenmann M, Boesken WH, Siede WH. Evaluation of proteinuria and GFR to diagnose and classify kidney disease: systematic review and proof of concept. Eur J Intern Med. 2009 Oct; 20(6):556-61.
Kashif W, Siddiqi N, Dincer AP, Dincer HE, Hirsch S. Proteinuria: how to evaluate an important finding. Cleve Clin J Med. 2003 Jun;70(6):535-7.
Xue L, Lou Y, Feng X, Wang C, Ran Z, Zhang X. Prevalence of chronic kidney disease and associated factors among the Chinese population in Taian, China. BMC Nephrol. 2014 Dec 21; 15(1): 205.
Brandt JR, Jacobs A, Raissy HH, Kelly FM, Staples AO, Kaufman E, Wong CS. Orthostatic proteinuria and the spectrum of diurnal variability of urinary protein excretion in healthy children. Pediatr Nephrol. 2010 Jun; 25(6): 1131-7.
Birck R, Krzossok S, Markowetz F, Schnülle P, van der Woude FJ, Braun C. Acetylcysteine for prevention of contrast nephropathy: meta-analysis. Lancet. 2003 Aug 23; 362(9384): 598-603.
Montero N, Soler MJ, Pascual MJ, Barrios C, Márquez E, Rodríguez E, et al. Correlación entre el cociente proteína/creatinina en orina esporádica y las proteínas en orina de 24 horas. Nefrologia. 2012; 32(4): 494-501.
Matar HE, Peterson P, Sangle S, D'Cruz DP. Correlation of 24-hour urinary protein quantification with spot urine protein:creatinine ratio in lupus nephritis. Lupus. 2012 Jul;21(8):836-9.
Ralston SH, Caine N, Richards I, O'Reilly D, Sturrock RD, Capell HA. Screening for proteinuria in a rheumatology clinic: comparison of dipstick testing, 24 hour urine quantitative protein, and protein/creatinine ratio in random urine samples. Ann Rheum Dis. 1988 Sep; 47(9): 759-63.
Solorzano GTM, Silva MV, Moreira SR, Nishida SK, Kirsztajn GM. Urinary protein/creatinine ratio versus 24-hour proteinuria in the evaluation of lupus nephritis. J Bras Nefrol. 2012; 34(1): 64-7.
Ali A, Taj A, Amin MJ, Iqbal F, Iqbal Z. Correlation between microalbuminuria and hypertension in type 2 diabetic patients. Pak J Med Sci. 2014 May; 30(3): 511-4.
Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, De Zeeuw D, Hostetter TH, Lameire N, Eknoyan G. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005 Jun; 67(6): 2089-100.
Gyamlani GG, Bergstralh EJ, Slezak JM, Larson TS. Urinary albumin to osmolality ratio predicts 24-hour urine albumin excretion in diabetes mellitus. Am J Kidney Dis. 2003 Oct; 42(4): 685-92.
Witte EC, Lambers Heerspink HJ, de Zeeuw D, Bakker SJ, de Jong PE, Gansevoort R. First morning voids are more reliable than spot urine samples to assess microalbuminuria. J Am Soc Nephrol. 2009 Feb; 20(2): 436-43.
Younes N, Cleary PA, Steffes MW, de Boer IH, Molitch ME, Rutledge BN, et al. Comparison of urinary albumin-creatinine ratio and albumin excretion rate in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Clin J Am Soc Nephrol. 2010 Jul; 5(7): 1235-42.
Halimi JM, Hadjadj S, Aboyans V, Allaert FA, Artigou JY, Beaufils M, et al. Microalbuminuria and urinary albumin excretion: French clinical practice guidelines. Diabetes Metab. 2007 Sep; 33(4): 303-9.
Gansevoort RT, Brinkman J, Bakker SJ, De Jong PE, de Zeeuw D. Evaluation of measures of urinary albumin excretion. Am J Epidemiol. 2006 Oct 15; 164(8): 725-7.
Wu HY, Peng YS, Chiang CK, Huang JW, Hung KY, Wu KD, Tu YK, Chien KL. Diagnostic performance of random urine samples using albumin concentration vs ratio of albumin to creatinine for microalbuminuria screening in patients with diabetes mellitus: a systematic review and meta-analysis. JAMA Intern Med. 2014 Jul; 174(7): 1108-15.
Brinkman JW, de Zeeuw D, Lambers Heerspink HJ, Gansevoort RT, Kema IP, de Jong PE, Bakker SJ. Apparent loss of urinary albumin during long-term frozen storage: HPLC vs immunonephelometry. Clin Chem. 2007 Aug; 53(8): 1520-6.
de Jong PE, Curhan GC. Screening, monitoring, and treatment of albuminuria: Public health perspectives. J Am Soc Nephrol. 2006 Aug; 17(8): 2120-6.
Remuzzi G, Ruggenenti P, Benigni A. Understanding the nature of renal disease progression. Kidney Int. 1997 Jan; 51(1): 2-15.
Bailie GR, Uhlig K, Levey AS. Clinical practice guidelines in nephrology: Evaluation, classification, and stratification of chronic kidney disease. Pharmacotherapy. 2005 Apr; 25(4): 491-502.
Yuyun MF, Adler AI, Wareham NJ. What is the evidence that microalbuminuria is a predictor of cardiovascular disease events? Curr Opin Nephrol Hypertens. 2005 May; 14(3): 271-6.
Vidt DG. Inflammation in renal disease. Am J Cardiol. 2006 Jan 16; 97(2A): 20A-27A.
Guérin AP, Pannier B, Marchais SJ, London GM. Cardiovascular disease in the dialysis population: prognostic significance of arterial disorders. Curr Opin Nephrol Hypertens. 2006 Mar; 15(2): 105-10.
Stuveling EM, Hillege HL, Bakker SJ, Gans RO, De Jong PE, De Zeeuw D. Creactive protein is associated with renal function abnormalities in a non-diabetic population. Kidney Int. 2003 Feb; 63(2): 654-61.
Amann K, Gross ML, Ritz E. Pathophysiology underlying accelerated atherogenesis in renal disease: closing in on the target. J Am Soc Nephrol. 2004 Jun; 15(6): 1664-6.
Currie G, McKay G, Delles C. Biomarkers in diabetic nephropathy: Present and future. World J Diabetes. 2014 Dec 15; 5(6): 763-76.
Dell'omo G, Giorgi D, Di Bello V, Mariani M, Pedrinelli R. Blood pressure independent association of microalbuminuria and left ventricular hypertrophy in hypertensive men. J Intern Med. 2003 Jul; 254(1): 76-84.
Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Kirkman MS, et al. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Diabetes Care. 2011 Jun; 34(6): e61-99.
de Boer IH, Rue TC, Cleary PA, Lachin JM, Molitch ME, Steffes MW, et al. Long-term renal outcomes of patients with type 1 diabetes mellitus and microalbuminuria: an analysis of the diabetes control and complications trial/epidemiology of diabetes interventions and complications cohort. Arch Intern Med. 2011 Mar 14; 171(5): 412-20.
Adler S. Diabetic nephropathy: Linking histology, cell biology, and genetics. Kidney Int. 2004 Nov; 66(5): 2095-106.
Tervaert TW1, Mooyaart AL, Amann K, Cohen AH, Cook HT, Drachenberg CB, et al. Pathologic classification of diabetic nephropathy. J Am Soc Nephrol. 2010 Apr; 21(4): 556-63.
Tapp RJ, Shaw JE, Zimmet PZ, Balkau B, Chadban SJ, Tonkin AM, Welborn TA, Atkins RC. Albuminuria is evident in the early stages of diabetes onset: results from the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Am J Kidney Dis. 2004 Nov; 44(5): 792-8.
Macisaac RJ, Ekinci EI, Jerums G. Markers of and risk factors for the development and progression of diabetic kidney disease. Am J Kidney Dis. 2014 Feb; 63(2 Suppl 2): S39-62.
Trevisan R, Viberti G. Genetic factors in the development of diabetic nephropathy. J Lab Clin Med. 1995 Oct; 126(4): 342-9.
Pettitt DJ, Saad MF, Bennett PH, Nelson RG, Knowler WC. Familial predisposition to renal disease in two generations of Pima Indians with type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia. 1990 Jul; 33(7): 438-43.
Satko SG, Langefeld CD, Daeihagh P, Bowden DW, Rich SS, Freedman BI. Nephropathy in siblings of African Americans with overt type 2 diabetic nephropathy. Am J Kidney Dis. 2002 Sep; 40(3): 489-94.
Bakris GL. Recognition, pathogenesis, and treatment of different stages of nephropathy in patients with type 2 diabetes mellitus. Mayo Clin Proc. 2011 May; 86(5): 444-56.
de Boer IH, Sibley SD, Kestenbaum B, Sampson JN, Young B, Cleary PA, et al. Central obesity, incident microalbuminuria, and change in creatinine clearance in the epidemiology of diabetes interventions and complications study. J Am Soc Nephrol. 2007 Jan; 18(1): 235-43.
Gross JL, de Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelmanovitz T. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care. 2005 Jan; 28(1): 164-76.
Rosas Guzmán J, García Rubí E, Gómez Pérez FJ, Calles J, Barceló A, García G, et al. Prevención, diagnóstico y tratamiento temprano de la Nefropatía Diabética. Revista de ALAD /Internet/. 2009 /citado 1 dic. 2014./; 17(3): 106-114. Disponible en: http://www.revistaalad.com/website/articulo.asp?id=98.
Eknoyan G, Hostetter T, Bakris GL, Hebert L, Levey AS, Parving HH, Steffes MW, Toto R. Proteinuria and other markers of chronic kidney disease: a position statement of the national kidney foundation (NKF) and the national institute of diabetes and digestive and kidney diseases (NIDDK). Am J Kidney Dis. 2003 Oct; 42(4): 617-22.
Newman DJ, Mattock MB, Dawnay AB, Kerry S, McGuire A, Yaqoob M, Hitman GA, Hawke C. Systematic review on urine albumin testing for early detection of diabetic complications. Health Technol Assess. 2005 Aug; 9(30): iii-vi, xiii-163.
Mattix HJ, Hsu CY, Shaykevich S, Curhan G. Use of the albumin/creatinine ratio to detect microalbuminuria: implications of sex and race. J Am Soc Nephrol. 2002 Apr; 13(4): 1034-9.
ADVANCE Collaborative Group, Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008 Jun 12; 358(24): 2560-72.
Gómez-Huelgas R, Martínez-Castelao A, Artola S, Górriz JL, Menéndez E. Consensus document on treatment of type 2 diabetes in patients with chronic kidney disease. Nefrología. 2014; 34(1): 34-45.
Adler AI, Stevens RJ, Manley SE, Bilous RW, Cull CA, Holman RR. Development and progression of nephropathy in type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int. 2003 Jan; 63(1): 225-32.
House AA, Ronco C. The burden of cardiovascular risk in chronic kidney disease and dialysis patients: cardiorenal syndrome type 4. Contrib Nephrol. 2011; 171: 50-6.
Gaede P, Tarnow L, Vedel P, Parving HH, Pedersen O. Remission to normoalbuminuria during multifactorial treatment preserves kidney function in patients with type 2 diabetes and microalbuminuria. Nephrol Dial Transplant. 2004 Nov; 19(11): 2784-8.
Segura J, Campo C, Ruilope LM. Effect of proteinuria and glomerular filtration rate on cardiovascular risk in essential hypertension. Kidney Int Suppl. 2004 Nov; (92): S45-9.
Stakhova TIu, Shcherbak AV, Kozlovskaia LV, Taranova MV, Balkarov IM. Clinical value of the determination of markers for endothelial dysfunction endothelin-1, microalbuminuria and tubulointerstitial tissue lesion β2-microglobulin, monocyte chemotactic protein-1 in hypertensive patients with uric acid metabolic disorders. Ter Arkh. 2014; 86(6): 45-51.
González Maqueda I. La microalbuminuria como factor pronóstico en el enfermo cardiovascular. Rev Esp Cardiol Supl. 2007; 7(Supl.A): 31-43.
Cirillo M, Stellato D, Laurenzi M, Panarelli W, Zanchetti A, De Santo NG. Pulse pressure and isolated systolic hypertension: Association with microalbuminuria. Kidney Int. 2000 Sep; 58(3): 1211-8.
Schrier RW, Estacio RO, Esler A, Mehler P. Effects of aggressive blood pressure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokes. Kidney Int. 2002 Mar; 61(3): 1086-97.
Lurbe E, Redon J, Kesani A, Pascual JM, Tacons J, Alvarez V, Batlle D. Increase in nocturnal blood pressure and progression to microalbuminuria in type 1 diabetes. N Engl J Med. 2002 Sep 12; 347(11): 797-805.
Pontremoli R, Sofia A, Ravera M, Nicolella C, Viazzi F, Tirotta A, et al. Prevalence and clinical correlates of microalbuminuria in essential hypertension: the MAGIC Study. Microalbuminuria: A Genoa Investigation on Complications. Hypertension. 1997 Nov; 30(5): 1135-43.
Tuttle KR. Cardiovascular implications of albuminuria. J Clin Hypertens (Greenwich). 2004 Nov; 6(11 Suppl 3): 13-7.
Jager A, Kostense PJ, Ruhé HG, Heine RJ, Nijpels G, Dekker JM, Bouter LM, Stehouwer CD. Microalbuminuria and peripheral arterial disease are independent predictors of cardiovascular and all-cause mortality, especially among hypertensive subjects: Five-year follow-up of the hoorn study. Arterioscler Thromb Vasc Biol. 1999 Mar; 19(3): 617-24.
Jensen JS, Feldt-Rasmussen B, Strandgaard S, Schroll M, Borch-Johnsen K. Arterial hypertension, microalbuminuria, and risk of ischemic heart disease. Hypertension. 2000 Apr; 35(4): 898-903.
Morales E, Huerta A, Gutiérrez E, Gutiérrez Solís E, Segura J, Praga M. The antiproteinuric effect of the blockage of the renin-angiotensin-aldosterone system (RAAS) in obese patients. Which treatment option is the most effective? Nefrologia. 2009; 29(5): 421-9.
Xu ZG, Lanting L, Vaziri ND, Li Z, Sepassi L, Rodriguez-Iturbe B, Natarajan R. Upregulation of angiotensin II type 1 receptor, inflammatory mediators, and enzymes of arachidonate metabolism in obese Zucker rat kidney: reversal by angiotensin II type 1 receptor blockade. Circulation. 2005 Apr 19; 111(15): 1962-9.
Engeli S, Böhnke J, Gorzelniak K, Janke J, Schling P, Bader M, Luft FC, Sharma AM. Weight loss and the renin-angiotensin-aldosterone system. Hypertension. 2005 Mar; 45(3): 356-62.
Krug AW, Ehrhart-Bornstein M. Aldosterone and metabolic syndrome: Is increased aldosterone in metabolic syndrome patients an additional risk factor? Hypertension. 2008 May; 51(5): 1252-8.
Nagase M, Yoshida S, Shibata S, Nagase T, Gotoda T, Ando K, Fujita T. Enhanced aldosterone signaling in the early nephropathy of rats with metabolic syndrome: possible contribution of fat-derived factors. J Am Soc Nephrol. 2006 Dec; 17(12): 3438-46.
Parving HH, Persson F, Lewis JB, Lewis EJ, Hollenberg NK. Aliskiren combined with losartan in type 2 diabetes and nephropathy. N Engl J Med. 2008 Jun 5; 358(23): 2433-46.
Jafar TH, Schmid CH, Landa M, Giatras I, Toto R, Remuzzi G, et al. Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. A meta-analysis of patient-level data. Ann Intern Med. 2001 Jul 17; 135(2): 73-87.
Ehrhart-Bornstein M, Lamounier-Zepter V, Schraven A, Langenbach J, Willenberg HS, Barthel A, et al. Human adipocytes secrete mineralocorticoid-releasing factors. PNAS. 2003 Nov 25; 100(24): 14211-6.
Goodfriend TL, Ball DL, Egan BM, Campbell WB, Nithipatikom K. Epoxy-keto derivative of linoleic acid stimulates aldosterone secretion. Hypertension. 2004 Feb; 43(2): 358-63.
Afshinnia F, Wilt TJ, Duval S, Esmaeili A, Ibrahim HN. Weight loss and proteinuria: systematic review of clinical trials and comparative cohorts. Nephrol Dial Transplant. 2010 Apr; 25(4): 1173-83.
Ruiz Irastorza G, Espinosa G, Frutos MA, Jiménez Alonso J, Praga M, Pallarés L, et al. Diagnosis and treatment of lupus nephritis. Consensus document from the systemic auto-immune disease group (GEAS) of the Spanish Society of Internal Medicine (SEMI) and Spanish Society of Nephrology (S.E.N.). Nefrologia. 2012; 32 Suppl 1: 1-35.
Steinhäuslin F, Wauters JP. Quantitation of proteinuria in kidney transplant patients: accuracy of the urinary protein/creatinine ratio. Clin Nephrol. 1995 Feb; 43(2): 110-5.
