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. 2012;5(1):9-15.

Urinary spot albumin:creatinine ratio for documenting proteinuria in women with preeclampsia

Qitao Huang  1 , Yunfei Gao, Yanhong Yu, Wei Wang, Shuoshi Wang, Mei Zhong
Affiliations

Urinary spot albumin:creatinine ratio for documenting proteinuria in women with preeclampsia

Qitao Huang et al. Rev Obstet Gynecol. 2012.

Abstract

Aim: To assess whether a single urinary spot urinary albumin:creatinine ratio (ACR) can be used to estimate 24-hour urinary protein excretion in women with preeclampsia.

Methods: ACR and 24-hour urinary protein excretion were measured in 50 consecutive patients with preeclampsia. ACR was determined in a spot midstream urine sample and the amount of protein excretion was quantified in a 24-hour urine collection performed the following day. The correlation between the spot ACR and 24-hour urine protein excretion was assessed, and the diagnostic value of ACR was expressed in terms of specificity and sensitivity. Receiver operating characteristic curve analysis was used to determine the best cutoff values of the spot ACR for mild preeclampsia (proteinuria ≥ 0.3 g/24 h) and severe preeclampsia (defined in China as proteinuria ≥ 2 g/24 h).

Results: A strong correlation was evident between the spot ACR and 24-hour urinary protein excretion (r = .938; P < .001). The optimal spot ACR cutoff point was 22.8 mg/mmol for 0.3 g/24 h of protein excretion (mild preeclampsia) with a sensitivity and specificity of 82.4% and 99.4%, respectively, and 155.6 mg/mmol for 2 g/24 h of protein excretion (severe preeclampsia) with a sensitivity and specificity of 90.6% and 99.6%, respectively.

Conclusions: Compared with 24-hour urinary protein excretion, the spot urinary ACR may be a simple, convenient, and accurate indicator of significant proteinuria in women with preeclampsia.

Keywords: Preeclampsia; Proteinuria; Urinary albumin:creatinine ratio.

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Figures

Figure 1
Figure 1
Correlation between urinary albumin:creatinine ratio (ACR) and 24-hour urine protein estimation in the study population. There was a strong correlation between the spot ACR and the 24-hour urine protein excretion value (r = .938; P < .001).
Figure 2
Figure 2
Receiver operating characteristic curve analysis in women with preeclampsia. A urinary albumin:creatinine ratio value of 22.8 mg/mmol was identified as the best threshold to detect a urine protein excretion of > 0.3 g/24 h, with a sensitivity and a specificity of 82.4% and 99.4%, respectively. Area under the curve = .918.
Figure 3
Figure 3
Receiver operating characteristic curve analysis in women with severe preeclampsia. A urinary albumin:creatinine ratio value of 155.6 mg/mmol was identified as the best threshold to detect a urine protein excretion of > 2 g/24 h, with a sensitivity and specificity of 90.6% and 99.6%, respectively. Area under the curve = .956.
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