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. 2023;45(2):2253324.
doi: 10.1080/0886022X.2023.2253324. Epub 2023 Sep 19.

Comparison of three spot proteinuria measurements for pediatric nephrotic syndrome: based on the International pediatric Nephrology Association 2022 Guidelines

Cahyani Gita Ambarsari  1   2   3 , Dwi Ambar Prihatining Utami  1   4 , Chika Carnation Tandri  5 , Hindra Irawan Satari  1
Affiliations

Comparison of three spot proteinuria measurements for pediatric nephrotic syndrome: based on the International pediatric Nephrology Association 2022 Guidelines

Cahyani Gita Ambarsari et al. Ren Fail. 2023.

Abstract

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.

Keywords: Creatinine; relapse; steroid-dependent; steroid-resistant; steroid-sensitive; urine.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Study workflow. Created with BioRender.com. eGFR: estimated glomerular filtration rate; IPNA: International Pediatric Nephrology Association; UPCR: urinary protein creatinine ratio; 24-h UP: 24-hour urine protein
Figure 2.
Figure 2.
The receiver operator characteristics curve showed that the optimal cutoff urinary protein creatinine ratio for no remission/relapse was 2.08 mg/mg with an AUC value of 0.93. AUC: area under the curve; CI: confidence interval; ROC: receiver operator characteristics; UPCR: urinary protein creatinine ratio
Figure 3.
Figure 3.
The receiver operator characteristics curve showed the optimal cutoff of urinary protein creatinine ratio for complete remission was 0.44 mg/mg with an AUC value of 0.83. AUC: area under the curve; CI: confidence interval; ROC: receiver operator characteristics; UPCR: urinary protein creatinine ratio
Figure 4.
Figure 4.
The receiver operator characteristics curve showed that the manual dipstick had higher AUC value of 0.93 compared to the automated dipstick for identifying no remission/relapse, k = 0.53 (p < 0.001). AUC: area under the curve; CI: confidence interval; ROC: receiver operator characteristics
Figure 5.
Figure 5.
The receiver operator characteristics curve showed that the automated dipstick had higher AUC value of 0.85 compared to the manual dipstick for identifying complete remission, k = 0.53 (p < 0.001). AUC: area under the curve; CI: confidence interval; ROC: receiver operator characteristics
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