Cross sectional longitudinal study of spot morning urine protein:creatinine ratio, 24 hour urine protein excretion rate, glomerular filtration rate, and end stage renal failure in chronic renal disease in patients without diabetes
Cross sectional longitudinal study of spot morning urine protein:creatinine ratio, 24 hour urine protein excretion rate, glomerular filtration rate, and end stage renal failure in chronic renal disease in patients without diabetes
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DOI：
10.1136/bmj.316.7130.504
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发表时间：
1998-02-14
影响因子：
--
通讯作者：
Remuzzi, G
中科院分区：
文献类型：
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作者：
Ruggenenti, P;Gaspari, F;Remuzzi, G
目的：为了评估是否蛋白质：肌酐比值在现场晨尿标本是一个可靠的指标，24小时尿蛋白排泄和预测肾小球滤过率的下降和进展到终末期肾功能衰竭的非糖尿病患者慢性nephropathy.Design：横截面之间的比率和尿蛋白排泄率的相关性。单变量和多变量分析基线预测因子，包括肾小球滤过率下降和终末期肾衰竭的比率和24小时尿蛋白。设置：意大利的研究中心。受试者：177名非糖尿病慢性肾病门诊患者，筛选参与肾病研究中的雷米普利疗效。主要结局指标：通过重复测量未标记的碘海醇血浆清除率和进展为肾衰竭的速率来评估滤过率的下降速率。结果：蛋白质：肌酐比值与绝对值和对数转换的24小时尿蛋白值显著相关（分别为P = 0.0001和P < 0.0001）。比值对肾小球滤过率下降率（单变量P = 0.0003，多变量P = 0.004）和终末期肾功能衰竭（P = 0.002和P = 0.04）也具有较高的预测价值。基线蛋白质：肌酐比值和肾小球滤过率下降率也显著相关（P < 0.0005），在蛋白质：肌酐比值最低的三分之一（< 1.7）有3%的肾功能衰竭，而在最高的三分之一（> 2.7）有21.2%的肾功能衰竭（P < 0.05）。结论：在非糖尿病慢性肾病患者中，晨尿蛋白：肌酐比值是蛋白尿的精确指标，也是疾病进展的可靠预测因子，是确定肾脏疾病严重程度和预后的一种简单而廉价的方法。
Objective: To evaluate whether the protein:creatinine ratio in spot morning urine samples is a reliable indicator of 24 hour urinary protein excretion and predicts the rate of decline of glomerular filtration rate and progression to end stage renal failure in non-diabetic patients with chronic nephropathy.Design: Cross sectional correlation between the ratio and urinary protein excretion rate. Univariate and multivariate analysis of baseline predictors, including the ratio and 24 hour urinary protein, of decline in glomerular filtration rate and end stage renal failure in the long term.Setting: Research centre in Italy.Subjects: 177 non-diabetic outpatients with chronic renal disease screened for participation in the ramipril efficacy in nephropathy study.Main outcome measures: Rate of decline in filtration rate evaluated by repeated measurements of unlabelled iohexol plasma clearance and rate of progression to renal failure.Results: Protein:creatinine ratio was significantly correlated with absolute and log transformed 24 hour urinary protein values (P = 0.0001 and P < 0.0001, respectively.) Ratios also had high predictive value for rate of decline of the glomerular filtration rate (univariate P = 0.0003, multivariate P = 0.004) and end stage renal failure (P = 0.002 and P = 0.04). Baseline protein:creatinine ratios and rate of decline of the glomerular filtration rate were also significantly correlated (P < 0.0005), In the lowest third of the protein:creatinine ratio (< 1.7) there was 3% renal failure compared with 21.2% in the highest third (> 2.7) (P < 0.05).Conclusions: Protein:creatinine ratio in spot morning urine samples is a precise indicator of proteinuria and a reliable predictor of progression of disease in non-diabetic patients with chronic nephropathies and represents a simple and inexpensive procedure in establishing severity of renal disease and prognosis.