The urine albumin-to-creatinine ratio is a reliable indicator for evaluating complications of chronic kidney disease and progression in IgA nephropathy in China.
The urine albumin-to-creatinine ratio is a reliable indicator for evaluating complications of chronic kidney disease and progression in IgA nephropathy in China.
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尿白蛋白肌酐比值是评估中国慢性肾脏病并发症和IgA肾病进展的可靠指标
DOI：
10.6061/clinics/2016(05)01
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发表时间：
2016-05
期刊：
影响因子：
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通讯作者：
HaiTao T
中科院分区：
文献类型：
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作者：
Huan L;Yuezhong L;Chao W;HaiTao T
目的：本研究探讨尿白蛋白与肌酐比值与24小时尿蛋白尿之间的相关性，以及该比值是否能比24小时尿蛋白尿更可靠地预测慢性肾脏疾病的进展，特别是在原发性IgA肾病中。方法：对182例原发性IgA肾病患者进行评估。在住院期间测定他们的平均尿白蛋白与肌酐比值和24小时蛋白尿。血液样本也进行了分析。记录了44例患者的随访数据。然后进行了一项横断面研究，以测试这些参数与慢性肾脏疾病并发症之间的相关性。随后，采用典型相关分析来评估基线蛋白尿与牛津分类参数之间的相关性。最后，进行了一项前瞻性观察性研究，以评估蛋白尿与临床结果之间的关系。我们的研究已在中国临床试验注册中心注册，注册号为ChiCTR-OCH-14005137。结果：除慢性肾脏疾病第5期外，该比值与24小时蛋白尿有很强的相关性（r=0.81, p<0.001）。第一天早晨尿白蛋白与肌酐比值≥125.15、154.44和760.31 mg/g可靠地预测等效24小时蛋白尿“阈值”分别≥0.15、0.3和1.0 g/24 h。在连续分析中，白蛋白与肌酐比值与贫血、酸中毒、低白蛋白血症、高磷血症、高钾血症、高胆固醇血症和血清胱抑素c升高显著相关。然而，较高的24小时蛋白尿仅与低白蛋白血症和高胆固醇血症相关。在典型相关分析中观察到，较高的小管萎缩和间质纤维化评分也与较高的白蛋白与肌酐比值相关。最后，在单变量分析中，白蛋白与肌酐比值和24小时蛋白尿与肾脏预后相关。结论：本研究支持使用白蛋白与肌酐比值而不是24小时蛋白尿来监测原发性IgA肾病的蛋白尿和预后的建议。
OBJECTIVE: This study investigated the correlation between the albumin-to-creatinine ratio in the urine and 24-hour urine proteinuria and whether the ratio can predict chronic kidney disease progression even more reliably than 24-hour proteinuria can, particularly in primary IgA nephropathy. METHODS: A total of 182 patients with primary IgA nephropathy were evaluated. Their mean urine albumin-to-creatinine ratio and 24-hour proteinuria were determined during hospitalization. Blood samples were also analyzed. Follow-up data were recorded for 44 patients. A cross-sectional study was then conducted to test the correlation between these parameters and their associations with chronic kidney disease complications. Subsequently, a canonical correlation analysis was employed to assess the correlation between baseline proteinuria and parameters of the Oxford classification. Finally, a prospective observational study was performed to evaluate the association between proteinuria and clinical outcomes. Our study is registered in the Chinese Clinical Trial Registry, and the registration number is ChiCTR-OCH-14005137. RESULTS: A strong correlation (r=0.81, p<0.001) was found between the ratio and 24-hour proteinuria except in chronic kidney disease stage 5. First-morning urine albumin-to-creatinine ratios of ≥125.15, 154.44 and 760.31 mg/g reliably predicted equivalent 24-hour proteinuria ‘thresholds’ of ≥0.15, 0.3 and 1.0 g/24 h, respectively. In continuous analyses, the albumin-to-creatinine ratio was significantly associated with anemia, acidosis, hypoalbuminemia, hyperphosphatemia, hyperkalemia, hypercholesterolemia and higher serum cystatin C. However, higher 24-hour proteinuria was only associated with hypoalbuminemia and hypercholesterolemia. Higher tubular atrophy and interstitial fibrosis scores were also associated with a greater albumin-to-creatinine ratio, as observed in the canonical correlation analysis. Finally, the albumin-to-creatinine ratio and 24-hour proteinuria were associated with renal outcomes in univariate analyses. CONCLUSION: This study supports the recommendation of using the albumin-to-creatinine ratio, rather than 24-hour proteinuria, to monitor proteinuria and prognosis in primary IgA nephropathy.