دانشور پزشکی

دانشور پزشکی

ارتباط بین نسبت پروتئین به کراتینین ادرار رندوم با پروتئین و کراتینین ادرار 24 ساعته در کودکان مبتلا به سندروم نفروتیک Correlation Between Protein and Creatinine Ratio of Random Urine with Protein and Creatinine 24-hour Urine in Children with Nephrotic Syndrome

نوع مقاله : مقاله پژوهشی

نویسندگان
هاشم محمودزاده 1
محمد ولی‌زاده 2
مریم توکلی 1
1 گروه بیماری‌های کودکان، دانشکده پزشکی، دانشگاه علوم پزشکی ارومیه، ارومیه، ایران.
2 مرکز تحقیقات نفرولوژی و پیوند کلیه، پژوهشکده تحقیقات بالینی، دانشگاه علوم پزشکی ارومیه، ارومیه، ایران.
10.22070/daneshmed.2025.20184.1592
چکیده
مقدمه و هدف: پروتئین ادرار 24 ساعته استاندارد طلایی برای تشخیص سندروم نفروتیک است. با این‌حال، کارایی نسبت کراتینین به پروتئین تصادفی ادرار (UPr/UCr) به‌عنوان جایگزین مطمئن برای پروتئین ادرار 24 ساعته نامشخص است. این مطالعه با هدف تعیین ارتباط بین نسبت UPr/UCr با سطح پروتئین و کراتینین ادرار 24 ساعته در کودکان مبتلا به سندروم نفروتیک انجام شد.
مواد و روش‌ها: این مطالعه به صورت مقطعی-تحلیلی انجام و 75 کودک مبتلا به سندروم نفروتیک (موارد جدید و عود) بستری شده در بیمارستان شهید مطهری ارومیه (1402–1401) وارد مطالعه شدند. اولین نمونه ادرار تصادفی صبحگاهی و در همان روز ادرار 24 ساعته جمع‌آوری و کراتینین و پروتئین آن اندازه‌گیری شد. داده‌ها با استفاده از نرم افزار SPSS و آزمون‌های من‌ویتنی  و ضریب همبستگی اسپیرمن آنالیز شدند.
نتایج: بین نسبت UPr/UCr و پروتئین 24 ساعته در کل بیماران و در دختران و پسران و بین نسبت UPr/UCr و نسبت پروتئین به کراتینین ادرار 24 ساعته همبستگی مستقیم و معنی‌داری وجود داشت. در گروه سنی بیشتر از 4 سال، ارتباط مستقیم و معنی‌داری بین نسبت UPr/UCr و پروتئین 24 ساعته و همچنین نسبت UPr/UCr و نسبت پروتئین به کراتینین 24 ساعته وجود داشت، اما در گروه سنی کمتر یا مساوی 4 سال این همبستگی معنی‌دار نبود.
نتیجه‌گیری: نسبت UPr/UCr با توجه به مزایای آن از نظر هزینه، زمان و راحتی بیمار می‌تواند به‌عنوان روشی جایگزین برای تشخیص سندرم نفروتیک در کودکان استفاده شود. با این‌وجود، تفسیر نتایج تست ادرار رندوم، به‌ویژه در کودکان زیر 4 سال، باید با احتیاط انجام شود.
Background and Objectives: The 24-hour urine protein measurement is the gold standard for diagnosing nephrotic syndrome. However, the efficacy of the ratio of creatinine to spot urine protein (UPr/UCr) as a substitute for 24-hour urine protein remains uncertain. This study aimed to investigate the relationship between the UPr/UCr ratio and protein and creatinine levels in 24-hour urine samples from children with nephrotic syndrome.
Materials and Methods: This cross-sectional study included 75 children with nephrotic syndrome (new and recurrent cases) admitted to Shahid Motahari Hospital in Urmia (2023-2024). Spot urine samples from the first morning and subsequent 24-hour urine collection were obtained, and creatinine and protein levels were measured. Data analysis was performed using the SPSS software, employing Mann-Whitney U tests and Spearman's correlation coefficients.
Results: A significant correlation was observed between the UPr/UCr ratio and 24-hour protein, and between the UPr/UCr ratio and the 24-hour urine protein-to-creatinine ratio in the total patient population and both male and female subgroups. In patients older than 4 years, a significant correlation was noted between the UPr/UCr ratio and 24-hour protein levels and between the UPr/UCr ratio and the 24-hour urine protein to creatinine ratio. However, in patients four years and younger, this correlation was not statistically significant.
Conclusion: Given its advantages of cost-effectiveness, time efficiency, and patient convenience, the UPr/UCr ratio may be considered an alternative method for diagnosing nephrotic syndrome in children. Nevertheless, the interpretation of spot urine test results, particularly in children under four years of age, should be approached cautiously.
کلیدواژه‌ها
سندروم نفروتیک
نسبت پروتئین/کراتینین ادرار رندوم
نسبت پروتئین/کراتینین ادرار 24 ساعته
کودکان Nephrotic syndrome؛ Spot urine protein/creatinine ratio؛ 24-hour urine protein/creatinine ratio؛ Children
موضوعات
  1. Noone DG, Iijima K, Parekh R. Idiopathic nephrotic syndrome in children. The Lancet 2018;392(10141):61-74.
  2. Trautmann A, Boyer O, Hodson E, Bagga A. Gipson DS. Samuel S. et al. IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome. Pediatric Nephrology 2023;38(3):877-919.
  3. Chen J, Qiao X-H, Mao J-H. Immunopathogenesis of idiopathic nephrotic syndrome in children: two sides of the coin. World Journal of Pediatrics 2021;17:115-22.
  4. Ambarsari CG, Utami DAP, Tandri CC, Satari HI. Comparison of three spot proteinuria measurements for pediatric nephrotic syndrome: based on the International pediatric Nephrology Association 2022 Guidelines. Renal Failure 2023;45(2):2253324.
  5. Viswanath D. Nephrotic syndrome in children. Journal of Indian Academy of Oral Medicine and Radiology 2013;25(1):18-23.
  6. Lennon R, Watson L, Webb NJ. Nephrotic syndrome in children. Paediatrics and Child Health 2010;20(1):36-42.
  7. Vivarelli M, Gibson K, Sinha A, Boyer O. Childhood nephrotic syndrome. The Lancet 2023;402(10404):809-24.
  8. Rodriguez-Ballestas E, Reid-Adam J. Nephrotic syndrome. Pediatrics in Review 2022;43(2):87-99.
  9. Tamura H. Trends in pediatric nephrotic syndrome. World Journal of Nephrology 2021;10(5):88.
  10. Rovin BH, Adler SG, Barratt J, Bridoux F, Burdge KA, Chan TM, et al. Executive summary of the KDIGO 2021 guideline for the management of glomerular diseases. Kidney International 2021;100(4):753-79.
  11. Downie ML, Gallibois C, Parekh RS, Noone DG. Nephrotic syndrome in infants and children: pathophysiology and management. Paediatrics and International Child Health 2017;37(4):248-58.
  12. Singh R, Bhalla K, Nanda S, Gupta A, Mehra S. Correlation of spot urinary protein: creatinine ratio and quantitative proteinuria in pediatric patients with nephrotic syndrome. Journal of Family Medicine and Primary Care 2019;8(7):2343-6.
  13. Ghaffar N, Riaz M, Shahzia Soomro B, Moorani K. Diagnostic accuracy of spot urine protein–creatinine ratio in children with nephrotic syndrome. Pakistan Pediatric Journal 2020;44(3):219-3.
  14. Rodby RA. Timed urine collections for albumin and protein:“The king is dead, long live the king!”. American Journal of Kidney Diseases 2016;68(6):836-8.
  15. Witte EC, Heerspink HJL, de Zeeuw D, Bakker SJ, de Jong PE, Gansevoort R. First morning voids are more reliable than spot urine samples to assess microalbuminuria. Journal of the American Society of Nephrology 2009;20(2):436-43.
  16. Miller WG, Bruns DE, Hortin GL, Sandberg S, Aakre KM, McQueen MJ, et al. Current issues in measurement and reporting of urinary albumin excretion. Clinical Chemistry 2009;55(1):24-38.
  17. Veljkovic K, Rodríguez-Capote K, Bhayana V. Pickersgill R. Beattie J. Clark L. et al. Assessment of a four hour delay for urine samples stored without preservatives at room temperature for urinalysis. Clinical Biochemistry 2012;45(10-11):856-8.
  18. Yu G, Cheng J, Li H, Li X, Chen J. Comparison of 24-h urine protein, urine albumin-to-creatinine ratio, and protein-to-creatinine ratio in IgA nephropathy. Frontiers in Medicine 2022;9:809245.
  19. Franke I, Aydin M, Llamas Lopez CE. Kurylowicz L, Ganschow R, Lentze M, et al. The incidence of the nephrotic syndrome in childhood in Germany. Clinical and Experimental Nephrology 2018;22:126-32.
  20. Parikh RV, Tan TC, Fan D, Law D, Salyer AS, Yankulin L, et al. Population-based identification and temporal trend of children with primary nephrotic syndrome: The Kaiser Permanente nephrotic syndrome study. PloS One 2021;16(10):e0257674.
  21. Sato M, Ishikura K, Ando T, Kikunaga K, Terano C. Hamada R. et al. Prognosis and acute complications at the first onset of idiopathic nephrotic syndrome in children: a nationwide survey in Japan (JP-SHINE study). Nephrology Dialysis Transplantation 2021;36(3):475-81.
  22. Yang EM, Yoon BA, Kim SW, Kim CJ. Clinical utility of spot urine protein-to-creatinine ratio modified by estimated daily creatinine excretion in children. Pediatric Nephrology 2017;32:1045-51.
  23. Huang Y, Yang X, Zhang Y, Yue S, Mei X, Bi L, et al. Correlation of urine protein/creatinine ratios to 24-h urinary protein for quantitating proteinuria in children. Pediatric Nephrology 2020;35:463-8.
  24. Zhai P, Huang Y, Yue S, Yang X, Luo J, Zhang Y, et al. Diagnostic efficacy and influence factors of urinary protein/creatinine ratio replacing 24-h urine protein as an evaluator of proteinuria in children. International Urology and Nephrology 2022:1-8.
  25. Akin D, Ozmen S. An unresolved issue: The relationship between spot urine protein-to-creatinine ratio and 24-hour proteinuria. Journal of International Medical Research 2019;47(3):1179-84.
  26. Patil P, Shah V, Shah B. Comparison of spot urine protein creatinine ratio with 24 hour urine protein for estimation of proteinuria. Journal of the Association of Physicians of India 2014;62(5):406-10.
  27. Sukmawati M, Suarta K. Validity of protein-creatinine and protein-osmolality ratios in the estimation of massive proteinuria in children with nephrotic syndrome. Paediatrica Indonesiana 2007;47(4):139-43.
  28. Lim D, Lee D-Y, Cho SH, Kim OZ, Cho SW, An SK, et al. Diagnostic accuracy of urine dipstick for proteinuria in older outpatients. Kidney Research and Clinical Practice 2014;33(4):199-203.
  29. Leung AK, Wong AH, Barg SS. Proteinuria in children: evaluation and differential diagnosis. American Family Physician 2017;95(4):248-54.
  30. Mejia JR, Fernandez-Chinguel JE, Dolores-Maldonado G, Becerra-Chauca N, Goicochea-Lugo S, Herrera-Añazco P, et al. Diagnostic accuracy of urine dipstick testing for albumin-to-creatinine ratio and albuminuria: A systematic review and meta-analysis. Heliyon 2021;7(11).
  31. Jang KM, Cho MH. Clinical approach to children with proteinuria. Childhood Kidney Diseases 2017;21(2):53-60.
  32. Sarker A. Banu NA, Sultana N, Nesa V. Comparative Evaluation of Quantitative Protein Measurement of 12-Hour and 24-hour Urine Sample for the Diagnosis of Nephrotic Syndrome and their Correlation with Spot Urinary Protein Creatinine Ratio. Sir Salimullah Medical College Journal 2021;29(2):105-11.
  33. Bint Anowar A, Sarker NR, Mahamuduzzaman ASM, Shome A, Morshed SS, Parvin J. Correlation between 24-hour Urinary Total Protein Excretion and Single Urinary Protein Creatinine ratio in the Diagnosis of Childhood Nephrotic Syndrome: Study in a Tertiary Level Hospital. Journal of Shaheed Suhrawardy Medical College 2021;13(2):137-42.
دانشور پزشکی
دوره 33، شماره 1 - شماره پیاپی 176
فروردین و اردیبهشت 1404
صفحه 23-30