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Spot Morning Urine Protein to Creatinine Ratio -- A Better Way to Predict Renal Failure.

The measurement of proteinuria may help predict the outcome of renal disease. The spot morning protein-to-creatinine ratio is an efficient predictor of protein excretion in patients with diabetic nephropathy; these Italian investigators tested its predictive value for patients with nondiabetic renal disease.

In 177 patients with nondiabetic renal disease and persistent proteinuria, 24-hour urinary protein was found to correlate well with spot morning urine protein-to-creatinine ratios. In further follow-up of a subgroup of 98 patients, decline in renal function was significantly correlated with the protein-to-creatinine ratio: at 12 months, kidney survival (i.e., lack of progression to end-stage renal disease) was greater than 95 percent with a ratio below 1.7, 87.5 percent with a ratio of 1.7 to 2.7, and 78.8 percent with a ratio greater than 2.7. In fact, the spot morning protein-to-creatinine ratio was more predictive of disease progression than was 24-hour urine protein excretion.

Comment: Although the study numbers were not large, the data were impressive. With its ease of use, low cost, and apparent accuracy, the spot morning urine protein-to-creatinine ratio deserves more attention as a prognostic indicator in patients with nondiabetic renal disease.

— KI Marton

Published in Journal Watch General Medicine March 10, 1998

Citation(s):

Ruggenenti P et al. 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. BMJ 1998 Feb 14 316 504-509.

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