Comparison of 24-h Urine Protein, Urine Albumin-to-Creatinine Ratio, and Protein-to-Creatinine Ratio in IgA Nephropathy

Guizhen Yu; Jun Cheng; Heng Li; Xiayu Li; Jianghua Chen

doi:10.3389/fmed.2022.809245

Comparison of 24-h Urine Protein, Urine Albumin-to-Creatinine Ratio, and Protein-to-Creatinine Ratio in IgA Nephropathy

Front Med (Lausanne). 2022 Feb 28:9:809245. doi: 10.3389/fmed.2022.809245. eCollection 2022.

Authors

Guizhen Yu^{1

2

3

4

5}, Jun Cheng^{1

2

3

4

5}, Heng Li^{1

2

3

4

5}, Xiayu Li^{1

2

3

4

5}, Jianghua Chen^{1

2

3

4

5}

Affiliations

¹ Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
² Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang University, Hangzhou, China.
³ National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, China.
⁴ Institute of Nephrology, Zhejiang University, Hangzhou, China.
⁵ The Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China.

Abstract

Background: Proteinuria is a strong risk factor for renal outcomes in IgA nephropathy. Random urine protein-to-creatinine ratio (PCR), random albumin-to-creatinine ratio (ACR), and 24-h urine protein excretion (24-h UP) have been widely used in clinical practice. However, the measurement which is the best predictor of long-term renal outcomes remains controversial. This study aimed to compare the three measurements in IgA nephropathy.

Methods: We conducted a retrospective study of 766 patients with IgA nephropathy. The associations among baseline ACR, PCR, and 24-h UP with chronic kidney disease (CKD) progression event, defined as 50% estimated glomerular filtration rate (eGFR) decline or end stage kidney disease (ESKD), were tested and compared.

Results: In this study, ACR, PCR, and 24-h UP showed high correlation (r = 0.671-0.847, P < 0.001). After a median follow-up of 29.88 (14.65-51.65) months, 51 (6.66%) patients reached the CKD progression event. In univariate analysis, ACR performed better in predicting the prognosis of IgA nephropathy, with a higher area under the receiver operating curve (ROC) curve than PCR and 24-h UP. After adjustment for traditional risk factors, ACR was most associated with composite CKD progression event [per log-transformed ACR, hazard ratio (HR): 2.82; 95% (95% CI): 1.31-6.08; P = 0.008].

Conclusions: In IgA nephropathy, ACR, PCR, and 24-h UP had a high correlation. ACR performed better in predicting the prognosis of IgA nephropathy.

Keywords: 24-h urine protein excretion (24-h UP); IgA nephropathy; albumin-to-creatinine ratio (ACR); kidney disease progression; protein-to-creatinine ratio (PCR).