[Albumin (or protein) to creatinine ratios in the diagnosis of chronic kidney disease in adults]

Haute Autorité de Santé
Record ID 32016000262
Authors' objectives: The objective of this study was to compare the diagnostic performance of ACR (or PCR) from a spot urine sample with albuminuria (or proteinuria) and from a 24-hour urine collection in the detection of significant albuminuria (or proteinuria), and to determine whether urine spot samples could replace 24-hour urine collection to detect albuminuria or proteinuria for early diagnosis of CKD in adult patients at increased risk of kidney disease.
Authors' recommendations: The identified guideline (NICE) recommends detection of urinary protein excretion rate with ACR or PCR using a spot urine sample instead of 24-hour urine collection. The literature identified in this report does not invalidate the NICE conclusion. Correlation of ACR and PCR from (spot) urine samples with 24-h albuminuria or proteinuria was high for CKD patients. The areas under the ROC curve, always close to 1, demonstrate the excellent discriminatory power of ACR or PCR in the detection of albuminuria or proteinuria. The PCR sensitivity in the detection of proteinuria above 500 mg/24 h was at least 91% with specificities greater than 85%. The positive likelihood ratios were higher than 6. The sensitivity of ACR in the detection of albuminuria above 300 mg/24 h was 100% (ACR threshold: 30 mg/mmol) with at least a 78% specificity (ACR threshold: 70 mg/mmol). The positive likelihood ratios were higher than 15. In patients with diabetes, the ACR sensitivity in the detection of microalbuminuria was at least 88% (ACR threshold less than 2.25 mg/mmol). Literature data conclusions: For screening, ACR and the PCR on spot urine sample showed sufficient diagnostic performance and may replace 24-hour urine collection.
Project Status: Completed
Year Published: 2011
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: France
MeSH Terms
  • Humans
  • Adult
  • Albumins
  • Creatinine
  • Renal Insufficiency, Chronic
Organisation Name: Haute Autorité de Santé
Contact Address: 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France. Tel: +33 01 55 93 71 88; Fax: +33 01 55 93 74 35;
Contact Name: has.seap.secretariat@has-sante.fr
Contact Email: has.seap.secretariat@has-sante.fr
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