A-061 Usefulness of a random spot urine proteins-to-creatinine ratio to screen for increased albuminuria in patients with type 1 diabetes

Abstract Background Moderately increased albuminuria is a biomarker for early onset diabetic nephropathy. One recommendation is to use proteinuria-to-creatininuria ratio (UPCR) to screen for increased albuminuria in countries with limited financial resources. The aim of this study was to evaluate the performance of UPCR at different cut-off to screen for increased albuminuria using albuminuria-to-creatininuria ratio (UACR) as a gold standard. Methods This was a cross-sectional study. A random spot urine sample was collected from patients with type 1 diabetes to measure albuminuria and total proteinuria using respectively an immunoturbidimetric and a colorimetric assays. Albuminuria was expressed as UACR and proteinuria as UPCR. The area under the curve (AUC) method and the kappa coefficient were used to compare UPCR and UACR. Results A total of 150 patients with a mean age of 15±4.42 years and a male frequency of 51.33% were included in this study. The frequency of moderately increased albuminuria according to UACR was 33.33% (n=50). The frequency of moderately increased albuminuria according to UPCR at the thresholds of 130, 150, 180 and 200 mg/g were all higher than that obtained with UACR whereas the frequency of moderately increased albuminuria according to the UPCR at the threshold of 272 mg/g was 35.33% (n = 53). For the five (5) UPCR cut-off values, the areas under the receiver operating curves (AUC) were all low i.e. < 70%. The highest kappa coefficient of the series was observed with the UPCR cut-off value of 272 mg/g. However, the level of agreement between UPCR 272 mg/g and UACR results was mild with a kappa coefficient of 0.276 [95%CI: 0.116 – 0.436] i.e. < 0.40. Conclusion The level of agreement between UPCR and UACR was moderate. It is not sufficient enough for UPCR to replace UACR to screen for increased albuminuria in patient with type 1 diabetes.