Siedner Mark J, Christopher-Stine Lisa, Astor Brad C, Gelber Allan C, Fine Derek M
Divisions of Nephrology and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Rheumatol. 2007 May;34(5):973-7. Epub 2007 Apr 15.
Screening for proteinuria in patients with lupus requires a diagnostic method with adequate validity to detect early disease. Recent studies have called into question the validity of qualitative proteinuria measurements. We set out to assess if American rheumatologists have changed their practice preferences in response to these data.
Using an online survey tool, we questioned practicing physicians, who were members of the American College of Rheumatology in 2005, about their demographic characteristics and preferred method to detect proteinuria in patients with known lupus.
In our survey, 64.6% of 473 respondents reported using qualitative urinalysis (dipstick) as the primary method of screening for proteinuria. The remaining 32.7% preferred quantitative measurements (spot protein to creatinine ratio 16.8%; 24-h protein 7.8%; microalbuminuria 4.1%; 24-h protein to creatinine ratio 4.1%). Rheumatologists in practice for more than 10 years were more likely than those in practice for less time to use a qualitative method. Although physicians using dipsticks were most likely to use 1+ as a cutoff for significant proteinuria, 28.5% report using a threshold of > or = 2+.
Despite recent reports describing the inadequacy of urine dipstick as a measurement for low-grade proteinuria, the majority of practicing rheumatologists are utilizing that method for screening in patients with lupus. Because early detection of lupus nephritis has implications for prevention of renal associated morbidity and mortality, these findings should prompt further investigation of the adequacy and role of urine dipstick as a screening tool for lupus.
对狼疮患者进行蛋白尿筛查需要一种具有足够效度的诊断方法来检测早期疾病。近期研究对定性蛋白尿测量的效度提出了质疑。我们旨在评估美国风湿病学家是否因这些数据而改变了他们的实践偏好。
我们使用在线调查工具，询问了2005年美国风湿病学会的执业医师关于他们的人口统计学特征以及检测已知狼疮患者蛋白尿的首选方法。
在我们的调查中，473名受访者中有64.6%报告使用定性尿液分析（试纸法）作为筛查蛋白尿的主要方法。其余32.7%则更喜欢定量测量（随机尿蛋白与肌酐比值16.8%；24小时尿蛋白7.8%；微量白蛋白尿4.1%；24小时尿蛋白与肌酐比值4.1%）。执业超过10年的风湿病学家比执业时间较短的更有可能使用定性方法。尽管使用试纸的医生最有可能将1+作为显著蛋白尿的临界值，但28.5%报告使用≥2+的临界值。
尽管近期有报告称尿液试纸法不足以测量低度蛋白尿，但大多数执业风湿病学家仍在使用该方法对狼疮患者进行筛查。由于狼疮性肾炎的早期检测对预防肾脏相关的发病率和死亡率有影响，这些发现应促使进一步研究尿液试纸法作为狼疮筛查工具的充分性和作用。
