Akbari Ayub, Fergusson Dean, Kokolo Madzouka B, Ramsay Tim, Beck Andrew, Ducharme Robin, Ruzicka Marcel, Grant-Orser Amanda, White Christine A, Knoll Greg A
Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Nephrol Dial Transplant. 2014 Apr;29(4):919-26. doi: 10.1093/ndt/gft520. Epub 2014 Jan 26.
Quantification of proteinuria (albuminuria) in renal transplant recipients is important for diagnostic and prognostic purposes. Recent guidelines have recommended quantification of proteinuria by spot protein-to-creatinine ratio (PCR) or spot albumin-to-creatinine ratio (ACR). Validity of spot measurements remains unclear in renal transplant recipients.
Systematic review of adult kidney transplant recipients. Studies that reported the diagnostic accuracy of PCR or ACR as compared with 24-h urine protein or albumin excretion in renal transplant recipients were included.
The search identified 8 studies involving 1871 renal transplant recipients. The correlation of the PCR to 24-h protein ranged from 0.772 to 0.998 with a median value of 0.92. PCR sensitivity ranged from 63 to 99 (50% of sensitivities were >90%); PCR specificity varied from 73 to 99 (50% of specificities were >90%). Only one study reported the bias; percent bias ranged from 12 to 21% and accuracy (within 30% of 24 h urine protein) ranged from 47 to 56% depending on the degree of proteinuria. For the ACR, percent bias ranged from 9 to 21%, and the accuracy (within 30%) ranged from 38 to 80%.
The data regarding diagnostic accuracy of PCR and ACR is limited. Only one report studied the absolute measures of agreement (bias and accuracy). We recommend verifying PCR and ACR measurements with a 24-h protein before making any major diagnostic (e.g. biopsy) or therapeutic (e.g. change in immunosuppressive agents) decisions in this population.
肾移植受者蛋白尿（白蛋白尿）的定量对于诊断和预后评估具有重要意义。近期指南推荐通过随机尿蛋白与肌酐比值（PCR）或随机尿白蛋白与肌酐比值（ACR）对蛋白尿进行定量。随机测量在肾移植受者中的有效性尚不清楚。
对成年肾移植受者进行系统评价。纳入报告了肾移植受者中PCR或ACR与24小时尿蛋白或白蛋白排泄相比诊断准确性的研究。
检索到8项研究，涉及1871名肾移植受者。PCR与24小时蛋白的相关性范围为0.772至0.998，中位数为0.92。PCR敏感性范围为63至99（50%的敏感性>90%）；PCR特异性从73至99不等（50%的特异性>90%）。只有一项研究报告了偏差；偏差百分比范围为12%至21%，准确性（在24小时尿蛋白的30%以内）根据蛋白尿程度从47%至56%不等。对于ACR，偏差百分比范围为9%至21%，准确性（在30%以内）范围为38%至80%。
关于PCR和ACR诊断准确性的数据有限。只有一份报告研究了一致性的绝对指标（偏差和准确性）。我们建议在对该人群做出任何重大诊断（如活检）或治疗（如改变免疫抑制剂）决策之前，用24小时尿蛋白来验证PCR和ACR测量结果。
