University of Tennessee Health Science Center, Memphis, Tennessee (K.S.).
Icahn School of Medicine at Mount Sinai, New York, New York (G.N.N.).
Ann Intern Med. 2020 Sep 15;173(6):426-435. doi: 10.7326/M20-0529. Epub 2020 Jul 14.
Although measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), total urine protein or dipstick protein is often measured instead.
To develop equations for converting urine protein-creatinine ratio (PCR) and dipstick protein to urine albumin-creatinine ratio (ACR) and to test their diagnostic accuracy in CKD screening and staging.
Individual participant-based meta-analysis.
12 research and 21 clinical cohorts.
919 383 adults with same-day measures of ACR and PCR or dipstick protein.
Equations to convert urine PCR and dipstick protein to ACR were developed and tested for purposes of CKD screening (ACR ≥30 mg/g) and staging (stage A2: ACR of 30 to 299 mg/g; stage A3: ACR ≥300 mg/g).
Median ACR was 14 mg/g (25th to 75th percentile of cohorts, 5 to 25 mg/g). The association between PCR and ACR was inconsistent for PCR values less than 50 mg/g. For higher PCR values, the PCR conversion equations demonstrated moderate sensitivity (91%, 75%, and 87%) and specificity (87%, 89%, and 98%) for screening (ACR >30 mg/g) and classification into stages A2 and A3, respectively. Urine dipstick categories of trace or greater, trace to +, and ++ for screening for ACR values greater than 30 mg/g and classification into stages A2 and A3, respectively, had moderate sensitivity (62%, 36%, and 78%) and high specificity (88%, 88%, and 98%). For individual risk prediction, the estimated 2-year 4-variable kidney failure risk equation using predicted ACR from PCR had discrimination similar to that of using observed ACR.
Diverse methods of ACR and PCR quantification were used; measurements were not always performed in the same urine sample.
Urine ACR is the preferred measure of albuminuria; however, if ACR is not available, predicted ACR from PCR or urine dipstick protein may help in CKD screening, staging, and prognosis.
National Institute of Diabetes and Digestive and Kidney Diseases and National Kidney Foundation.
虽然测量白蛋白尿是定义和分期慢性肾脏病（CKD）的首选方法，但通常会测量总尿蛋白或尿试纸蛋白。
建立将尿蛋白肌酐比（PCR）和尿试纸蛋白转换为尿白蛋白肌酐比（ACR）的方程，并检验其在 CKD 筛查和分期中的诊断准确性。
基于个体参与者的荟萃分析。
12 个研究队列和 21 个临床队列。
919383 例同日进行 ACR 和 PCR 或尿试纸蛋白检测的成年人。
建立了将尿 PCR 和尿试纸蛋白转换为 ACR 的方程，并用于 CKD 筛查（ACR≥30mg/g）和分期（分期 A2：ACR 为 30 至 299mg/g；分期 A3：ACR≥300mg/g）。
中位 ACR 为 14mg/g（队列的第 25 至 75 百分位数，5 至 25mg/g）。在 PCR 值小于 50mg/g 时，PCR 与 ACR 的相关性不一致。对于更高的 PCR 值，PCR 转换方程对筛查（ACR＞30mg/g）和分类为 A2 和 A3 阶段的敏感性分别为 91%、75%和 87%，特异性分别为 87%、89%和 98%。对于分别筛查 ACR 值大于 30mg/g 和分类为 A2 和 A3 阶段的尿试纸条痕或以上、痕至+和++类别，其敏感性分别为 62%、36%和 78%，特异性分别为 88%、88%和 98%。对于个体风险预测，使用 PCR 预测的 ACR 构建的估计 2 年 4 变量肾衰竭风险方程与使用观察到的 ACR 构建的方程具有相似的判别能力。
使用了多种 ACR 和 PCR 定量方法；并非总是在同一尿液样本中进行测量。
尿 ACR 是白蛋白尿的首选测量方法；然而，如果无法获得 ACR，则可使用 PCR 或尿试纸蛋白预测的 ACR 来帮助进行 CKD 的筛查、分期和预后。
美国国立卫生研究院国家糖尿病、消化和肾脏疾病研究所和美国国家肾脏基金会。
