random urine tests for proteinuria/renal...
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Random Urine Tests for
Proteinuria/Renal disorderProteinuria/Renal disorderClinical Chemistry LaboratoryClinical Chemistry Laboratory
4 August 2009
Mrs Bussakorn SuntisuklapponMrs. Bussakorn Suntisuklappon
UPCR (1) UPCR (1) UPCR U i P t i t C ti i R ti UPCR = Urine Protein to Creatinine Ratio
UPCR = Protein urine/ Creatinine urine
specimen = Random Urine
For quantification and monitoring of Proteinuria.
Reference Range = < 0.3 g/g.
UACR (1) ( ) UACR = Urine Albumin to Creatinine Ratio
Or Microalbumin (MAU) in random urineOr Microalbumin (MAU) in random urine.
UACR = Albumin urine/ Creatinine urine
NKF recommends annual screening for
proteinuria in diabetics.
UACR (2) UACR (2) Early morning urine preferredEarly morning urine preferred.
A positive result must be comfirmed.
Reference range = < 30 mg/g (30-300 mg/g)
The UACR is significantly more expensive g y p
than UPCR.
UACR (3) UACR (3) The UACR is a more sensitive screening test The UACR is a more sensitive screening test
than the UPCR.
If P t i i i d t t d > 300 / It i If Proteinuria is detected > 300 mg/g. It is
inappropriate to measure the UACR and inappropriate to measure the UACR and
patients should be monitored using the UPCR.p g
Flow chart for Evaluation of Proteinuria Evaluation of Proteinuria
Standard dipstick
> 1+ Trace/Neg
UPCR UACR (MAU)UPCR UACR (MAU)
0 3 / 30 / 300 /0.3 g/g < 0.3 g/g < 30 mg/g > 300 mg/g
Recheck at periodic health evaluationRecheck at periodic health evaluation
Diagnostic evalutionDiagnostic evalution
eGFR ( Estimate of Glomerular Filtration Rate) eGFR ( Estimate of Glomerular Filtration Rate)
*used for identification of moderate to severe decrease in *used for identification of moderate to severe decrease in
renal function and as a staging tool for Chronic Kidney
Disease ( CKD)
eGFR (mL/min/1.73 m2 ) = 186 x (Scr )-1.154 x (Age) -0.203 x (0.742
) ( ) ( )if female) x (1.212 if African-American) (conventional units)
GFR I t t ti
ั Interpretation
eGFR Interpretation
ระดั
บ
คา eGFR
(ml/min/1.73 m2 )
Interpretation
1 90 Normal or increased eGFR ( Stage 1 )
2 60 89 Kid d ith ild d d GFR ( St 2 )2 60-89 Kidney damage with mild decreased eGFR ( Stage 2 )
3 30-59 Moderate decreased eGFR ( Stage 3 )( g )
4 15-29 Severe decreased eGFR ( Stage 4 )
5 < 15 Kidney failure ( ESRD) or on dialysis ( Stage 5 )
Fractional Excretion of Phosphorus(FeP)Fractional Excretion of Phosphorus(FeP)
Ph h b i E i ll dPhosphorus reabsorption/Excretion are controlled by the kidney (the proximal tubule)
FeP ( % ) = Percent of the excretion of Ph h i th i l t b lPhosphorous in the proximal tubule
FeP ( % ) = Urine P x Plasma Creatinine x 100Pl P U i C ti i Plasma P x Urine Creatinine
Fractional Excretion of Phosphorus(FeP)Fractional Excretion of Phosphorus(FeP)
InterpretationIf > 20 % then suggests renal loss of PhosphorousPhosphorous.
Notice : If low phosphorous (in blood)Notice : If low phosphorous (in blood) and FeP > 10% then suggests renal loss of Phosphorous.
Renal tubular maximum reasorption rate of Renal tubular maximum reasorption rate of
phosphate to glomerular filtration rate (TmP/GFR)
TmP/GFR = Maximum reabsorption ofTmP/GFR Maximum reabsorption of Phosphate per unit volume of GFR
TmP/GFR = Plasma P - Urine P x Plasma Creatinine
Urine Creatinine
Renal tubular maximum reasorption rate of Renal tubular maximum reasorption rate of
phosphate to glomerular filtration rate (TmP/GFR)
Interpretation
Normal = 2.8 - 4.4 mg/dl
If reabsorb the renal tubular disorders
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