Diagnostic accuracy of urinary spot protein:creatinine ratio for proteinuria in hypertensive pregnant women: systematic review

doi:10.1136/bmj.39532.543947.BE

BMJ 2008;336:1003-1006 (3 May), doi:10.1136/bmj.39532.543947.BE (published 10 April 2008)

Research

Diagnostic accuracy of urinary spot protein:creatinine ratio for proteinuria in hypertensive pregnant women: systematic review

Anne-Marie Côté, obstetric medicine fellow¹, Mark A Brown, professor of medicine², Elaine Lam, medical student¹, Peter von Dadelszen, associate professor of obstetrics and gynaecology³, Tabassum Firoz, resident internal medicine¹, Robert M Liston, professor and chair in obstetrics and gynaecology³, Laura A Magee, clinical associate professor of medicine³

¹ BC Women’s Hospital and Health Centre, Vancouver, BC, Canada, ² St George Hospital and University of New South Wales, Kogarah, Sydney, NSW, Australia, ³ Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada V6H 3N1

Correspondence to: L A Magee, BC Women’s Hospital and Health Centre, Vancouver, BC, Canada V6P 1S8 LMagee{at}cw.bc.ca

Objective To review the spot protein:creatinine ratio and albumin:creatinineratio as diagnostic tests for significant proteinuria in hypertensivepregnant women.

Design Systematic review.

Data sources Medline and Embase, the Cochrane Library, referencelists, and experts.

Review methods Literature search (1980-2007) for articles ofthe spot protein:creatinine ratio or albumin:creatinine ratioin hypertensive pregnancy, with 24 hour proteinuria as the comparator.

Results 13 studies concerned the spot protein:creatinine ratio(1214 women with primarily gestational hypertension). Nine studiesreported sensitivity and specificity for eight cut-off points,median 24 mg/mmol (range 17-57 mg/mmol; 0.15-0.50 mg/mg). Laboratoryassays were not well described. Diagnostic test characteristicswere recalculated for a cut-off point of 30 mg/mmol. No significantheterogeneity in cut-off points was found between studies overa range of proteinuria. Pooled values gave a sensitivity of83.6% (95% confidence interval 77.5% to 89.7%), specificityof 76.3% (72.6% to 80.0%), positive likelihood ratio of 3.53(2.83 to 4.49), and negative likelihood ratio of 0.21 (0.13to 0.31) (nine studies, 1003 women). Two studies of the spotalbumin:creatinine ratio (225 women) found optimal cut-off pointsof 2 mg/mmol for proteinuria of 0.3 g/day or more and 27 mg/mmolfor albuminuria.

Conclusion The spot protein:creatinine ratio is a reasonable"rule-out" test for detecting proteinuria of 0.3 g/day or morein hypertensive pregnancy. Information on use of the albumin:creatinineratio in these women is insufficient.

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to Technorati Technorati What's this?

Relevant Articles

Assessment of proteinuria in pregnancy: Lucy C Chappell and Andrew H Shennan
BMJ 2008 336: 968-969. [Extract] [Full Text] [PDF]

Eclampsia in the United Kingdom: K A Douglas and C W G Redman
BMJ 1994 309: 1395-1400. [Abstract] [Full Text]

This article has been cited by other articles:

Magee, L. A (2008). Albumin:creatinine ratio using an automated analyser was accurate for diagnosing proteinuria in pregnancy. Evid. Based Med. 13: 119-119 [Full text]
Chappell, L. C, Shennan, A. H (2008). Assessment of proteinuria in pregnancy. BMJ 336: 968-969 [Full text]

Rapid Responses:

Read all Rapid Responses

Could Cystatin C improve the detection of Pre-eclampsia ?: Prof. Enrique J. S�nchez-Delgado MD
bmj.com, 16 Apr 2008 [Full text]
Proteinuria in Pregnancy: Muthukrishnan Jayaraman
bmj.com, 7 May 2008 [Full text]
Proteinuria in pregnancy; not always pre-eclampsia: Clara J Day, et al.
bmj.com, 8 May 2008 [Full text]
Optimal cut-off point for protein:creatinine ratio: Shehnaaz Jivraj, et al.
bmj.com, 19 May 2008 [Full text]