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

doi:10.1136/bmj.39532.543947.BE

BMJ, 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.

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Chappell, L. C, Shennan, A. H (2008). Assessment of proteinuria in pregnancy. BMJ 336: 968-969 [Full text]

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