Assessment of The Use of Urinary Protein-Creatinine-Ratio Versus Urinary Albumin-Creatinine-Ratio in Detecting Albuminuria Among Type 2 Diabetes Mellitus Patients in FCT Nigeria
Keywords:
Albuminuria, Proteinuria, Type 2 DM, Diabetic Nephropathy, End-stage renal disease, FCTAbstract
Urinary Albumin Creatinine Ratio (UACR) is the recommended reference method for detecting and monitoring diabetic nephropathy (DN). However, this method is very expensive and not readily available in resource-limited settings. As a result, this study assessed the likelihood for Urinary Protein Creatinine Ratio (UPCR) to serve as an alternative tool by evaluating its diagnostic performance against UACR. This study also assessed how UPCR detects DN at various other cut-off limits as against the commonly used 150 mg/g threshold. A total of 136 confirmed T2DM patients in FCT Nigeria were recruited for the study. Their UPCR and UACR were calculated from measuring the Urinary Protein, Urinary Albumin and Urinary Creatinine concentrations. UPCR diagnostic performance was assessed and a possible optimal threshold of UPCR was determined as against UACR. Results showed that UPCR was readily available and four times cheaper than UACR, which was available in only 42.9% of laboratories surveyed. An optimal UPCR threshold was established at 186 mg/g, yielding a Receiver Operating Curve of 71.8%. This threshold showed better agreement with UACR (Cohen's kappa = 0.456) than the standard 150 mg/g guideline (Cohen kappa = 0.353). UPCR demonstrated moderate diagnostic performance and may be useful as an initial screening tool for diabetic nephropathy in resource-limited settings. A cut-off threshold of 186 mg/g appears to be more appropriate for the studied population and supports a two-step protocol: initial UPCR screening followed by UACR confirmation for positive cases.
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