Analyze The Consistency Of Random Urine Protein And 24h Urine Protein In Patients With Chronic Kidney Disease

Objective:To analyze the consistency between random urine protein and 24h urine protein in patients with chronic kidney disease(CKD)at different time in the same day.Meanwhile,to explore whether random urine protein can accurately assess 24h urine protein,and to analyze the advantages and disadvantages of using urine creatinine to correct random urine protein,so as to provide reference for clinicians to accurately evaluate the urinary protein excretion level of patients with chronic kidney disease.Method:41 healthy volunteers and 117 patients with different stages of chronic kidney disease(CKD)were recruited and trained,the random urine and 24-hour urine were collected and the urine volume and excretion time were recorded accurately.The intraday variation of UPCR,ACR,UPro,UAlb and UCr in different populations was analyzed;The consistency of random urinary ACR,UPCR,with ACR-Mix and UPCR-Mix was analyzed;The patients were divided into groups according to the excretion level of UCr,and the accuracy of 24hUTP was evaluated under different UCr levels.Results:(1)The median intraday variation of random urine Upro,UAlb,UPCR and ACR in different populations were 40.5-52.0%,40.7-68.7%,18.6-28.9%and 17.7-38.6%,respectively,with large variation.(2)Calculate by ROC curve the Cutoff value of random urine ACR for different time periods corresponding to 30mg/24h and 300mg/24h for 24hUAlb is 10-36mg/g,224-360mg/g;The Cutoff value of random urine UPCR corresponding to 300mg/24h,500mg/24h,1000mg/24h of 24hUTP is 183-301mg/g,252-413mg/g,420-707mg/g,with great difference.(3)Passing-Babloc statistical results showed that the slope of the second urine regression equation was the closest to 1,and the confidence interval of the slope included 1,and the confidence interval of the intercept included 0.Bland-Altman results showed that the differences of ACR and UPCR between the second morning urine and 24-hour urine were the smallest,which were 5.3 mg/g and 2.47 mg/g,respectively,the confidence interval includes 0;The kappa value of the consistency of ACR and 24hUAlb classification was 0.71-0.85.(4)Among the patients with different urinary creatinine excretion levels,When the 24h UTP is 300mg/24h,1000mg/24h,2000mg/24h,3000mg/24h,the Cutoff value of the second urine UPCR is 230.5-426.5mg/g,452-1228mg/g,833-1929mg/g,1115.5-4122.5 mg/g,the difference is obvious.Conclusion:(1)Due to the large variation of random urine protein in different populations and the large difference Cutoff value in random urine,it will cause clinical interference.(2)When analyzing the quantitative consistency between random urine and 24h urine protein in different time periods,the second morning urine and 24h urine protein had the best consistency;When analyzing the consistency of random urine and 24h urine protein staging,the consistency between random urine and 24h urine staging in different time periods was better,and the consistency of morning urine and evening urine with 24h urine staging was the best.(3)24h urine protein will be overestimated after random urine protein is corrected by low urine creatinine.On the contrary,24h urine protein will be underestimated after random urine protein is corrected by hight urine creatinine.It is hoped to establish the corresponding Cutoff value for different levels of urine creatinine.