Dr. Abhishek Vadher*, Dr Chitralekha Vora, Dr. Jagruti Chandpa, Dr. Yogesh Malviya and
Gayatri Chudasama


Background: The first step in the screening and diagnosis of diabetic nephropathy is to look for proteinuria. Quantitative measurement of protein in a 24-hour urine collection remains the gold standard, since protein excretion may vary with the circadian rhythm. However, the 24 hour urine collection is cumbersome, inconvenient especially in female patients, is often incomplete and difficult to administer in outpatients and it is reported that 24 hour urine collection is unreliable in up to one third of the patients due to incomplete collection. An alternative method for quantitative evaluation of proteinuria is the measurement of urine protein to creatinine ratio. This study aims to evaluate the diagnostic value of P:C ratio in single voided urine sample for detection of proteinuria compared to that of a 24-hr sample in patients with diabetic nephropathy. Methods: The present study was carried in the department of General Medicine at Civil hospital affiliated with a government medical college, Gujarat after the approval from Institutional Ethical Committee (IEC).This was a cross sectional study in which 50 patients with diabetic nephropathy were taken.50 patients were taken who met the inclusion and the exclusion criteria. 24 hour urine sample was collected by instructing the participants to begin collection immediately after completion of first voiding in morning and to collect all urine into the same container having 5ml of 10% thymol in iso-propanol as a preservative for 24 hours. This was thoroughly mixed and a sample of 10 ml was taken for the estimation of proteins. On the next day, early morning second sample was collected. Approx 10 ml of mid stream urine was collected. This sample was used to test spot protein creat ratio. Urine creatinine was measured by modified Jaffe’s method and urine protein was measured by pyrogallol red modified fujita method. Results: In our study, the mean expected 24 hours urinary protein was 2.972 grams and standard deviation was 0.832. Estimated 24 hour urinary protein was 3.065 and standard deviation was 0.569. The correlation coefficient ratio was 0.851 with a p value of 0.03. In our study, in patients with minimal proteinuria, the correlation coefficient was 0.881 with a p value of 0.03 when estimated 24 hour urine protein was compared with expected 24 hour urine protein. In patients with moderate proteinuria, the correlation coefficient was 0.851 with a p value of 0.02. In patients with heavy proteinuria, the correlation coefficient ratio was 0.755 with a p value of 0.05. This shows that as the protein loss increases in urine, the correlation coefficient reduces showing that the correlation between expected 24 hour urinary protein measured from spot protein creat ratio and estimated 24 hour urinary protein decreases. Conclusion: There is no significant difference between expected and estimated 24 hours urine protein from both samples. The correlation is best in patients with mild and moderate degree of proteinuria and the correlation reduces when there is heavy proteinuria. Urine Protein Creatinine ratio is easy to perform, inexpensive,less time consuming and a very accurate method for measuring of proteinuria when compared to estimated 24 hours urinary protein.

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