Random Urine Tests for

Proteinuria/Renal disorderProteinuria/Renal disorderClinical Chemistry LaboratoryClinical Chemistry Laboratory

4 August 2009

Mrs Bussakorn SuntisuklapponMrs. Bussakorn Suntisuklappon

UPCR (1) UPCR (1) UPCR U i P t i t C ti i R ti UPCR = Urine Protein to Creatinine Ratio

UPCR = Protein urine/ Creatinine urine

specimen = Random Urine

For quantification and monitoring of Proteinuria.

Reference Range = < 0.3 g/g.

UPCR (2) Example UPCR (2) Example

UACR (1) ( ) UACR = Urine Albumin to Creatinine Ratio

Or Microalbumin (MAU) in random urineOr Microalbumin (MAU) in random urine.

UACR = Albumin urine/ Creatinine urine

NKF recommends annual screening for

proteinuria in diabetics.

UACR (2) UACR (2) Early morning urine preferredEarly morning urine preferred.

A positive result must be comfirmed.

Reference range = < 30 mg/g (30-300 mg/g)

The UACR is significantly more expensive g y p

than UPCR.

UACR (3) UACR (3) The UACR is a more sensitive screening test The UACR is a more sensitive screening test

than the UPCR.

If P t i i i d t t d > 300 / It i If Proteinuria is detected > 300 mg/g. It is

inappropriate to measure the UACR and inappropriate to measure the UACR and

patients should be monitored using the UPCR.p g

UACR (4) Example UACR (4) Example

Flow chart for Evaluation of Proteinuria Evaluation of Proteinuria

Standard dipstick

> 1+ Trace/Neg

UPCR UACR (MAU)UPCR UACR (MAU)

0 3 / 30 / 300 /0.3 g/g < 0.3 g/g < 30 mg/g > 300 mg/g

Recheck at periodic health evaluationRecheck at periodic health evaluation

Diagnostic evalutionDiagnostic evalution

eGFR ( Estimate of Glomerular Filtration Rate) eGFR ( Estimate of Glomerular Filtration Rate)

*used for identification of moderate to severe decrease in *used for identification of moderate to severe decrease in

renal function and as a staging tool for Chronic Kidney

Disease ( CKD)

eGFR (mL/min/1.73 m2 ) = 186 x (Scr )-1.154 x (Age) -0.203 x (0.742

) ( ) ( )if female) x (1.212 if African-American) (conventional units)

GFR I t t ti

ั Interpretation

eGFR Interpretation

ระดั

บ

คา eGFR

(ml/min/1.73 m2 )

Interpretation

1 90 Normal or increased eGFR ( Stage 1 )

2 60 89 Kid d ith ild d d GFR ( St 2 )2 60-89 Kidney damage with mild decreased eGFR ( Stage 2 )

3 30-59 Moderate decreased eGFR ( Stage 3 )( g )

4 15-29 Severe decreased eGFR ( Stage 4 )

5 < 15 Kidney failure ( ESRD) or on dialysis ( Stage 5 )

Ne t** F P ?

Next…Tenofovir Phosphate loss !!!

** FeP ?

*** TmP/eGFR ??

Fractional Excretion of Phosphorus(FeP)Fractional Excretion of Phosphorus(FeP)

Ph h b i E i ll dPhosphorus reabsorption/Excretion are controlled by the kidney (the proximal tubule)

FeP ( % ) = Percent of the excretion of Ph h i th i l t b lPhosphorous in the proximal tubule

FeP ( % ) = Urine P x Plasma Creatinine x 100Pl P U i C ti i Plasma P x Urine Creatinine

Fractional Excretion of Phosphorus(FeP)Fractional Excretion of Phosphorus(FeP)

InterpretationIf > 20 % then suggests renal loss of PhosphorousPhosphorous.

Notice : If low phosphorous (in blood)Notice : If low phosphorous (in blood) and FeP > 10% then suggests renal loss of Phosphorous.

Renal tubular maximum reasorption rate of Renal tubular maximum reasorption rate of

phosphate to glomerular filtration rate (TmP/GFR)

TmP/GFR = Maximum reabsorption ofTmP/GFR Maximum reabsorption of Phosphate per unit volume of GFR

TmP/GFR = Plasma P - Urine P x Plasma Creatinine

Urine Creatinine

Renal tubular maximum reasorption rate of Renal tubular maximum reasorption rate of

phosphate to glomerular filtration rate (TmP/GFR)

Interpretation

Normal = 2.8 - 4.4 mg/dl

If reabsorb the renal tubular disorders

Th k Thank you