Abstract
About 20% of cases of chronic renal failure is due to diabetic nephropathy and is the most common cause of end stage renal disease (ESRD) in many countries. Proteinuria is an independent risk factor for renal diseases and a predictor of ESRD. For the diagnosis and management of chronic renal disease, accurate identification and quantification of proteinuria is very important. An increased proteinuria has both diagnostic and prognostic values in detection and confirmation of renal diseases and to assess response to therapy. Increased proteinuria is associated with an increased risk of progressive renal failure. The gold standard for the quantitative evaluation of proteinuria is the measurement of protein excretion in a 24hr urine sample. 24hr urine sample collection is an inconvenient method especially in outpatient setting. An alternate convenient method for evaluation of proteinuria is measurement of protein to creatinine ratio in a spot urine sample. There are a number of studies that show urine spot protein to creatinine ratio (urinary PCR) can replace 24hr urine protein estimation in the screening and evaluation of diabetic nephropathy.
Objectives
1) To determine the correlation of spot urine protein creatinine ratio (PCR) with 24 hr urine protein estimation in patients with type 2 diabetes mellitus.
2) To study the association of biochemical and clinical parameters like serum creatinine, eGFR , glycated hemoglobin, duration of diabetes, presence of diabetic retinopathy with urine PCR in patients with type 2 diabetes mellitus.
Methodology: The design of study is cross sectional study and the study population included Type II Diabetes Mellitus patients attending Medicine OPD, of either sex, in Govt. TDMC, Alappuzha for a period of 12 months from December 2015 to December 2016.The sample size is 73. 24hour urine protein and urine protein creatinine ratio was done in the study population.The patients were also evaluated for associated clinical and biochemical parameters. The data collected was analyzed using a standard statistical package-SPSS version 16.
Results: Seventy three patients with type 2 diabetes mellitus and proteinuria were studied. Maximum number of patients were noted in the age group 41-50 years. Males were more than females in the ratio of 2.04:1. The mean duration of diabetes was 9.24 +/- 6.1 yrs. Majority of patients had a duration of diabetes between 5 -10 yrs (52.05%).Ten patients (13.7%) did not have diabetic retinopathy. Twenty five patients (34.25%) had nephrotic range proteinuria. There was good correlation between urine PCR and 24 hr urine protein at different levels of GFR. The correlation in different levels of GFR were : (0-15 ) group : r = 0.784 , p = <0.001 , (15-30) group : r = 0.756 , p = <0.001, (30-60) group : r = 0.725 , p = <0.001 , >60 group : r = 0.99 , p = <0.001. Maximum correlation between urine PCR and 24 hr urine protein was seen in the GFR >60 group. There was good correlation between urine PCR and 24 hr urine protein at different ranges of proteinuria. The correlation in different levels of proteinuria were: <300 mg ( r= 0.93, P<0.001), 300-3500 mg (r= 0.632, P<0.001) and ≥3500 mg (r=0.783, P <0.001).Maximum correlation between urine PCR and 24 hr urine was seen in the proteinuria group <300 mg. No statistically significant correlation was found between HBA1C levels and degree of proteinuria. There was good correlation between degree of diabetic retinopathy and proteinuria. No significant correlation was found between duration of diabetes and urine PCR.
Conclusion: Spot urine protein creatinine ratio can replace 24 hr urine protein estimation in the screening and evaluation of diabetic nephropathy.
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Corresponding Author
Sharath Thomas Roy
Junior Resident, Department of General Medicine
Govt. T D Medical College, Alappuzha, Kerala
DOI: https://dx.doi.org/10.18535/jmscr/v6i6.69
