Comparative study of 24-hour urinary protein and spot urine protein creatinine ratio in pre-eclamptic women


  • Rupakala B. M. Department of Obstetrics and Gynecology, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India
  • Akshata S. Hiremath Department of Obstetrics and Gynecology, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India



24-Hour urine protein, Spot urine protein creatinine ratio, Pre-eclampsia


Background: The aim of the study was to evaluate the ability of the random urine P/C ratio to predict significant proteinuria, as well as to introduce a diagnostic test for pre-eclampsia which will avoid the inconvenience and time consumption of 24-hour urine protein collection. The objective of this study was to compare spot urine protein- creatinine ratio with 24-hour urine protein for estimation of proteinuria in pre-eclampsia.

Methods: A total of 50 pregnant women with pre-eclampsia were prospectively studied for proteinuria in Rajarajeswari medical college and Hospital Bangalore for a period of 9 months from September 2018 to May 2019. Spot urine specimens for measuring P/C ratio were obtained immediately before 24-hour urine collection. The correlation between the spot urine P/C ratio and urinary protein excretion in the 24-hour collections was examined using the Spearman correlation test.

Results: PCR at a cut off value 0.15 g/mmol had sensitivity and specificity of 96.6% and 55% respectively. In prediction of proteinuria of 300 mg/24 hr positive predictive value and negative predictive value 76.3% and 91.6% respectively.

Conclusions: We found that there was a strong correlation between 24-hour urine protein excretion and spot urine protein creatinine ratio in pre-eclamptic women. Spot PCR can be used as a reasonable alternative to 24-hour urine protein test which is a cumbersome.


WHO. WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia: implications and actions. Geneva: WHO; 2014.

Duley L, Meher S, Abalos E. Management of pre-eclampsia. BMJ. 2006;332(7539):463-8.

Cote AM, Firoz T, Mattman A, Lam EM, von Dadelszen P, Magee LA. The 24-hour urine collection: gold standard or historical practice? Am J Obstet Gynecol. 2008;199(6):625.

Al RA, Baykal C, Karacay O, Geyik PO, Altun S, Dolen I. Random urine protein-creatinine ratio to predict proteinuria in new-onset mild hypertension in late pregnancy. Obstet Gynecol. 2004;104(2):367-71.

Boulware LE, Jaar BG, Tarver CME, Brancati FL, Powe NR. Screening for proteinuria in US adults: a cost- effectiveness analysis. JAMA. 2003;290(23):3101-14.

Durnwald C, Mercer B. A prospective comparison of total protein/creatinine ratio versus 24-hour urine protein in women with suspected preeclampsia. Am J Obstet Gynecol. 2003;189(3):848-52.

Haas DM, Sabi F, Namara M, Rivera AM. Comparing ambulatory spot urine protein/creatinine ratios and 24-h urine protein measurements in normal pregnancies. J Matern Fetal Neonatal Med. 2003;14(4):233-6.

Lindheimer MD, Kanter D. Interpreting abnormal proteinuria in pregnancy: the need for a more pathophysiological approach. Obstet Gynecol. 2010;115(2):365-75.

Saudan PJ, Brown MA, Farrell T, Shaw L. Improved methods of assessing proteinuria in hypertensive pregnancy. Br J Obstet Gynaecol. 1997;104(10):1159-64.

Bell SC, Halligan AW, Martin A, Ashmore J, Shennan AH, Lambert PC, et al. The role of observer error in antenatal dipstick proteinuria analysis. Br J Obstet Gynaecol. 1999;106:1177-80.

Rizk DE, Agarwal MM, Pathan JY, Obineche EN. Predicting proteinuria in hypertensive pregnancies with urinary protein-creatinine or calciumcreatinine ratio. J Perinatol. 2007;27:272-7.

Roudsari FV, Ayati S, Ayatollahi H, Shakeri MT. Protein/creatinine ratio on random urine samples for prediction of proteinuria in preeclampsia. Hypertens Pregnancy. 2012;31(2):240-2.

Sethuram R, Kiran TS, Weerakkody AN. Is the urine spot protein/creatinine ratio a valid diagnostic test for pre-eclampsia? J Obstet Gynaecol. 2011;31(2):128-30.

Christopher SL, Petri M, Astor BC, Fine D. Urine protein-to-creatinine ratio is a reliable measure of proteinuria in lupus nephritis. J Rheumatol. 2004;31(8):1557-9.

Chitalia VC, Kothari J, Wells EJ, Livesey JH, Robson RA, Searle M, et al. Cost-benefit analysis and prediction of 24-hour proteinuria from the spot urine protein-creatinine ratio. Clin Nephrol. 2001;55:436-47.

Xin G, Wang M, Jiao LL, Xu GB, Wang HY. Protein-to-creatinine ratio in spot urine samples as a predictor of quantitation of proteinuria. Clin Chim Acta. 2004;350(1):35-9.

Torng S, Rigatto C, Rush DN, Nickerson P, Jeffery JR. The urine protein to creatinine ratio (P/C) as a predictor of 24-hour urine protein excretion in renal transplant patients. Transplantation. 2001;72:1453-6.

Keane WF, Eknoyan G. Proteinuria, albuminuria, risk, assessment, detection, elimination (PARADE): a position paper of the National Kidney Foundation. Am J Kidney Dis. 1999;33(5):1004-10.

Robert M, Sepandj F, Liston RM, Dooley KC. Random protein-creatinine ratio for the quantitation of proteinuria in pregnancy. Obstet Gynecol. 1997;90(6):893-5.

Neithardt AB, Dooley SL, Borensztajn J. Prediction of 24-hour protein excretion in pregnancy with a single voided urine protein-to-creatinine ratio. Am J Obstet Gynecol. 2002;186(5):883-6.

Rodriguez TD, Lieberman ES. Use of a random urinary protein-to-creatinine ratio for the diagnosis of significant proteinuria during pregnancy. Am J Obstet Gynecol. 2001;185(4):808-11.

Yamasmit W, Chaithongwongwatthana S, Charoenvidhya D, Uerpairojkit B, Tolosa J. Random urinary protein-to-creatinine ratio for prediction of significant proteinuria in women with preeclampsia. J Matern Fetal Neonatal Med. 2004;16(5):275-9.

Zadehmodarres S, Razzaghi MR, Habibi G, Najmi Z, Jam H, Mosaffa N, Kaboosi M. Random urine protein to creatinine ratio as a diagnostic method of significant proteinuria in pre-eclampsia. Aust N Z J Obstet Gynaecol. 2006;46(6):501-4.

Wheeler TL, Blackhurst DW, Dellinger EH, Ramsey PS. Usage of spot urine protein to creatinine ratios in the evaluation of preeclampsia. Am J Obstet Gynecol. 2007;196(5):465.

Stout MJ, Scifres CM, Stamilio DM. Diagnostic utility of urine protein-to-creatinine ratio for identifying proteinuria in pregnancy. J Matern Fetal Neonatal Med. 2013;26(1):66-70.

Cote AM, Brown MA, Lam E, Dadelszen P, Firoz T, Liston RM, et al. Diagnostic accuracy of urinary spot protein:creatinine ratio for proteinuria in hypertensive pregnant women: systematic review. BMJ. 2008;336(7651):1003-6.

Morris RK, Riley RD, Doug M, Deeks JJ, Kilby MD. Diagnostic accuracy of spot urinary protein and albumin to creatinine ratios for detection of significant proteinuria or adverse pregnancy outcome in patients with suspected pre-eclampsia: systematic review and meta-analysis. BMJ. 2012;345.

Visintin C, Mugglestone MA, Almerie MQ, Nherera LM, James D, Walkinshaw S, et al. Management of hypertensive disorders during pregnancy: summary of NICE guidance. BMJ. 2010;341:2207.






Original Research Articles