Published: 2017-04-27

Diagnostic accuracy of spot urinary protein/creatinine ratio for proteinurea in pregnancy induced hypertension

Sami Jan, Chachoo Javaid, Nighat Firdous


Background: Hypertensive disorders are the most common medical complications of pregnancy with an incidence of 12-22% and are rampant globally. To assess the diagnostic accuracy of spot urinary protein-creatinine ratio keeping 24 hr urinary protein as gold standard in pregnancy induced hypertension.

Methods: Spot urinary protein-creatinine ratio was determined in a mid-stream urine sample. 24 hours, urine protein was measured. The correlation between the spot urinary protein-creatinine ratio and 24-hour urine protein amount was done. Sensitivity, specificity, positive predictive value and negative predictive value along with diagnostic accuracy was calculated from data.

Results: There was a strong correlation between the spot urinary protein-creatinine ratio and 24-hour urine protein excretion (pearson’s correlation coefficient r = 0.824; P <0.0001). The optimal spot P/C ratio cut off point was 0.33, for 300 mg/24 hours of protein excretion, with sensitivity and specificity of 82.8% and 76.1% respectively. Positive and negative predictive value are 58.8% and 91.5%.

Conclusions: Spot urine P/C ratio is an accurate, reliable and steady fast, timesaving test which can be used as an alternative method for evaluation of proteinuria in pregnancy induced hypertension and it can substitute 24 hours urinary protein excretion estimation in clinical practice.


24-hours urine proteinuria, Cutoff point, Urine protein-creatinine ratio

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Miranda AL, Acosta JM, Arauz FR. Protein/ creatinine ratio in random urine samples is a reliable marker of increased 24hr protein excretion in hospitalized Women with hypertensive disorders of pregnancy. J Clin Chem. 2007;53:1623.

Hennessy A, Makris A. Preeclamptic nephropathy. Nephrol. 2011;16:134-43.

Brown MA, Lindheimer MN, De Swiet M, Van Assche A, Moutquin JM. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregn. 2001;20:11-4.

Airoldi J, Weinstein L. Clinical significance of proteinuria in pregnancy. Obstet Gynecol Surv. 2007;62:117-24.

Thangaratinam S, Coomarasamy A, O'Mahony F, Sharp S, Zamora J, Khan KS, et al. Estimation of proteinuria as a predictor of complications of preeclampsia: a systematic review. BMC Med. 2009;7:10.

National Institute for Health and Clinical Excellence. Antenatal care: routine care for the healthy pregnant woman. (NICE clinical guideline 62.) NICE. Kuo VS, 2008. Available at /guidance/cg62.

Koumanantakis G, Gallery EDM. Proteinuria and its assessment in normal and hypertensive pregnancy. Am J Obstet Gynecol. 1992;167(3):723-8.

Meyer NL, Mercer BM, Friedman SA, Sibai BM. Urinary dipstick protein: a poor predictor of absent or severe proteinuria. Am J Obst Gynecol. 1994;170:137-41.

Waugh JJS, Bell SC, Kilby MD, Blackwell CN, Seed P, Shennan AH, et al. Optimal bedsideanalysis for the detection of proteinuria in hypertensive pregnancy: a study of diagnostic accuracy. Br J Obstet Gynaecol. 2005;112:412-7.

Côté AM, Firoz T, Mattman A, Lam EM, von Dadelszen P, Magee LA. The 24 hour urine collection: gold standard or historical practice? Am J Obst Gynecol. 2008;199:e1-6.

Waugh J, Bell SC, Kilby MD, Lambert P, Shennan AH, Halligan AWF. Urine proteinestimation in hypertensive pregnancy: which thresholds and laboratory assay best predict clinical outcome? Hypertens Pregnancy. 2005;24:291-302.

Steinhauslin F, Wauters JP. Quantitation of proteinuria in kidney transplant patients: accuracy of the protein/creatinine ratio. Clin Nephrol 1995;43:110-5.

Skweres T, Preis K, Ciepluch R, Mickiewicz K, Ginekol Pol. The value of a urine protein-to-creatinine ratio assessment in a single voided urine specimen in prediction of 24-hour proteinuria in pregnancy induced hypertension. Europe PMC Plus. 2006;77:415-21.

Amin A, Kiran N, Naeem, Ahmad F. Diagnostic accuracy of spot urinary protein; creatinine ratio for proteinuria in hypertensive pregnant women. SZPGMI. 2012;26(2):69-73.

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

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;189:848-52.

Cote AM, Brown MA, Lam E, Von 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.

Thomas L, Wheeler I, Dawn W, Blockhurst, Eric H, Dellinger, et al. Usage of spot protein to creatinine ratios in the evaluation of preeclampsia. AJOG. 2007;65:1-465e4.

Rahman MM, Azad K, Ahmed N, Haque MR, Wahab MA, Asad HB, et al. Spot morning urine protein creatinine ratio and 24 hours urinary total protein excretion rate. Mymensingh Med J. 2006;15:146-9.

Vural P, Akgul C, Canbaz M. Calcium and phosphate excreuon in preeclampsia Turkey. J Med Sci. 2000;30:39-42.

Bilgin T, Kutulu O, Kimya Y, Kucukkommurcu S, Uncu G. Urine calcium excretion in preeclampsia. J Gynecol Obstetrics. 2000;10:29-32.

Xiong X, Mayes D. Impact of pregnancy induced hypertension on fetal growth. Am J Obstet Gynecol. 1999;180(l):207-3.

Ivanov S, Ovav S. Association between the protein loss and the perinatal outcome in preeclamptic pregnant women. Journal of Akush Gineko. 2005;44(7):11-5 .

Majundar S, Dasgupta H, Bhattacharya K, Bhattacharya AJ. Morphological, histological and radiological study of calcified placenta and its relationship with fetal outcome. Anot Soc India. 2005;54(2):1-9.