Guest guest Posted October 17, 2005 Report Share Posted October 17, 2005 Pierre, your post reminded me again of something I have long wondered about. Elisabet's neph. has long maintained that the amount of protein is not as significant (to predict the future of kidney function/damage) as the protein to creatinine ratio. I have never heard anybody speak of that on this board. Have you ever heard this before? I am interested in your thoughts. I believe he is not just speaking of measurement techniques (24 hour vs. the pediatric ratio from a random sample), but the actual amount of protein in the urine vs. amount or protein divided by creatintine. He maintains the later is a better indicator of future kidney function. He further states that as long as the ratio is under 1, the kidneys are being protected, EVEN in the presence of significanly high proteinuria. I've never been quite sure I believe him, since I've never heard anything like that from the people on this site. Can you let me know what you think? Thanks so much Pierre, for all you do for all of us, B, Elisabet's mom > but, what isn't really known is at what level of proteinuria it > should be prescribed. There is no black and white answer for this. Does > having your proteinuria lowered to 1000 mg/day from 1500 mg/day protect from > progression of IgAN? Who knows. You would have to be taking the prednisone > for 25 years to find out, because that's how long it takes for IgAN to > " progress " to renal failure (I'm just using 25 as a convenient number here, > but it could be anywhere from 10 to 30 years or more). > > Pierre > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2005 Report Share Posted October 17, 2005 I think Elisabeth's neph is talking about protein/creatinine ratio as opposed to the amount of protein in spot urine samples. Protein/creatinine ratio is equivalent to obtaining 24 hour proteinuria from a 24 hour urine collection. Either is a more meaningful measure of measuring proteinuria with respect to its predictive value as a risk factor for progression to esrd than would be look simply at absolute protein in a spot urine sample. Just to be clear, protein/creatinine ratio gives the same information as proteinuria measured in a 24 hour urine sample. But, there is still no way whatsoever to correlate the amount of proteinuria to actual progression. It's just a risk factor, and the higher the proteinuria over a long period of time, the greater the risk. But there are other risk factors. Hypertension is a major one. Many people with IgAN reach esrd without ever having had heavy proteinuria. Pierre Re: Question for Pierre > Pierre, your post reminded me again of something I have long wondered > about. Elisabet's neph. has long maintained that the amount of > protein is not as significant (to predict the future of kidney > function/damage) as the protein to creatinine ratio. I have never > heard anybody speak of that on this board. Have you ever heard this > before? I am interested in your thoughts. > > I believe he is not just speaking of measurement techniques (24 hour > vs. the pediatric ratio from a random sample), but the actual amount > of protein in the urine vs. amount or protein divided by creatintine. > He maintains the later is a better indicator of future kidney > function. He further states that as long as the ratio is under 1, the > kidneys are being protected, EVEN in the presence of significanly high > proteinuria. I've never been quite sure I believe him, since I've > never heard anything like that from the people on this site. > > Can you let me know what you think? Thanks so much Pierre, for all > you do for all of us, > B, Elisabet's mom > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2005 Report Share Posted October 18, 2005 , A few comments on your message below. Firstly, I get my labs presented both the way you show below and with totals. You say the volume is 2.5l and the protein level is 447mg/l. Multiplying these gives a total protein of around 1.23g. With regards the ratio, the litre unit does drop out of the equation. My way of explaining it mathematically if this helps is: You are calculating: mg/l divided by mmol/l When you divide, the units on the right hand side swap over and the final units become: mg/l x l/mmol In other words, the litres bit cancels and you end up with mg/mmol. I make the 51mg/mmol spot on. OK then, how do you relate this value to total protein and is it any use? The comment Pierre has made before is that the higher it is, the higher your total protein. It is not an exact science but it is a good estimator. Some examples from my results, when I had a protein level of 1.3g, my ratio was 76, somewhat higher than yours. When my protein level was around 2.3g it was 136. So, the higher the protein the higher the ratio. But, if you are measuring the total volume and you know the protein per litre, you have the actual numbers anyway. I do not think that the ratio is therefore any use in this case. The point Pierre has made before is that the ratio can be used from a short term sample to estimate a 24- hour value as the creatinine level gives a urine concentration estimation. Hope I have not confused everyone or said anything totally incorrect! Ian Original Message: I'm not at all convinced by this as there is no allowance for volume, I'll use my own example here as maybe someone can explain it!! Last month after nagging my GP I had a 24 hour collection done for the first time, for some obtuse reason the path lab decided only to do a UPr:UCr rather than a total and the results were as follows UPr= 447mg/litre UCr= 8.7mmol/litre Ratio = 51mg/mmol Ok so far, in my school chemistry lessons Im sure it should be in mg/mmol/litre but that's by the by. The issue ladies and gentlemen of the jury is that my 24 hour sample was approx 2.75 litres... To my mind if we are saying that the ratio is equivilent to the 24hour loss then there was 447mg in the first litre and there would only of been 63mg in the remaining 1.75 litres, this, as Mr Spock wouldve said, is not logical Captain! Surely the actual loss is closer to 1.1g, I know its not huge but its my protein and I want it back or at the very least accounted for so as I can claim it back from the IRS!!! Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.