Urinary Spot Albumin/Creatinine Ratio for Documenting Proteinuria in Women with Hypertensive Disorders with Pregnancy

Background: Although, twenty-four hour urine collection was considered the gold standard for quantification of proteinuria, it has many limitations. It is cumbersome for the patient and often inaccurate because of under collection and result availability is delayed for at least 24 hours. The spot albumin creatinine (A/C) ratio use in pregnancy has been extensively studied. Its use has been adopted by some authors as they found that it had been significantly correlated to 24 hour urinary protein estimation while others did not support its use as in cases of preeclampsia kidney function may deteriorate rapidly. Objective: To evaluate the accuracy of random urine albumin/creatinine ratio as a diagnostic method for quantitative evaluation of proteinuria in hypertensive disorders in pregnant women. Methods: A total of 70 patients fulfilling inclusion criteria were evaluated with urine albumin/creatinine ratio performed on random voided sample. The entire 24 hour urine sample was collected and analyzed for daily protein excretion. A/C ratio was compared to the 24 hour results. Results: There was significant positive correlation detected between A/C ratio and 24 hour protein at a cutoff value of 347.35 mg/gm. Area under curve for A/C ratio was 0.730 (P<0.001) showing sensitivity 80.6% and specificity 51.2% to detect protein excretion of 300 mg/24 hr. While, there was significant negative correlation detected between A/C ratio and urine creatinine. Conclusion: Random A/C ratio could be used as a rapid, easy and reliable test for diagnosis of significant proteinuria in hypertensive disorders with pregnancy, so it can substitute 24 hour urinary protein collection.