Pattern of ordering of tests for proteinuria by clinicians in broad and super specialities in medicine

Background -Protein creatinine ratio (PCR) and albumin creatinine ratio (ACR) in first morning or random urine samples and estimation of total protein in a 24-hour urine collection are tests commonly used in clinical practice for quantification of proteinuria. Different views exist on which of these is the best to be used for this purpose. The aim of this study was to study the pattern of ordering of tests for proteinuria by clinicians in broad and super specialities in medicine. Material and methods- Laboratory tests ordered for quantification of proteinuria during the period between Oct 1st and 7th 2014 were tabulated. Data for the study was obtained from the computerized hospital information processing system (CHIPS) and the Department of Clinical Biochemistry at Christian Medical College, Vellore. Tests ordered were classified into those from broad and super specialities in medicine. A further classification was done, based on whether the tests were ordered for purposes of screening, monitoring or confirmation of proteinuria. Results -Both types of specialities used ACR to similar extents and for screening purposes more than for monitoring of proteinuria. PCR was used more as a screening tool by the broad specialities and as monitoring tool by the super specialities. The broad specialities utilized ACR and PCR estimations to a greater extent than estimations of total protein in 24-hours urine collections, while the super specialities utilized the estimation of 24-hours urine protein more frequently than ACR and PCR. In the broad specialities, tests for proteinuria were found to be used for screening purposes to a greater extent than for monitoring or confirmation of proteinuria. The observations made in this study with respect to utilization of ACR and PCR by clinicians in both broad and super specialities were consistent with internationally accepted guidelines. Estimations of 24-hours urine protein was, however, seen to be utilized more as a screening tool by broad specialities, which is not recommended. This finding may be an outcome of the limitation of the methodology used, whereby classification of the tests done was based on laboratory reports, and not on patients medical records.