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What Does The Protein-to-creatinine Ratio Indicate?
Question: Dear Dr Naval
Its me xxxxxxxx after a long time. Just wanted to inform you that things were going well for my son in the sense the value of urine protien creat ratio was in the range 143 194 but last time it was 330. As u had advised we were to do a 24 hr protien this time. Just to remind you that there was a variation in the value of this ratio in a gap of 1 day by about 700. May be thats because of variation in createnine due to hydration.
Now when i asked our nephro about 24 hr protein he said the ratio gives the same result. Then my question is the variation we saw in the past within a gap of one day , is that possible?
And does the 24 hr protein has also this createnine in picture?
xxxxxxxxxxxxx
Its me xxxxxxxx after a long time. Just wanted to inform you that things were going well for my son in the sense the value of urine protien creat ratio was in the range 143 194 but last time it was 330. As u had advised we were to do a 24 hr protien this time. Just to remind you that there was a variation in the value of this ratio in a gap of 1 day by about 700. May be thats because of variation in createnine due to hydration.
Now when i asked our nephro about 24 hr protein he said the ratio gives the same result. Then my question is the variation we saw in the past within a gap of one day , is that possible?
And does the 24 hr protein has also this createnine in picture?
xxxxxxxxxxxxx
Brief Answer:
lupus Nephritis
Detailed Answer:
Good morning xxxxxxxxxxx
Sorry for the delayed reply. Just got tagged in and so I realized the question came for me.
Good to hear from you and I hope your kid is doing fine out there.
Well, there is always a variation in UPCR but nephrologist still like to observe that. It is a more of a difference of opinion. Rheumatologist use it as a good screening tool but not to monitor the disease progression. For us, we still prefer 24 hour urine protein as it quantifies the leakage. Protein improvement takes the most time to recover but at least from quantification we know it is not getting worse.UPCR from 149 to 330 and to 700 and then returning to normal are a bit unusual. Either the method or the kit they are using could be faulty. SO we dont know who to rely on.
We can do 24 hour creatinine in the urine as well, but in Lupus nephritis if his creatinine is ok, we dont need to monitor it. It is more of leakage of proteins and the presence of RBCs and casts which are of concern.
When is your next appointment with the rheumatologist.?? I hope rest of the things are fine
REgards
Dr Naval
lupus Nephritis
Detailed Answer:
Good morning xxxxxxxxxxx
Sorry for the delayed reply. Just got tagged in and so I realized the question came for me.
Good to hear from you and I hope your kid is doing fine out there.
Well, there is always a variation in UPCR but nephrologist still like to observe that. It is a more of a difference of opinion. Rheumatologist use it as a good screening tool but not to monitor the disease progression. For us, we still prefer 24 hour urine protein as it quantifies the leakage. Protein improvement takes the most time to recover but at least from quantification we know it is not getting worse.UPCR from 149 to 330 and to 700 and then returning to normal are a bit unusual. Either the method or the kit they are using could be faulty. SO we dont know who to rely on.
We can do 24 hour creatinine in the urine as well, but in Lupus nephritis if his creatinine is ok, we dont need to monitor it. It is more of leakage of proteins and the presence of RBCs and casts which are of concern.
When is your next appointment with the rheumatologist.?? I hope rest of the things are fine
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
We are going for a 24 hr protein today and will get the report by tomorrow. We have an appointment with Dr XXXXXXX our ped. rheumatologist on 31st.
Brief Answer:
24 hour protein
Detailed Answer:
Dear xxxxxxxxxxxxx
DO let me know that report. But I do feel there is nothing much to worry at this stage.
Is it XXXXXXX from XXXXXXX XXXXXXX Delhi???
DO let me know the reports.
REgards
Dr Naval
24 hour protein
Detailed Answer:
Dear xxxxxxxxxxxxx
DO let me know that report. But I do feel there is nothing much to worry at this stage.
Is it XXXXXXX from XXXXXXX XXXXXXX Delhi???
DO let me know the reports.
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Yes your guess is right. Dr XXXXXXX from Gangaram. Please find the report.
Brief Answer:
24 hour protein result
Detailed Answer:
Dear xxxxxxxxxxxxxxx
the result is absolutely fine. Even the PCR ratio is in normal limits and the leakage seems to have subsided.
I am quite happy to see the results and there wont be a need to step up the therapy from here. He should continue the same drugs and maybe over time we can taper it to minimum dose needed.
Do let me know what XXXXXXX says. Give my regards to her...
All in all, Satisfactory results from my side...Not sure what your nephrologist will be expecting. :)
REgards
Dr Naval
24 hour protein result
Detailed Answer:
Dear xxxxxxxxxxxxxxx
the result is absolutely fine. Even the PCR ratio is in normal limits and the leakage seems to have subsided.
I am quite happy to see the results and there wont be a need to step up the therapy from here. He should continue the same drugs and maybe over time we can taper it to minimum dose needed.
Do let me know what XXXXXXX says. Give my regards to her...
All in all, Satisfactory results from my side...Not sure what your nephrologist will be expecting. :)
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Dear dr Naval
Thanks u will not believe the amount of satisfaction we get seeing your mail. On the other front i was bit confused for the points mentioned below.
1. We were on the tapperimg down path of the steroid due to which micophenolate was increased to 2 gm per day. Accoding to Dr XXXXXXX we would have come to less than 10 mg per day of steroid @ 2.5mg reduction per 10 days. But our nephro has made us reduce 2.5 mg every 14 days moreover he has made us stay in 12.5mg for whole last month and still not ready to reduce till next month. Then what whould be the use of increasing mocophenolate to 2 gm per day if we cannot reduce steroid? Actually we followed our nephro as he being in baroda. But i think i will fully switch over to dr XXXXXXX
2. He said that 24 hr protein and spot protein results are same. Its very simple to understand that the average of the whole days urine gives a far accurate result than a spot value. We have seen in the past that the spotratio variation is in the range of 700 within 12 hrs tested from the same lab. We can do spot on regular basis but can do a 24hr once in 4-6 months.
3. On yesterdays report I feel the range of 24 hr protein is not the one as its mentioned below the report. as its for albumin. Is the range for albumin and total protein same? Moreover when the protein conc is 6.4 mg/dL is in the normal range, how did the total protein go five times more than the normal value? Is it because the range mentioned is for albumin?
Sorry i am bothering u can take your time to answer them.
Thanks
xxxxxxxxxxx
Thanks u will not believe the amount of satisfaction we get seeing your mail. On the other front i was bit confused for the points mentioned below.
1. We were on the tapperimg down path of the steroid due to which micophenolate was increased to 2 gm per day. Accoding to Dr XXXXXXX we would have come to less than 10 mg per day of steroid @ 2.5mg reduction per 10 days. But our nephro has made us reduce 2.5 mg every 14 days moreover he has made us stay in 12.5mg for whole last month and still not ready to reduce till next month. Then what whould be the use of increasing mocophenolate to 2 gm per day if we cannot reduce steroid? Actually we followed our nephro as he being in baroda. But i think i will fully switch over to dr XXXXXXX
2. He said that 24 hr protein and spot protein results are same. Its very simple to understand that the average of the whole days urine gives a far accurate result than a spot value. We have seen in the past that the spotratio variation is in the range of 700 within 12 hrs tested from the same lab. We can do spot on regular basis but can do a 24hr once in 4-6 months.
3. On yesterdays report I feel the range of 24 hr protein is not the one as its mentioned below the report. as its for albumin. Is the range for albumin and total protein same? Moreover when the protein conc is 6.4 mg/dL is in the normal range, how did the total protein go five times more than the normal value? Is it because the range mentioned is for albumin?
Sorry i am bothering u can take your time to answer them.
Thanks
xxxxxxxxxxx
Brief Answer:
Pertaining to queries
Detailed Answer:
Good evening xxxxxxxxxxxx
Pertaining to your queries:
1. Well, I feel you can reduce the dose of steroids now.You have been on higher dose for quite a while and I really dont see the point in continuing 12.5 mg especially when the protein leakage is almost near normal. Little bit can persist for a while as the inflammation in kidneys can leave a bit of damage behind which will cause protein to leak for a while. It will affect his growth if we continue so much dose. You can discuss with Dr Manajri and come down to 10 and eventually 7.5 and 5 mg. MMF is doing it s bit
2. Nephrologist do believe in Urinary PCR, but once we have quantified for a day that still remains the gold standard. You can check with the UK guidelines as well. Urinary PCR is just a good test for spot screening. It never really quantifies the exact leakage
3. 24 hour protein checked is the albumin only as in nephritis there is selective protein loss which is the albumin. They mention in the report as protein, but it is the albumin leakage which is checked. Even in serum one needs to check for albumin than the total protein. His value is 150 mg which is almost reaching normal. So you can take it easy for now and continue same medications. Taper steroids and do monitor for any relapses
DO let me know for more queries
REgards
Dr Naval
Pertaining to queries
Detailed Answer:
Good evening xxxxxxxxxxxx
Pertaining to your queries:
1. Well, I feel you can reduce the dose of steroids now.You have been on higher dose for quite a while and I really dont see the point in continuing 12.5 mg especially when the protein leakage is almost near normal. Little bit can persist for a while as the inflammation in kidneys can leave a bit of damage behind which will cause protein to leak for a while. It will affect his growth if we continue so much dose. You can discuss with Dr Manajri and come down to 10 and eventually 7.5 and 5 mg. MMF is doing it s bit
2. Nephrologist do believe in Urinary PCR, but once we have quantified for a day that still remains the gold standard. You can check with the UK guidelines as well. Urinary PCR is just a good test for spot screening. It never really quantifies the exact leakage
3. 24 hour protein checked is the albumin only as in nephritis there is selective protein loss which is the albumin. They mention in the report as protein, but it is the albumin leakage which is checked. Even in serum one needs to check for albumin than the total protein. His value is 150 mg which is almost reaching normal. So you can take it easy for now and continue same medications. Taper steroids and do monitor for any relapses
DO let me know for more queries
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The answers u gave are excellent. Thanks somuch
The only reason i had a doubt about albumin is because in the past it had happened that we had been in this lab with prescription of another doc asking albumin to createnine ratio. The lab guy told me its different then PCR and the ranges are also different. I checked with our nephro and he said some people track with PCR and some with albumin to creat ratio. But you can get the PCR done. Thats thebreason for my doubt.
Thanks anyway and i am tryimg to contact dr XXXXXXX for the reduction
Regards
xxxxxxxxxxx
The only reason i had a doubt about albumin is because in the past it had happened that we had been in this lab with prescription of another doc asking albumin to createnine ratio. The lab guy told me its different then PCR and the ranges are also different. I checked with our nephro and he said some people track with PCR and some with albumin to creat ratio. But you can get the PCR done. Thats thebreason for my doubt.
Thanks anyway and i am tryimg to contact dr XXXXXXX for the reduction
Regards
xxxxxxxxxxx
Brief Answer:
PCR Ratio
Detailed Answer:
Good evening
Well, nah it is mostly the same
Yeah meet her and decide the further course. She s quite good at her work. Pay my regards to her..:)
DO let me know for any doubts
Regards
Dr Naval
PCR Ratio
Detailed Answer:
Good evening
Well, nah it is mostly the same
Yeah meet her and decide the further course. She s quite good at her work. Pay my regards to her..:)
DO let me know for any doubts
Regards
Dr Naval
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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