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Tim Ellam, Improving the interpretation of protein: creatinine ratios. The impact of creatinine excretion, Nephrology Dialysis Transplantation, Volume 26, Issue 3, March 2011, Pages 1108–1113, https://doi.org/10.1093/ndt/gfq739
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Sir,
I read with interest the article by Methven et al. [1] comparing albumin:creatinine ratio (ACR), total protein:creatinine ratio (PCR) and 24-hour urine protein. The sensitivity and specificity of PCR values for predicting 24-hour proteinuria have been reported in a number of papers and this constitutes the justification for PCR thresholds in current guidelines. Of particular interest in the study of Methven et al., however, is the finding that in spite of the overall good correlation found between PCR and 24-hour proteinuria, there was a marked change in performance of PCR thresholds across different gender and age groups (attributed to differences in creatinine excretion). It seems that previous publications correlating PCR and 24-hour proteinuria thresholds have obscured the importance of differences in creatinine excretion, leading to guidelines that are potentially flawed. A simple consideration of the Cockcroft-Gault equation makes it clear that creatinine excretion is predicted to be proportional to weight and (140 − age) [2,3]. The impact of gender is given by the appropriate gender-specific Cockcroft-Gault coefficient:
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