Tjandrawati, A
Indonesian Rheumatology Association

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Correlation of Random Urine Protein Creatinine (P-C) Ratio with 24-Hour Protein Urine in Lupus Nephritis Patients Aini, Y H; Tjandrawati, A; Suraya, N; Hamijoyo, Laniyati
Indonesian Journal of Rheumatology Vol 8, No 1 (2016)
Publisher : Indonesian Rheumatology Association

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Abstract

Background : Systemic lupus erythematosus (SLE) is a systemic autoimmune disease involving multiple organs including kidney and known as lupus nephritis (LN). Lupus nephritis has a poor prognosis after a 10-years onset, more than 25% will be ended by end stage renal disease. There are glomerular and tubulointerstitial tissue damages due to immune complex deposits in LN which is activating inflamation cascade and causing disfunction of glomerular filtration and tubular reabsorption resulting proteinuria. In LN, proteinuria is used to diagnose, to assess the disease activity and to monitor the therapy. The gold standard of proteinuria is 24-hour urine protein examination, but the process ofcollecting in 24 hour urine is difficult, then the result is less accurate and reliable. Another alternative parameter is spot urine protein/creatinine ratio. Several studies have found a positive correlation between spot urine protein/creatinine ratio and 24-hour urine protein levels, but in LN, the results are various.Objective: The aim of this study was analyzing the correlation between spot urine protein/creatinine ratio and 24-hour urine protein in lupus nephritis.Methods: The study was conducted at Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia in October 2014 to December 2014. The subjects were 45 patients with lupus nephritis based on the criteria of the American College of Rheumatology. The study analyzedcorrelation through cross-sectional model. Results: The results of Spearman correlation test analysis showed a significantly strong positive correlation between spot urine protein/creatinine ratio and 24-hour urine protein levels in lupus nephritis (rs =0.96; p <0.001). Based on the degree of proteinuria there was a strong positive correlation between spot urine protein/creatinine ratio and 24-hour urine protein levels in lupus nephritis significantly on the degree of protein <1 g/24-h (rs = 0.91; p <0.001) and at 1–3.5 g/24-h (rs = 0.73; p<0.05).Conclusion : There is a significant strong positive correlation between spot urine protein/creatinine ratio and the 24-hour urine protein levels in lupus nephritis, so it is recommended to use spot urine protein/creatinine ratio, as an alternative quantitative examination in lupus nephritis.Keywords: lupus nephritis, 24-hour urine protein, spot urine protein/creatinine ratio
Validity test of anti-c1q serum as diagnostic marker for lupus nephritis Enrica, M; Tjandrawati, A; Rachmayati, S; Hamijoyo, Laniyati
Indonesian Journal of Rheumatology Vol 8, No 1 (2016)
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (276.891 KB)

Abstract

Background: Lupus nephritis is defined as renal involvement in systemic lupus erythematosus (SLE) patients and the most important cause of morbidity and mortality. The diagnostic criteria that used to diagnose lupus nephritis are 1997 American Collegeof Rheumatology is 24 hours urine protein ≥500 mg and/or cellular cast, but significant renal damage can occur without proteinuria or cellular cast. Anti-C1q is an autoantibody that is produced by a chronic alteration of C1q collagen domain. Anti-C1q is a new specific marker for renal marker.Objective: To determine the validity of anti-C1q serum by using 1997 American College of Rheumatology criteria as a gold standard. Methods: This is a cross sectional study, conducted in October to December 2014 at Hasan Sadikin Hospital Bandung. The subjects had systemic lupus erythematosus with and without renal involvement, based on 1997 American College of Rheumatology criteria for SLE.Results: There were 65 subjects included in this study, 64 subjects were female and 1 subject was male. The age average was 32 (SD 11.7) years old. As many as 66.2% subjects had been diagnosed with lupus erythematosus systemic at least 3 years. Twenty four hours urine protein was measured using spectrophotometry, urine sediment was examinedfor cellular cast, and anti-C1q serum was measured using micro enzyme linked immunosorbent assay. Based on American College of Rheumatology criteria, 34 subjects were classified as lupus nephritis group while 31 subjects were classified as non-lupus nephritis group. The area under the curve of anti-C1q was 0.610. The cut-off value used in this study was 10.43 U/ml. The sensitivity, specificity, positive predictive value,negative predictive value and accuracy of anti-C1q assay were 41.18%, 77.42%, 66.67%, 54.55% and 58.46% respectively.Conclusion: Anti-C1q assay, based on this study, hasa low sensitivity and medium specificity to detect lupusnephritis