SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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R. Savoca1 , A.R. Huber1 , I.A.F.M. Heijnen1 , A. Bock 2

1Center for Laboratory Medicine, Kantonspital Aarau, CH-5001 Aarau, 2Division of Nephrology, Kantonspital Aarau, CH-5001 Aarau

Aim: Quantification of proteins in urine is widely used for the diagnosis and follow-up of renal disease. Proteins of different molecular weight are helpful for the diagnosis of tubular and glomerular damage. Initially these proteins were only determined in 24h urine. To circumvent the error-prone and laborious collection of 24h urine, most laboratories now use second morning urine to determine urine proteins divided by urine creatinine to compensate for diuresis. However, only scarce information about the comparability of the two sampling strategies is available. Therefore the aim of this study was to compare the protein per creatinine ratios in 24h versus second morning urine in renal transplant patients.
Methods: Total protein, creatinine, albumin, alpha-1-microglobulin (a-1-MG) and IgG (Dimension RXL and BNII, Dade Behring) in the second morning and 24h urines of 70 renal transplant patients were determined and compared using the Wilcoxon Matched-Pairs Signed-Ranks Test. To elucidate a possible role of antihypertensive drugs, 42 patients donated their second morning urine before taking the first daily dose.
Results: The protein to creatinine ratios were higher in second morning urine compared to 24h urine (albumin p < = 0.047, a-1-MG p < = 0.005, IgG p < =0.059) The comparison of urine protein of patients taking their antihypertensive medication before collecting the second morning urine showed no significant difference to the 24h urine values (p = 0.306-0.627) while the values of second morning urine before antihypertensive medication differed significantly (0.005-0.01).
Conclusion: Second morning urine may be used instead of 24h urine to differentiate proteinuria in renal transplant patients. However, it is important not to discontinue antihypertensive medications before urine donation to avoid falsely elevated values of albumin, IgG and alpha-1-microglobulin to creatinine ratios.

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