A diagnostic programme for quantitative analysis of proteinuria.

Abstract

A spectrum of quantitative methods was adapted to the Kone Specific Analyser for the purpose of recognizing, quantifying and differentiating various forms of proteinuria. Total protein, IgG, albumin and alpha 1-microglobulin (measured by turbidimetry), N-acetyl-beta-D-glucosaminidase activity and creatinine (measured photometrically), were measured in undiluted urine; in addition alpha 1-microglobulin was measured in serum. Within and between run precision, accuracy and linearity of the turbidimetric methods were in good agreement with nephelometric procedures. All turbidimetric methods exhibited a correlation coefficient r greater than 0.98 when compared with the radial immunodiffusion procedure as reference method. Total protein measured turbidimetrically with the Kone Specific Analyser was in good agreement with the manual biuret procedure. The low detection limits and linearities allowed quantification of urine analytes from the lower range of normals up to ten times the upper limit of normals. The measured analytes exhibited stability in urine at pH 4-8 over at least seven days at 4-6 degrees C and -20 degrees C. Only IgG showed a significant loss (up to 30 percent), when measured after storage at -20 degrees C. Quantities per mol creatinine showed significantly lower intra-individual and inter-individual variability than quantities per liter. In 31 normal persons, the intraindividual variation was lowest for N-acetyl-beta-D-glucosaminidase activity (13%) and highest for total protein (33%), when measured in the second morning urine on 5 consecutive days. When related to creatinine, results obtained in the second morning urine showed no significant differences from those in 24 h urine, except for alpha 1-microglobulin which gave lower values in 24 h urines. The upper normal limits, calculated as the 95% ranges, were determined from 154 urines of 31 individuals. Nearly all analytes showed an asymmetric distribution. Because of a wide tailing of the upper limit, preliminary upper normal limits were set above this range: (table; see text) Application of the newly adapted programme to unselected urines sent for urine analysis revealed a threefold increase in the proportion of results outside the normal ranges, compared with the routinely used protein test strip procedure. All additional positive urines exhibited either signs of glomerular or tubular proteinuria. Determination of albumin or N-acetyl-beta-D-glucosaminidase excretion was sufficient to detect these additional cases.