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Protein Creatinine Ratio (PCR) - Spot Sample
Kidney
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No Fasting Required
Details
Evaluates protein loss in urine normalized to creatinine; used in diagnosing and monitoring kidney disease.
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Protein Creatinine Ratio (PCR) - Spot Sample
- Why is it done?
- Measures the amount of protein in a single urine sample relative to creatinine concentration to detect and quantify proteinuria (protein in urine)
- Screening and diagnosis of kidney disease, particularly in patients with diabetes, hypertension, or systemic disease
- Monitoring kidney function in patients with known chronic kidney disease (CKD) or diabetic nephropathy
- Assessment of proteinuria progression and response to treatment
- Evaluation of patients with persistent microscopic or macroscopic hematuria
- Preferred screening test during pregnancy to detect preeclampsia or gestational proteinuria
- Typically performed during routine physical examinations or when kidney disease is suspected
- Normal Range
- Reference Range: Less than 30 mg/mmol creatinine (or <30 mg/g creatinine)
- Units of Measurement: mg/mmol creatinine (SI units) or mg/g creatinine (conventional units)
- Albumin-to-Creatinine Ratio (ACR) - Alternative: Less than 2.5 mg/mmol for men; less than 3.5 mg/mmol for women
- Normal Result: PCR <30 mg/mmol indicates normal kidney function with absent or minimal proteinuria, suggesting no significant protein loss in urine
- Abnormal Result: PCR ≥30 mg/mmol indicates proteinuria and suggests kidney dysfunction, disease process, or other medical conditions requiring further investigation
- Interpretation
- PCR <30 mg/mmol (Normal/Negative): Indicates normal protein excretion and generally healthy kidney function; absence of clinically significant proteinuria
- PCR 30-300 mg/mmol (Microalbuminuria/Mild Proteinuria): Suggests early kidney disease or early-stage diabetic nephropathy; requires follow-up testing and medical intervention to prevent progression
- PCR >300 mg/mmol (Macroalbuminuria/Significant Proteinuria): Indicates substantial kidney damage, moderate to advanced chronic kidney disease, or active kidney disease requiring urgent medical attention and management
- Factors Affecting Results: Acute infection or fever, intense exercise, dehydration, menstrual cycle, pregnancy, hypertension, medications, urinary tract infection, or recent illness may temporarily elevate PCR; repeat testing recommended after resolution of acute conditions
- Clinical Significance: PCR is a sensitive marker of glomerular filtration barrier dysfunction; persistent proteinuria indicates progressive kidney disease requiring treatment with ACE inhibitors or ARBs to slow disease progression and prevent kidney failure
- Serial Measurements: Multiple measurements over time are more clinically meaningful than single measurements to establish disease trajectory and treatment response
- Associated Organs
- Primary Organ System: Kidneys and urinary system; specifically the glomeruli (filtering units of the kidney)
- Common Conditions Associated with Abnormal Results:
- Type 1 and Type 2 diabetes mellitus with diabetic nephropathy
- Hypertension and hypertensive nephrosclerosis
- Glomerulonephritis (various types including IgA nephropathy, membranous nephropathy, lupus nephritis)
- Chronic kidney disease (CKD) stages 1-5
- Systemic lupus erythematosus (SLE) and other autoimmune diseases
- Polycystic kidney disease
- Preeclampsia and eclampsia during pregnancy
- Vasculitis syndromes affecting kidney vasculature
- Amyloidosis affecting kidney tissue
- Potential Complications of Abnormal Results:
- Progressive decline in glomerular filtration rate (GFR) leading to acute or chronic kidney failure
- End-stage renal disease (ESRD) requiring dialysis or transplantation
- Cardiovascular complications including hypertension, myocardial infarction, and stroke
- Fluid and electrolyte imbalances
- Anemia and bone disease (renal osteodystrophy)
- Follow-up Tests
- Recommended Follow-up Testing if PCR is Abnormal:
- Serum creatinine and estimated glomerular filtration rate (eGFR) to assess overall kidney function
- Blood urea nitrogen (BUN) to evaluate kidney function and protein metabolism
- 24-hour urine protein collection for comprehensive proteinuria quantification and validation
- Albumin-to-creatinine ratio (ACR) as alternative or confirmatory test for proteinuria
- Complete metabolic panel (electrolytes, glucose, calcium, phosphorus) to assess overall metabolic status
- Hemoglobin A1C in diabetic patients to assess glycemic control
- Blood pressure monitoring and lipid profile to assess cardiovascular risk
- Urinalysis to examine for hematuria, casts, and other abnormalities
- Renal ultrasound or kidney imaging if kidney disease is suspected or confirmed
- Immunological testing (ANA, complement levels) if autoimmune disease is suspected
- Kidney biopsy if diagnosis remains unclear or rapid progression is observed
- Monitoring Frequency:
- Initial normal result: Repeat annually or per clinical guidelines for at-risk populations
- Microalbuminuria detected: Repeat testing within 3-6 months; confirm with repeat measurements
- Significant proteinuria detected: Repeat testing at 1-3 month intervals during initial diagnostic phase
- Established kidney disease: Monitor every 3-6 months depending on disease stage and treatment response
- Fasting Required?
- Fasting Requirement: No
- Specimen Collection: A random (spot) urine sample can be collected at any time of day; first morning urine is preferred and most commonly used due to more concentrated creatinine levels
- Patient Preparation Instructions:
- No special fasting requirements; patient may eat and drink normally before specimen collection
- Patient should maintain normal hydration status; extreme dehydration or excessive fluid intake may affect urine concentration and results
- Avoid strenuous exercise or intense physical activity for 24 hours before specimen collection as this may transiently increase protein excretion
- For women: Avoid testing during menstruation as this may contaminate the specimen and cause false results
- Use of clean-catch midstream collection technique to minimize bacterial contamination and prevent false positive results
- Medications to Continue:
- Continue all regular medications as prescribed unless otherwise instructed by physician; no medications need to be withheld for specimen collection
- Specimen Handling:
- Collect at least 30-50 mL of urine in a clean, sterile container provided by the laboratory
- Do not refrigerate specimen; deliver to laboratory within 2 hours of collection at room temperature
- Label specimen container clearly with patient identification, date, and time of collection
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