What is the significance of a protein to creatinine ratio of 157, indicating proteinuria?

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Last updated: April 21, 2025View editorial policy

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From the Guidelines

A protein-creatinine ratio of 157 mg/g indicates mild proteinuria, which suggests some kidney dysfunction that requires medical attention. According to the National Kidney Foundation (NKF) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) position statement, a normal protein-creatinine ratio is typically less than 200 mg/g, with values above this threshold indicating proteinuria 1. Your value of 157 mg/g is slightly elevated, suggesting some degree of kidney dysfunction. This could be due to various conditions, including:

  • Early kidney disease
  • Diabetes
  • High blood pressure
  • Urinary tract infection
  • Temporary factors like strenuous exercise or fever

It is essential to consult with a healthcare provider for proper evaluation and management. Your doctor will likely recommend additional tests, such as:

  • A complete urinalysis
  • Blood tests to check kidney function
  • Possibly a 24-hour urine collection to confirm the finding

While waiting for your appointment, it is recommended to:

  • Maintain good hydration
  • Follow a balanced diet moderate in protein
  • Control blood pressure and blood sugar if you have hypertension or diabetes
  • Avoid medications that may harm the kidneys, like certain pain relievers

Proteinuria occurs when the kidney's filtering units (glomeruli) become damaged, allowing protein molecules that should remain in the blood to leak into the urine. Early detection and management can help prevent progression to more serious kidney disease, as highlighted in the position statement by the NKF and NIDDK 1.

From the FDA Drug Label

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From the Research

Protein Creatinine Ratio

  • A protein creatinine ratio of 157 is considered significant, as it indicates the presence of proteinuria, which is a common marker of kidney disease 2.
  • The protein creatinine ratio is a useful test for detecting and estimating proteinuria, with a cutoff value of >20 mg/mmol (0.2 mg/mg) commonly reported for detecting proteinuria 2.
  • A ratio value >350 mg/mmol (3.5 mg/mg) is often used to confirm nephrotic proteinuria, while a ratio of 30 mg/mmol (0.3 mg/mg) is recommended for the classification of proteinuria in pregnant women at risk of preeclampsia 2.

Comparison with Other Tests

  • The protein creatinine ratio has been compared to the albumin creatinine ratio (ACR) in various studies, with the protein creatinine ratio showing higher sensitivity and specificity for detecting significant proteinuria 3.
  • The relationship between ACR and protein creatinine ratio is non-linear, and the protein creatinine ratio is highly correlated with 24-h urine protein 3.
  • The choice of test depends on the clinical context, with semi-quantitative tests being easy to handle but having limitations, and quantitative methods having higher test accuracy but being more expensive and requiring access to a laboratory or electronic point of care device 4.

Clinical Significance

  • Proteinuria is a common marker of kidney disease, and the protein creatinine ratio is a useful test for detecting and estimating proteinuria 5, 2.
  • The presence of proteinuria is associated with a higher risk of kidney disease progression and cardiovascular disease, and early detection and treatment are crucial for preventing or slowing disease progression 5, 2.
  • The protein creatinine ratio can be used to monitor disease progression and response to treatment, with changes in the ratio indicating changes in proteinuria and kidney function 2, 3.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Assessing proteinuria in chronic kidney disease: protein-creatinine ratio versus albumin-creatinine ratio.

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2010

Research

Methods for Diagnosing Proteinuria: When to Use Which Test, and Why.

American journal of kidney diseases : the official journal of the National Kidney Foundation, 2024

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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