Background. Proteinuria is a common pathological finding in renal disease. Examining the urinary protein electrophoretic pattern gives clues to the site of origin of the protein. We hypothesized that the type of proteinuria, classified by urine protein electrophoresis and immunofixation (uPEI), may be predicted by simply examining the proportion of higher molecular weight protein (e.g. albumin) in urine total protein content.

Methods. One thousand and eleven patients, whose urine had been sent to the pathology department for uPEI, were analysed for total protein and albumin to creatinine ratio (uPCR and uACR) and the ratio reported as the albumin to total protein ratio (uAPR). In a group of renal outpatients (n = 248), we also specifically measured tubular proteins (N-acetyl-β-D-glucosaminidase, NAG, and β₂-microglobulin) and expressed these as ratios to creatinine (uNCR and uβ₂CR). To validate these findings, we correlated these measurements with 68 patients in whom we also had renal biopsy data.

Results. In receiver operating characteristic (ROC) curve analysis, the AUC for uAPR was 0.84 for predicting tubular proteinuria pattern on uPEI. In the renal outpatient subgroup, uAPR predicted a tubular pattern of urinary protein equally as well as testing for specific tubular protein markers (uNCR and uβ₂CR). In the validation cohort, a uAPR cut-off of <0.40 was 88% sensitive and 99% specific for the diagnosis of primary tubulointerstitial disorders on renal biopsy.

Conclusions. Useful information about the origins of urinary protein may be inferred by measuring uAPR, the measurement of which is both simple and inexpensive.