Effect of laboratory and sample storage factors on urinary protein:creatinine ratios and clinical decision making in cats

Abstract

AbstractBackgroundUrinary protein:creatinine ratio (UPC) results affect the diagnosis, prognosis, and therapy of chronic kidney disease in cats.ObjectivesTo investigate the interlaboratory and intralaboratory variability and the effect of storage on UPC and International Renal Interest Society (IRIS) proteinuria substaging in cats.AnimalsHealthy and diseased client‐owned cats.MethodsProspective study. Urine of 60 cats was randomly sent to 4 (of 9) participating laboratories (to assess interlaboratory variability) and per cat, 2 laboratories each received 2 aliquots (to determine intralaboratory variability). Samples of 23 cats were analyzed in the same laboratory the day of collection, after preservation at 22°C for 1 day and at 4°C during 1‐7 days (short‐term storage) and at −24°C and −80°C for 6‐12 months (long‐term storage). Storage conditions were compared by equivalence testing.ResultsUPCs showed good interclass correlation (ICC‐inter, 0.90) and excellent intraclass correlation (ICC‐intra, 0.99). However, in 30/60 (50%) cats at least 1 of 4 laboratories assigned a different IRIS proteinuria substage. Urinary protein:creatinine ratio remained stable with short‐term storage, but not after 6 months storage at −24°C and after 12 months storage at −24°C or −80°C. Long‐term storage caused a change in IRIS proteinuria substage in 27% of cats, whereas a shift occurred only in 4% of cats during short‐term storage.Conclusions and Clinical ImportanceLaboratory choice for UPC measurement can result in different IRIS substaging for the same cat, whereas urine storage at room temperature for 1 day or in the refrigerator for up to 7 days does not clinically affect UPC.