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Article Open Access

A bedside equation to estimate 24‑h proteinuria in children with nephrotic syndrome: Derivation and temporal validation

  • Authors:
    • Quang Chi Ngo
    • Hung Do Tran
    • Uyen Huynh Ai Nguyen
    • Trung Tien Huynh
    • Loan Thi Kim Duong
    • Phung Hong Phi Nguyen
  • View Affiliations / Copyright

    Affiliations: Department of Pediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam, Department of Microbiology, Faculty of Nursing and Medical Technology, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
    Copyright: © Ngo et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 33
    |
    Published online on: February 26, 2026
       https://doi.org/10.3892/wasj.2026.448
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Abstract

To date, 24‑h urine protein (24hUP) excretion remains the gold standard for quantifying proteinuria and is a strong predictor of renal outcomes in glomerular diseases. Although current guidelines allow nephrotic‑range proteinuria to be diagnosed using either single‑void urine protein‑creatinine ratio (UPCR) or 24hUP thresholds, these cut‑offs primarily confirm disease presence and provide limited quantitative guidance for clinical decision‑making during the acute phase of pediatric primary nephrotic syndrome (PNS). The present study thus aimed to provide a method with which to estimate 24hUP in children with PNS. A total of 251 children with PNS were included and divided into a derivation cohort (n=171) and an independent validation cohort (n=80). Log‑log linear regression models were constructed using UPCR adjusted by estimated 24‑h creatinine excretion derived from the Cockcroft‑Gault, Hellerstein and Ghazali‑Barratt equations, with age and sex incorporated as covariates. Model performance was assessed using coefficients of determination (R2), root mean square error (RMSE), mean absolute error (MAE) and calibration analyses. The optimal model, based on Cockcroft‑Gault‑adjusted UPCR, demonstrated good predictive performance in external validation (RMSE, 11.39 mg/m2/h; MAE, 9.26 mg/m2/h; R2, 0.91), with 93.8 and 96.3% of estimates within 20 and 30% of observed 24hUP values, respectively. The application of the model indicated that a substantial proportion of children could safely avoid immediate 24‑h urine collection without missing cases of marked proteinuria. On the whole, a bedside equation using adjusted UPCR may serve as a practical surrogate for estimating 24hUP in children with PNS and facilitate clinical decision‑making in routine practice.
View Figures

Figure 1

Study flow chart. 24hUP, 24-hour
urine protein; 24hUCr, 24-hour urine creatinine; UPCR, urine
protein-creatinine ratio.

Figure 2

Calibration for model M6:
Observed Log10(24hUP) vs. predicted
Log10(24hUP). The 45˚ line is the ideal reference. The
solid line shows the apparent fit; the dashed line shows the
optimism-corrected fit from bootstrap (B=2,000). The two lines
nearly overlap (slope=0.999; intercept=0.002). Model M6:
Log10[24hUP (mg/m2/h)]=0.291 + 0.880 x
Log10 (adjusted UPCR)-0.006xage (years)+0.057xsex
(0=boy, 1=girl). Adjusted
UPCR=mUPCRxe24hUCrCockcroft-Gault; n=171; adjusted
R2=0.80. 24hUP, 24-h urine protein; lm, linear model;
OP-corr, optimism-corrected.

Figure 3

Calibration and agreement of the
original M6 estimator on external validation. (A) Observed vs.
predicted 24hUP. The blue 45˚ line indicates perfect calibration;
the purple line is the linear calibration fit (a=-9.51, b=1.12);
R2=0.912; CCC=0.939. (B) Bland-Altman plot of the
difference (observed - predicted) vs. the mean, with mean bias=2.99
mg/m2/h and 95% LoA=-18.69 to 24.66 mg/m2/h.
A fitted trend line indicates proportional bias (+1.61
mg/m2/h per 10 mg/m2/h increase in the mean).
24hUP, 24-hour urine protein; CCC, concordance correlation
coefficient; LoA, limits of agreement
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Copy and paste a formatted citation
Spandidos Publications style
Ngo QC, Tran HD, Nguyen UH, Huynh TT, Duong LT and Nguyen PH: A bedside equation to estimate 24‑h proteinuria in children with nephrotic syndrome: Derivation and temporal validation. World Acad Sci J 8: 33, 2026.
APA
Ngo, Q.C., Tran, H.D., Nguyen, U.H., Huynh, T.T., Duong, L.T., & Nguyen, P.H. (2026). A bedside equation to estimate 24‑h proteinuria in children with nephrotic syndrome: Derivation and temporal validation. World Academy of Sciences Journal, 8, 33. https://doi.org/10.3892/wasj.2026.448
MLA
Ngo, Q. C., Tran, H. D., Nguyen, U. H., Huynh, T. T., Duong, L. T., Nguyen, P. H."A bedside equation to estimate 24‑h proteinuria in children with nephrotic syndrome: Derivation and temporal validation". World Academy of Sciences Journal 8.2 (2026): 33.
Chicago
Ngo, Q. C., Tran, H. D., Nguyen, U. H., Huynh, T. T., Duong, L. T., Nguyen, P. H."A bedside equation to estimate 24‑h proteinuria in children with nephrotic syndrome: Derivation and temporal validation". World Academy of Sciences Journal 8, no. 2 (2026): 33. https://doi.org/10.3892/wasj.2026.448
Copy and paste a formatted citation
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Spandidos Publications style
Ngo QC, Tran HD, Nguyen UH, Huynh TT, Duong LT and Nguyen PH: A bedside equation to estimate 24‑h proteinuria in children with nephrotic syndrome: Derivation and temporal validation. World Acad Sci J 8: 33, 2026.
APA
Ngo, Q.C., Tran, H.D., Nguyen, U.H., Huynh, T.T., Duong, L.T., & Nguyen, P.H. (2026). A bedside equation to estimate 24‑h proteinuria in children with nephrotic syndrome: Derivation and temporal validation. World Academy of Sciences Journal, 8, 33. https://doi.org/10.3892/wasj.2026.448
MLA
Ngo, Q. C., Tran, H. D., Nguyen, U. H., Huynh, T. T., Duong, L. T., Nguyen, P. H."A bedside equation to estimate 24‑h proteinuria in children with nephrotic syndrome: Derivation and temporal validation". World Academy of Sciences Journal 8.2 (2026): 33.
Chicago
Ngo, Q. C., Tran, H. D., Nguyen, U. H., Huynh, T. T., Duong, L. T., Nguyen, P. H."A bedside equation to estimate 24‑h proteinuria in children with nephrotic syndrome: Derivation and temporal validation". World Academy of Sciences Journal 8, no. 2 (2026): 33. https://doi.org/10.3892/wasj.2026.448
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