This study evaluated whether spot urinary ACR can reliably substitute for PCR in diagnosing relapse and remission in children aged 1–18 years with steroid-sensitive nephrotic syndrome (SSNS), using PCR as the reference standard.
In 202 children, ACR and PCR were very strongly correlated (Spearman's rs = 0.97) with good Bland-Altman agreement. Recommended ACR thresholds: **≥1.50 mg/mg** for relapse (sensitivity 90–100%, specificity 91–100%) and **≤0.19 mg/mg** for remission (sensitivity 100%, specificity 79–100%).
- Internal cross-validation only; no external validation cohort was used. - Single-center study from one institution in India, limiting generalizability. - Specificity for remission varied widely (79–100%), suggesting some uncertainty at the remission cutoff.
When PCR is unavailable, clinicians managing pediatric SSNS can use a spot urine ACR of **≥1.50 mg/mg** to identify relapse and **≤0.19 mg/mg** to confirm remission with high sensitivity. These cutoffs may also be useful for retrospective data analysis when only ACR was recorded.
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