Abstract
Background. Progressive proteinuria indicates worsening of the condition in hypertensive disorders of pregnancy and hence its quantification guides clinician in decision making and treatment planning. Objective. To evaluate the efficacy of spot dipstick analysis and urinary protein-creatinine ratio (UPCR) in hypertensive disease of pregnancy for predicting 24-hour proteinuria. Subjects and Methods. A total of 102 patients qualifying inclusion criteria were evaluated with preadmission urine dipstick test and UPCR performed on spot voided sample. After admission, the entire 24-hour urine sample was collected and analysed for daily protein excretion. Dipstick estimation and UPCR were compared to the 24-hour results. Results. Seventy-eight patients (76.5%) had significant proteinuria of more than 300 mg/24 h. Dipstick method showed 59% sensitivity and 67% specificity for prediction of significant proteinuria. Area under curve for UPCR was 0.89 (95% CI: 0.83 to 0.95, P < 0.001) showing 82% sensitivity and 12.5% false positive rate for cutoff value of 0.45. Higher cutoff values (1.46 and 1.83) predicted heavy proteinuria (2 g and 3 g/24 h, resp.). Conclusion. This study suggests that random urinary protein : creatine ratio is a reliable investigation compared to dipstick method to assess proteinuria in hypertensive pregnant women. However, clinical laboratories should standardize the reference values for their setup.
Highlights
Haemorrhage, sepsis, and hypertension during pregnancy are the important cause for maternal morbidity and mortality in India and worldwide [1]
The methods to quantify proteinuria vary, but till today 24-hour urine protein measurement is considered as gold standard for protein estimation [2]
The present study aims at comparison of diagnostic utility of two tests: urine dipstick method and spot urine protein : creatinine ratio in diagnosis of significant proteinuria in patients with hypertensive disorder of pregnancy for our hospital, which is a teaching hospital for Kasturba Medical College, Manipal, which caters to the need for more than six districts of Karnataka state, representing South Indian population
Summary
Haemorrhage, sepsis, and hypertension during pregnancy are the important cause for maternal morbidity and mortality in India and worldwide [1]. Irrespective of the cause of hypertension, quantification of proteinuria in the pregnancy is important for making diagnosis, and for predicting maternal and fetal outcome. Normal women excrete minimal quantity of proteins in the urine (up to 150 mg/day), but because of renal changes that occur during pregnancy, proteinuria in excess of 300 mg/day is considered as abnormal for pregnant women. To evaluate the efficacy of spot dipstick analysis and urinary protein-creatinine ratio (UPCR) in hypertensive disease of pregnancy for predicting 24-hour proteinuria. Dipstick estimation and UPCR were compared to the 24-hour results. Dipstick method showed 59% sensitivity and 67% specificity for prediction of significant proteinuria. This study suggests that random urinary protein : creatine ratio is a reliable investigation compared to dipstick method to assess proteinuria in hypertensive pregnant women. Clinical laboratories should standardize the reference values for their setup
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