Proteinuria In Pregnant Women Research Articles

Coffee intake leads to preeclampsia-like syndromes in susceptible pregnant rats.

Coffee is one of the most popular beverages worldwide, and there is an increasing concern of the health risk of coffee consumption in pregnancy. Preeclampsia (PE) is a serious pregnancy disease that causes elevated blood pressure and proteinuria in pregnant women and growth restriction of fetuses due to poorly developed placental vasculature. The aim of our study is to investigate the possible effect of coffee intake during pregnancy in rats with potential underlying vasculature conditions. The endothelial nitric oxide synthase inhibitor N(gamma)-nitro-L-arginine methyl ester (L-NAME) at a high dose (125 mg/kg/d) was used to induce PE in pregnant rats, which were used as the positive control group. In addition, low-dose L-NAME (10 mg/kg/d) was used to simulate the compromised placental vasculature function in pregnant rats. Coffee was given together with low-dose L-NAME to the pregnant rats from gestational day 10.5-18.5. Our results show that the pregnant rats treated with low-dose L-NAME + coffee, but not low-dose L-NAME alone, developed PE symptoms such as prominent fetal growth restriction, hypertension, and proteinuria. Therefore, our findings suggest that coffee intake during pregnancy may cause an increased risk of PE in susceptible women.

A Syudy on Comparative Evaluation of Four Different Methods to Quantify Proteinuria in Pre-Eclampsia in a Tertiary Care Hospital

Background: Preeclampsia is a progressive, multisystem disorder due to spasm of small blood vessels of all organ systems characterized by new-onset hypertension and end- organ dysfunction in the last half of pregnancy. Objectives: Estimation of proteinuria by sulphosalicylic acid test in women with preeclampsia. Material & Methods: Prospective hospital based clinical study. Study conducted in the Department of Obstetrics and Gynaecology, Murshidabad Medical college, Berhampore, Murshidabad, West Bengal. Sep. 2021 - Aug. 2022. Pregnant women after 20weeks of gestation diagnosed as preeclampsia and admitted in antenatal ward in obstetrics and gynaecology department, Murshidabad Medical college, Berhampore, Murshidabad, West Bengal. Study consisted a total of 100 subjects. Simple Random sampling method. The pregnant women diagnosed as preeclampsia meeting the inclusion and exclusion criteria included in the study. The study comprised of pregnant women who are more than 20 weeks of gestation diagnosed as preeclampsia fulfilling the inclusion and exclusion criteria. Written and informed consent was taken from all pregnant women participating in the study. The pregnant women in the study were subjected to a detailed history and general abdominal and pelvic examination. A first voided morning urine sample was obtained for sulphosalicylic acid test, dipstick test, spot urine PCR. Subsequent urine samples were collected for 24 h, including a next-day first-morning voided sample for the 24-h urine protein estimation. Results: On assessment of the ROC curve to assess the predictability of three methods for spot urine compared against the 24hr urine protein estimation, the AUC for the Sulphosalicylic acid was found to be significantly better (AUC=0.970, p<0.05) compared to the urinary PCR (AUC=0.964, p<0.05) and for urinary dipstick it was AUC=0.784, p<0.05. Conclusion: This study concluded that spot urine sulphosalicylic acid and urine protein creatinine ratio are reliable investigations compared to the dipstick method to assess the proteinuria in hypertensive pregnant women or for diagnosis of pre-eclampsia. So, spot urine Sulphosalicylic acid and urine protein-creatinine ratio can be used for detection of proteinuria in pregnant women with suspected pre-eclampsia with high accuracy, which is more rapid than time consuming 24-hour urine protein estimation

Accuracy of Spot Urine Albumin Creatinine Ratio With Respect to 24-Hour Urine Albumin for the Detection of Proteinuria in Antenatal Women With Preeclampsia: A Descriptive Study.

Background Among the hypertensive disorders of pregnancy, certain diseases like preeclampsia (PE) and eclampsia have the maximum impact on morbidity and mortality of the mother as well as the newborn. Proteinuria determination is used to assess renal damage in PE. There are several ways to evaluate proteinuria in pregnant women, but the gold standard remains the 24-hour urine albumin (24-h UA) excretion. Spot urine albumin creatinine ratio (UACR) can be used for rapid diagnosis of PE which is fast, reliable, and easy to use. Hence, our tertiary care center conducted the current study to assess the accuracy of spot UACR with 24-h UA for detecting proteinuria in antenatal women to diagnose PE and to evaluate the obstetric outcome in antenatal women with PE. Methodology A descriptive, cross-sectional study was conducted on 98 antenatal women diagnosed with PE.Urine albumin was done by dipstick method and the presence or absence of proteinuria was noted. Both, the 24-hurine sample and a random sample for spot UACR were sent for analysis. Results Spot UACR has more specificity than sensitivity along with a high negative predictive value for the detection of proteinuria. Additionally, significant proteinuria was associated with an increased rate of induced labor, a cesarean section in patients, lower mean gestational age at the time of delivery, lower birth weight, and increased rate of intrauterine fetal death. Conclusion The study concluded that spot UACR has more specificity than sensitivity along with a high negative predictive value for the detection of proteinuria and therefore, can be used for the diagnosis of proteinuria in women with PE. Hence, spot UACR is a reliable, faster, and more accurate method for the detection of proteinuria in PE and can be used for early diagnosis and timely management leading to a decrease in mortality and morbidity of the mother and the fetus.

Effect of yoga practice in reducing blood pressure, platelet blood count, and proteinuria in pregnant women with mild preeclampsia

Effect of yoga practice in reducing blood pressure, platelet blood count, and proteinuria in pregnant women with mild preeclampsia

LC/MS/MS assessment of changes in placental angiotensin I metabolism in preeclampsia.

Preeclampsia (PE) is a condition characterized by high blood pressure and significant proteinuria in pregnant women. It affects about 7% pregnancies and can be cause of fetal and maternal morbidity and mortality. During pregnancy, a physiological overexpression of the Renin-Angiotensin System (RAS) components is observed, including increased plasma Ang II level. Dysregulation of RAS in placenta may contribute to preeclampsia and uterine growth retardation. The aim of the study was to evaluate the Ang I metabolism in human preeclamptic placentas and to compare to normal pregnancies condition. Fragments of placental tissues were collected right after ceasarian section from PE and physiological pregnancies. Tissues were incubated in Krebs buffer in the presence of Ang I. Evaluation of Ang I metabolites in incubating fluid was performed by LC/MS/MS method. mRNA expression of main RAS components was measured by RT-PCR. Pattern of angiotensin metabolites did not differ between groups. The main products were Ang 1-7 and Ang II. Comparing to control group, more than 3-fold lower production of Ang II and Ang 1-7 in preeclampsia was observed. mRNA expressions of ACE and AT1 were significantly decreased in pre- eclamptic placentas, whereas higher expression of mRNA of ACE2 and MAS receptor were observed. Production of Ang 1-7 by PE placentas was significantly lower than in control group. Significantly decreased mRNA expression of ACE and AT1 receptor and lower production of Ang II in placentas of PE patients suggest that placental Ang II/ACE/AT1r pathway could be less important than Ang 1-7/ACE-2/MASr pathway in development of preeclampsia, but this requires further investigations.

The Role of the Urine Dipstick Test in the Detection of Abnormal Proteinuria Using Different Cut-off Levels in Hypertensive Pregnancies

Aim: The aim of this study was to determine the diagnostic accuracy of different urine dipstick protein threshold levels in predicting the presence of abnormal proteinuria in pregnant women with hypertension. Material and Methods: A total of 326 singleton pregnant women who underwent 501 urine protein tests and who had suspected preeclampsia were included in this retrospective study. Patient data was taken including medical and obstetric history. The results of dipstick urinalysis and concurrent 24-hour urine protein excretion measurements were compared to determine the accuracy of urinalysis. Results: A dipstick result of 1+ was found to be the best cut-off to predict 500 mg of protein excretion per day, with sensitivity and specificity of 62.09% and 88.97%, respectively. A 2+ proteinuria dipstick cut-off had high specificity and positive predictive value (PPV) (99.05% and 98.84%, respectively) for the prediction of 300 mg of protein excretion per day; this cut-off had low sensitivity (21.46%). A cut-off of 1+ also provided satisfactory specificity and PPV (91.43% and 94.48%, respectively) for the detection of 300 mg of protein excretion per day, but sensitivity was compromised (38.89%). Among 301 patients with negative dipstick results, 212 had a 24-hour urine protein extraction greater than 300 mg, with a false negative rate of 70.43%. Conclusion: The results suggest that the urine protein dipstick measurement has limited quantitative ability for the prediction of abnormal proteinuria. Additionally, the use of 500 mg 24-hours protein excretion as a cut-off value for abnormal proteinuria may provide useful data.

Diagnostic accuracy of urine dipstick tests for proteinuria in pregnant women suspected of preeclampsia: A systematic review and meta-analysis.

Dipstick tests are frequently used as bedside proteinuria tests to evaluate women suspected of preeclampsia and may inform diagnosis in low resource settings lacking laboratory facilities. This systematic review and meta-analysis aimed to (1) estimate the diagnostic accuracy of urine dipsticks in diagnosing proteinuria, (2) compare performance of different dipstick types and (3) estimate their related costs. MEDLINE and EMBASE were searched up to August 1, 2020 for primary studies with cross-sectional diagnostic accuracy data on dipstick test(s) compared to a laboratory reference standard (24-hour protein≥300mg or protein-creatinine ratio≥30mg/mmol) in pregnant women≥20weeks of gestation suspected of preeclampsia. Risk of bias and applicability was assessed with QUADAS-2. Data were analysed using a bivariate model with hierarchical addition of covariates for subgroups. Nineteen studies were included. Protein-only dipsticks at 1+threshold had a pooled sensitivity of 0.68 [95%CI: 0.57-0.77] and specificity of 0.85 [95% CI: 0.73-0.93] (n=3700 urine samples, 18 studies). Higher specificity was found with automatedly (0.93 [95% CI: 0.82-0.98]) compared to visually (0.81 [95% CI: 0.65-0.91]) read dipsticks, whereas sensitivity was similar and costs were higher. The use of albumin-creatinine ratio (ACR) dipsticks was only reported in two studies and did not improve accuracy. Heterogeneity in study design and prevalence of preeclampsia amongst studies complicated interpretation of pooled estimates. Urine dipsticks performed poorly at excluding preeclampsia in hypertensive pregnant women. Further development of accurate and low-cost bedside proteinuria tests is warranted.

DETEKSI PRE-EKLAMPSIA PADA IBU HAMIL TRIMESTER 2-3 MELALUI PEMERIKSAAN PROTEIN URIN

Pre-eclampsia is a pregnancy-specific condition characterized by systemic dysfunction with endothelial activation and coagulation. This condition is characterized by blood pressure 140/90 mmHg after 20 weeks of gestation or sometimes earlier, accompanied by proteinuria ≥ 300 mg/24 hours and/or edema. This research is descriptive observational using 6% acetic acid method. The number of respondents in this study were 30 urine samples of pregnant women. The results of the examination are known from a total of 30 pregnant women respondents, as many as 15 proteinuria was detected. The most proteinuria in pregnant women is positive +/1 with the highest number in the age range of 30 -35 years. Proteinuria is most detected in the third trimester of pregnancy and occurs in the group of working pregnant women.

Protein-creatinine ratio and albumin-creatinine ratio for the diagnosis of significant proteinuria in pregnant women with hypertension: Systematic review and meta-analysis of diagnostic test accuracy.

The gold standard for assessment and diagnosis of significant proteinuria in pregnancy has been by 24-hour urine collection and analysis. Determining fast, accurate methods to identify clinically significant proteinuria would aid diagnosis of pre-eclampsia. The objective of this study was to determine the accuracy of spot protein-creatinine ratio (PCR) and albumin-creatinine ratio (ACR) measurements compared with 24-hour urine collection for the identification of clinically significant proteinuria in women with hypertensive disorders of pregnancy. Search strategies were developed for electronic databases from inception to 1st October 2020. Data were assessed for methodological quality using the QUADAS-II checklist for risk of bias and quality of the evidence using GRADE. Meta-analysis was performed where there were at least four studies presenting data for the same comparison (test and threshold). This is an update of the review for NICE guideline NG133 (published June 2019) and includes additional data. Twenty-nine studies were included. PCR measurements (28 studies) showed high sensitivity (91%) and specificity (89%) at a threshold of 30mg/mmol (n=3577). Higher thresholds (>60mg/mmol) increased specificity, but reduced sensitivity. At a threshold of PCR 30mg/mmol, diagnostic accuracy improved for sensitivity and specificity (93% for both) in studies where the first morning void was excluded (n=1868). Data available (4 studies) for ACR supports ruling out of significant proteinuria at less than 2mg/mmol, though evidence was limited by paucity of data and wide confidence intervals around the result. PCR and ACR have high accuracy compared to the gold standard 24-hour urine collection.

PERBEDAAN PENURUNAN TEKANAN DARAH PADA IBU DENGAN PRE EKLAMPSIA YANG DITERMINASI PADA USIA KEHAMILAN KURANG BULAN DAN CUKUP BULAN

Pre-eclampsia is the second leading cause of maternal death worldwide, with the main symptoms of hypertension and proteinuria in pregnant women. Various factors can affect the occurrence of pre-eclampsia and cause serious disease complications and even death. The purpose of this study was to determine the difference in blood pressure reduction in pre-eclampsia mothers who were terminated at the age of less and at term with a comparative analytic study design using a cross sectional approach. The population in this study were all pregnant women with pre-eclampsia who were terminated by caesarean section at preterm and full-term gestation, as many as 56 people. The sampling technique used is stratified proportional random samplingwith as many as 30 people. Through the Independent T-Test statistical test with a significance level of 0.05. The t-count is -3.209 and the significance is 0.003, then Ho is rejected, which means that there is a difference between the decrease in blood pressure in mothers with pre-eclampsia who were terminated at preterm and full-term gestation Keywords: Decrease in Blood Pressure, Pre Eclampsia, Aterm and Preterm

Study of random urinary calcium/creatinine ratio as a predictor of preeclampsia in and around Chitradurga

Pre-eclampsia is defined as development of hypertension and proteinuria (>300 mg in 24 hours urine) after 20th week of gestation. The presence of proteinuria remains central to the diagnosis of pre-eclampsia. 24 hours urinary protein measurement is time-consuming and needs more assistance. Spot urinary calcium: creatinine ratio (CCR) has been used to determine the diagnostic accuracy of proteinuria in pre-eclampsia. A case control comparative study was done with women having pre-eclampsia and normal pregnant women admitted in Gynecology department at Basaveshwara Medical College Hospital, Chitradurga according to the criteria. There was a significant negative correlation between calcium: creatinine ratio and 24-hours urinary proteinuria (r= -0.51). Spot urinary calcium: creatinine ratio at cut off value of 0.18 shows 100% sensitivity and 84% specificity. We conclude that the urinary calcium: creatinine ratio should be considered as a potential alternative for 24-hours urine collection for proteinuria in pregnant women to detect pre-eclampsia.

The impact of baseline proteinuria in pregnant women with pregestational diabetes mellitus

The incidence of diabetes in pregnancy has increased dramatically with the rising rates of obesity. Because there are a number of recognized adverse maternal and fetal outcomes associated with diabetes, there have been several attempts to classify this disorder for perinatal risk stratification. One of the first classification systems for pregnancy was developed by White nearly 70 years ago. More recently, efforts to stratify diabetic disease severity according to vasculopathy have been adopted. Regardless of classification system, vasculopathy-associated effects have been associated with worsening pregnancy outcomes. Defining vasculopathy within an organ system, however, has not been consistent. For example, definitions of diabetic kidney disease differ from the previously used threshold of ≥500 mg/d by White for pregnancy to varying thresholds of albuminuria by the American Diabetes Association. To evaluate a proteinuria threshold that was a relevant determinant of perinatal risk in a cohort of women with type 2 diabetes. This was a retrospective cohort study of women with pregestational diabetes delivered of nonanomalous, singleton, liveborn infants. All women were assessed for baseline maternal disease burden with a 24-hour proteinuria quantification performed before 20 weeks' gestation. Women with <500 mg/d on 24-hour urine collections were included. Perinatal outcomes were analyzed according to the following protein excretion values: 50-100, 101-200, 201-300, and 301-499 mg/d. Based on trends noted in these results and using the prior definition of the American Diabetes Association of 300 mg/d of albumin for diabetic kidney disease, women were then analyzed according to 24-hour urine collections of ≤300 or >300 mg/d. Between 2009 and 2016, a total of 594 women with pregestational diabetes were found to meet study criteria. When analyzed according to protein excretion values 50-100, 101-200, 201-300, and 301-499 mg/d, there were no differences in maternal demographics. The rate of preeclampsia with severe features (P for trend= .02), preterm birth at <37 weeks (P for trend <.001), and birthweight <10th percentile (P for trend= .02) were significantly associated with increasing proteinuria excretion, with the highest rates in the >300 mg/d group. Perinatal outcomes were then examined in the context of 24-hour urine protein excretion values of ≤300 or >300 mg/d, with no differences in maternal demographics. Protein excretion values >300 mg/d were significantly associated with preterm birth <37 weeks (P= .003), preeclampsia with severe features (P= .002), and birthweight <10th percentile (P= .048). White's classification in 1949 was developed to stratify perinatal risks based on maternal disease burden, and it was found that urinary protein excretion of >500 mg/d was associated with adverse pregnancy outcomes. In a contemporary cohort of pregnant women, proteinuria >300 mg/d was associated with preterm birth, preeclampsia with severe features, and birthweight <10th percentile.

Could circRNA be a new biomarker for pre-eclampsia?

Pre-eclampsia is a devastating complication of pregnancy which is characterized by hypertension and proteinuria in pregnant women. Pre-eclampsia is important as it is the leading cause of death. Moreover, untreated pre-eclampsia might lead to other lethal complications, for both fetus and mother. Pre-eclampsia can also affect the quality of life in affected women. Despite a large number of risk factors for pre-eclampsia, these risk factors are able to detect just 30% of women who are susceptible to pre-eclampsia. Heterogeneous manifestations of pre-eclampsia necessitate the discovery of potential biomarkers required for its early detection. Circular RNAs (circRNAs) are a type of RNA which are more abundant, specific, and highly organized compared with other types of RNA. Accordingly, circRNAs have been suggested as one of the potential biomarkers for different diseases. Recently, researchers have shown interest in the effects of circRNAs in pre-eclampsia, although the current evidence is limited. The majority of obstetricians are probably not aware of circRNAs as a useful biomarker. Here, we aimed to summarize recent supporting evidence and assess the mechanisms by which circRNAs are involved in pre-eclampsia.

ANALYSIS OF OXIDATIVE STRESS MARKERS MALONDIALDEHYDE, GLUTATHIONE, NITRIC OXIDE, AND PRORENIN LEVEL IN PREECLAMPSIA PLACENTAL TISSUES

Objective: Preeclampsia was a syndrome of hypertension proteinuria in pregnant women. In failure of pseudo vasculogenesis, there is persistency of endothelial and smooth muscle cell of vessel wall in spiral artery. Spiral artery could not be emphasis and lead to relative hypoxia, and oxidative stress in placental tissues. Endothelial cell has property to produce nitric oxide (NO) that can dilated vessel. Placenta also produces prorenin, to maintain vascular wall tonicity. Therefore, we want to uncover the property of placenta is there any capacity of prorenin, is that prorenin could overcome the NO level, or is there any depression of NO production, and any oxidative stress.Methods: This observational study was used case–control design. We search preeclampsia cases during September-December 2015. We used preeclampsia placentas from early and late onset. We collect preeclampsia placentas from Cipto Mangunkusumo and normal placentas from Budi Kemuliaan Hospital. We used 30 preeclampsia placentas and 30 normal placentas. Markers measured were NO and prorenin. NO was measured using colorimetric assay kit (K262-200/ BioVision), and prorenin was measured using human prorenin enzyme-linked immunosorbent assay kit (ab157525/ Abcam). Glutathione (GSH) was measured using Ellman method and malondialdehyde (MDA) using Wills method.Results: Prorenin concentration between normal and preeclampsia placenta was analyzed using Mann–Whitney and show that there had no significant difference between preeclampsia and normal placentas (p=0.23). Besides, NO data analyzed using independent t-test show significant differences between preeclampsia and normal placentas (p=0.001). The difference between normal and preeclampsia GSH concentration was not significant (p=0.757), besides the difference between normal and preeclampsia MDA concentration was significant (p=0.000).Conclusion: NO concentration in preeclampsia placenta was increase, higher than normal placenta. There was no effect of preeclampsia on prorenin concentration and GSH. There was marked decrease of MDA in preeclampsia placentas.

ANALYSIS OF OXIDATIVE STRESS MARKERS MALONDIALDEHYDE, GLUTATHIONE, NITRIC OXIDE, AND PRORENIN LEVEL IN PREECLAMPSIA PLACENTAL TISSUES

Objective: Preeclampsia was a syndrome of hypertension proteinuria in pregnant women. In failure of pseudo vasculogenesis, there is persistency of endothelial and smooth muscle cell of vessel wall in spiral artery. Spiral artery could not be emphasis and lead to relative hypoxia, and oxidative stress in placental tissues. Endothelial cell has property to produce nitric oxide (NO) that can dilated vessel. Placenta also produces prorenin, to maintain vascular wall tonicity. Therefore, we want to uncover the property of placenta is there any capacity of prorenin, is that prorenin could overcome the NO level, or is there any depression of NO production, and any oxidative stress.Methods: This observational study was used case–control design. We search preeclampsia cases during September-December 2015. We used preeclampsia placentas from early and late onset. We collect preeclampsia placentas from Cipto Mangunkusumo and normal placentas from Budi Kemuliaan Hospital. We used 30 preeclampsia placentas and 30 normal placentas. Markers measured were NO and prorenin. NO was measured using colorimetric assay kit (K262-200/ BioVision), and prorenin was measured using human prorenin enzyme-linked immunosorbent assay kit (ab157525/ Abcam). Glutathione (GSH) was measured using Ellman method and malondialdehyde (MDA) using Wills method.Results: Prorenin concentration between normal and preeclampsia placenta was analyzed using Mann–Whitney and show that there had no significant difference between preeclampsia and normal placentas (p=0.23). Besides, NO data analyzed using independent t-test show significant differences between preeclampsia and normal placentas (p=0.001). The difference between normal and preeclampsia GSH concentration was not significant (p=0.757), besides the difference between normal and preeclampsia MDA concentration was significant (p=0.000).Conclusion: NO concentration in preeclampsia placenta was increase, higher than normal placenta. There was no effect of preeclampsia on prorenin concentration and GSH. There was marked decrease of MDA in preeclampsia placentas.

Community health workers' knowledge and practice in relation to pre-eclampsia in Ogun State, Nigeria: an essential bridge to maternal survival.

BackgroundPre-eclampsia is a leading cause of maternal and fetal morbidity and mortality worldwide. Early detection and treatment have been instrumental in reducing case fatality in high-income countries. To achieve this in a low-income country, like Nigeria, community health workers who man primary health centres must have adequate knowledge and skills to identify and provide emergency care for women with pre-eclampsia.This study aimed to determine community health workers’ knowledge and practice in the identification and treatment of pre-eclampsia, as they are essential providers of maternal care services in Nigeria.MethodsThis study was part of a multi-country evaluation of community treatment of pre-eclampsia. Qualitative data were obtained from four Local Government Areas of Ogun State, in south western Nigeria by focus group discussions (N = 15) and in-depth interviews (N = 19). Participants included a variety of community-based health care providers - traditional birth attendants, community health extension workers, nurses and midwives, chief nursing officers, medical officers – and health administrators. Data were transcribed and validated with field notes and analysed with NVivo 10.0.ResultsCommunity-based health care providers proved to be aware that pre-eclampsia was due to the development of hypertension and proteinuria in pregnant women. They had a good understanding of the features of the condition and were capable of identifying women at risk, initiating care, and referring women with this condition. However, some were not comfortable managing the condition because of the limitation in their ‘Standing Order’; these guidelines do not explicitly authorize community health extension workers to treat pre-eclampsia in the community.ConclusionCommunity-based health care providers were capable of identifying and initiating appropriate care for women with pre-eclampsia. These competencies combined with training and equipment availability could improve maternal health in the rural areas. There is a need for regular training and retraining to enable successful task-sharing with these cadres.Trial registration NCT01911494.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0218-9) contains supplementary material, which is available to authorized users.

122 Evaluation of urine protein/creatinine ratio in hypertensive disorders during pregnancy

Introduction Assessment of proteinuria is essential to diagnose preeclampsia; it can be detected in spot urine sample or 24-hour urine collection. It has been shown that urine protein to creatinine (P/C) ratio seems to be highly predictive for detection of proteinuria in preeclampsia (PE). Objectives Evaluation of P/C ratio in normal pregnancy, and pregnant women with chronic hypertension (CH) and with PE. Methods P/C ratio was measured in 24 normal pregnant women, 14 with PE and 97 with CH. Proteinuria was detected by automated pyrogallol method and creatininuria by alkaline picrate method. Results Mean age of control group was 26 years, of PE group, 26 years and of CH group 34 years. P/C ratio was undetected in the control group, it was elevated in 5.2% of the CH group and in 100% of the PE group, also confirmed with 24-hour urine collection. Serum creatinine was elevated in 19.6% of the CH group and 42.8% of the PE group. Conclusions P/C ratio may be a good predictor of PE and it could be used as an alternative test to detect proteinuria in pregnant women, because it is faster and it is not influenced by serum creatinine concentration. Proteinuria should be evaluated during the prenatal care of CH women allowing early detection of incipient nephropathy. Fapesp n° 2014/00213-7. Renal evaluation in preeclampsia group. Download : Download high-res image (159KB) Download : Download full-size image

The Utility of 12-Hour Urine Collection for the Diagnosis of Preeclampsia

To systematically review the literature and synthesize data on the diagnostic performance of a 12-hour urine collection for proteinuria in pregnant women with suspected preeclampsia. We performed a literature search of PubMed, Embase, Scopus, ClinicalTrials.gov, and CINAHL through February 2014 using key words related to gestational hypertension, preeclampsia, and proteinuria. Studies that contained results of both the 12-hour and 24-hour urine collection in the same patients were eligible. Three independent reviewers abstracted test performance characteristics from each study for the performance of a 12-hour urine collection for the diagnosis of proteinuria defined as 300 mg in 24 hours. Diagnostic meta-analysis was performed to obtain summary statistics. Heterogeneity was assessed using the Cochrane Q or I. Receiver operating characteristic curve analysis was used to assess the optimal diagnostic cutpoint for proteinuria from a 12-hour urine collection. Stratified analysis was performed based on whether patients were on bed rest during urine collection. A total of seven studies met inclusion criteria. The 12-hour urine protein was overall highly predictive of proteinuria on 24-hour urine collection area under receiver operating characteristic curve: 0.97 (95% confidence interval [CI] 0.95-0.98). The pooled sensitivity was 92% (95% CI 86-96) and specificity was 99% (95% CI 75-100). The optimal cutpoint based on the receiver operating characteristic curve was 150 mg of protein on 12-hour collection. A 12-hour urine collection compares favorably with a 24-hour urine collection for the diagnosis of proteinuria in women with suspected preeclampsia and has the advantage of convenience and improved clinical efficiency.

Association between urinary angiotensinogen, hypertension and proteinuria in pregnant women with preeclampsia

Preeclampsia is a life-threatening disorder of pregnancy. The pathogenic mechanisms of preeclampsia remain uncertain. The aim of this study is to investigate the relation between urinary angiotensinogen (UAGT) levels, an indicator of local renin-angiotensin system (RAS) activity in the kidney, and blood pressure and urinary protein excretion in preeclampsia. For this study, 90 women aged between 20-39 years were recruited. Spot urine samples were collected to measure urinary angiotensinogen/creatinine ratio (UAGT/UCre). Log(UAGT/UCre) was compared in pregnancies with and without preeclampsia and non-pregnant controls. Factors affecting log(UAGT/UCre) in pregnancies were also investigated. In all pregnancies log(UAGT/UCre) levels were significantly higher than in non-pregnant controls (0.58±0.19 vs. 0.33±0.14, respectively, p=0.002). However, log(UAGT/UCre) levels in pregnancies with preeclampsia were slightly lower than in normal pregnancies (0.52±0.18 vs. 0.64±0.19, respectively, p=0.012). Log(UAGT/UCre) levels were correlated positively with blood pressure and proteinuria in pregnancies with preeclampsia. However, log(UAGT/UCre) levels were not correlated with age, height, body weight, gestational age, body mass index, and serum creatinine. This study showed that elevated local RAS activity in kidney was correlated with high blood pressure and proteinuria in preeclampsia. Local RAS activation in the kidneys may be one of the contributing factors in the development of preeclampsia.

Evaluation of Current and New Biomarkers in Severe Preeclampsia: A Microarray Approach Reveals the VSIG4 Gene as a Potential Blood Biomarker

Preeclampsia is a placental disease characterized by hypertension and proteinuria in pregnant women, and it is associated with a high maternal and neonatal morbidity. However, circulating biomarkers that are able to predict the prognosis of preeclampsia are lacking. Thirty-eight women were included in the current study. They consisted of 19 patients with preeclampsia (13 with severe preeclampsia and 6 with non-severe preeclampsia) and 19 gestational age-matched women with normal pregnancies as controls. We measured circulating factors that are associated with the coagulation pathway (including fibrinogen, fibronectin, factor VIII, antithrombin, protein S and protein C), endothelial activation (such as soluble endoglin and CD146), and the release of total and platelet-derived microparticles. These markers enabled us to discriminate the preeclampsia condition from a normal pregnancy but were not sufficient to distinguish severe from non-severe preeclampsia. We then used a microarray to study the transcriptional signature of blood samples. Preeclampsia patients exhibited a specific transcriptional program distinct from that of the control group of women. Interestingly, we also identified a severity-related transcriptional signature. Functional annotation of the upmodulated signature in severe preeclampsia highlighted two main functions related to “ribosome” and “complement”. Finally, we identified 8 genes that were specifically upmodulated in severe preeclampsia compared with non-severe preeclampsia and the normotensive controls. Among these genes, we identified VSIG4 as a potential diagnostic marker of severe preeclampsia. The determination of this gene may improve the prognostic assessment of severe preeclampsia.