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Rao S, Somalwar S, Bhalerao A, Raman V. 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. Cureus 2023; 15:e39961. [PMID: 37416042 PMCID: PMC10320648 DOI: 10.7759/cureus.39961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
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-h urine 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.
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Affiliation(s)
- Shraddha Rao
- Department of Obstetrics and Gynecology, NKP Salve Institute of Medical Sciences and Research Center, Nagpur, IND
| | - Savita Somalwar
- Department of Obstetrics and Gynecology, NKP Salve Institute of Medical Sciences and Research Center, Nagpur, IND
| | - Anuja Bhalerao
- Department of Obstetrics and Gynecology, NKP Salve Institute of Medical Sciences and Research Center, Nagpur, IND
| | - Vishal Raman
- Department of Obstetrics and Gynecology, NKP Salve Institute of Medical Sciences and Research Center, Nagpur, IND
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Aitekenov S, Sultangaziyev A, Boranova A, Dyussupova A, Ilyas A, Gaipov A, Bukasov R. SERS for Detection of Proteinuria: A Comparison of Gold, Silver, Al Tape, and Silicon Substrates for Identification of Elevated Protein Concentration in Urine. SENSORS (BASEL, SWITZERLAND) 2023; 23:1605. [PMID: 36772644 PMCID: PMC9921516 DOI: 10.3390/s23031605] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Excessive protein excretion in human urine is an early and sensitive marker of diabetic nephropathy and primary and secondary renal disease. Kidney problems, particularly chronic kidney disease, remain among the few growing causes of mortality in the world. Therefore, it is important to develop an efficient, expressive, and low-cost method for protein determination. Surface enhanced Raman spectroscopy (SERS) methods are potential candidates to achieve these criteria. In this paper, a SERS method was developed to distinguish patients with proteinuria from the healthy group. Commercial gold nanoparticles (AuNPs) with diameters of 60 nm and 100 nm, and silver nanoparticles (AgNPs) with a diameter of 100 nm were tested on the surface of four different substrates including silver and gold films, silicon, and aluminum tape. SERS spectra were acquired from 111 unique human urine samples prepared and measured for each of the seven different nanoparticle plus substrate combinations. Data analysis by the PCA-LDA algorithm and the ROC curves gave results for the diagnostic figures of merits. The best sensitivity, specificity, accuracy, and AUC were 0.91, 0.84, 0.88, and 0.94 for the set with 100 nm Au NPs on the silver substrate, respectively. Among the three metal substrates, the substrate with AuNPs and Al tape performed slightly worse than the other three substrates, and 100 nm gold nanoparticles on average produced better results than 60 nm gold nanoparticles. The 60 nm diameter AuNPs and silicon, which is about one order of magnitude more cost-effective than AuNPs and gold film, showed a relative performance close to the performance of 60 nm AuNPs and Au film (average AUC 0.88 (Si) vs. 0.89 (Au)). This is likely the first reported application of unmodified silicon in SERS substrates applied for direct detection of proteins in any biofluid, particularly in urine. These results position silicon and AuNPs@Si in particular as a perspective SERS substrate for direct urine analysis, including clinical diagnostics of proteinuria.
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Affiliation(s)
- Sultan Aitekenov
- Department of Chemistry, School of Sciences and Humanities (SSH) Nazarbayev University, Nur-Sultan 010000, Kazakhstan
| | - Alisher Sultangaziyev
- Department of Chemistry, School of Sciences and Humanities (SSH) Nazarbayev University, Nur-Sultan 010000, Kazakhstan
| | - Aigerim Boranova
- Department of Chemistry, School of Sciences and Humanities (SSH) Nazarbayev University, Nur-Sultan 010000, Kazakhstan
| | - Aigerim Dyussupova
- Department of Chemistry, School of Sciences and Humanities (SSH) Nazarbayev University, Nur-Sultan 010000, Kazakhstan
| | - Aisha Ilyas
- Department of Chemistry, School of Sciences and Humanities (SSH) Nazarbayev University, Nur-Sultan 010000, Kazakhstan
| | - Abduzhappar Gaipov
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan
| | - Rostislav Bukasov
- Department of Chemistry, School of Sciences and Humanities (SSH) Nazarbayev University, Nur-Sultan 010000, Kazakhstan
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Surface-enhanced Raman spectroscopy (SERS) for protein determination in human urine. SENSING AND BIO-SENSING RESEARCH 2022. [DOI: 10.1016/j.sbsr.2022.100535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Geneen LJ, Webster KE, Reeves T, Eadon H, Maresh M, Fishburn S, Chappell LC. 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. Pregnancy Hypertens 2021; 25:196-203. [PMID: 34237632 DOI: 10.1016/j.preghy.2021.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS Twenty-nine studies were included. PCR measurements (28 studies) showed high sensitivity (91%) and specificity (89%) at a threshold of 30 mg/mmol (n = 3577). Higher thresholds (>60 mg/mmol) increased specificity, but reduced sensitivity. At a threshold of PCR 30 mg/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 2 mg/mmol, though evidence was limited by paucity of data and wide confidence intervals around the result. CONCLUSIONS PCR and ACR have high accuracy compared to the gold standard 24-hour urine collection.
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Affiliation(s)
- Louise J Geneen
- National Guideline Alliance (NGA), Hosted by the Royal College of Obstetricians and Gynaecologists (RCOG), 10-18 Union Street, London Bridge, London SE1 1SZ, UK; Department of Clinical, Education, and Health Psychology, University College London, Gower Street, London WC1E 6BT, United Kingdom; Systematic Review Initiative, NHS Blood and Transplant (NHSBT), John Radcliffe Hospital, Oxford OX3 9BQ, UK.
| | - Katie E Webster
- National Guideline Alliance (NGA), Hosted by the Royal College of Obstetricians and Gynaecologists (RCOG), 10-18 Union Street, London Bridge, London SE1 1SZ, UK; Department of Clinical, Education, and Health Psychology, University College London, Gower Street, London WC1E 6BT, United Kingdom; Cochrane ENT, Nuffield Department of Surgical Sciences, Oxford University, Oxford OX2 7LG, UK
| | - Tim Reeves
- National Guideline Alliance (NGA), Hosted by the Royal College of Obstetricians and Gynaecologists (RCOG), 10-18 Union Street, London Bridge, London SE1 1SZ, UK; Department of Clinical, Education, and Health Psychology, University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - Hilary Eadon
- National Guideline Alliance (NGA), Hosted by the Royal College of Obstetricians and Gynaecologists (RCOG), 10-18 Union Street, London Bridge, London SE1 1SZ, UK
| | - Michael Maresh
- St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Sarah Fishburn
- Hampshire Thames Valley Clinical Delivery and Networks, Oxford, UK
| | - Lucy C Chappell
- Department of Women and Children's Health, King's College London, London SE1 7EH, UK
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Bae EH, Kim JW, Choi HS, Ma SK, Kim SW. Impact of random urine proteinuria on maternal and fetal outcomes of pregnancy: a retrospective case-control study. Korean J Intern Med 2017; 32:1062-1068. [PMID: 27733023 PMCID: PMC5668390 DOI: 10.3904/kjim.2016.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/25/2016] [Accepted: 05/06/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Proteinuria is associated with hypertension and preeclampsia in pregnancy. However, the impact of random urine proteinuria on fetal and maternal outcomes has not been established. We investigated the influence of random urine proteinuria on the clinical outcomes of pregnancy. METHODS From January 2008 to December 2010, 2,822 patients were retrospectively studied. A total of 536 pregnant women with proteinuria in random urine and matched controls without proteinuria via propensity score matching were analyzed. Proteinuria was checked by the dipstick method. RESULTS The patients' mean age was 33.0 ± 4.7 years, and the mean gestational age was 235.6 ± 50.6 days on admission. The prevalence of hypertension and chronic kidney disease was 2.4% (n = 67) and 1.0% (n = 29), respectively. Women with random urine proteinuria showed higher blood urea nitrogen levels and a higher incidence of hematuria. These women also had a higher incidence of preeclampsia, preterm labor, premature rupture of membranes, and intrauterine growth restriction. Proteinuria was strongly correlated with preeclampsia in both propensity score matching (p < 0.001, r = 0.783) and unmatched whole samples (p < 0.001, r = 0.851). CONCLUSIONS These findings suggest that random urine proteinuria is associated with preeclampsia, preterm labor, premature rupture of membrane, and intrauterine growth restriction.
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Affiliation(s)
- Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jong Woon Kim
- Department of Obsterics, Chonnam National University Medical School, Gwangju, Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Correspondence to Soo Wan Kim, M.D. Department of Internal Medicine, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-220-6271 Fax: +82-62-225-8578 E-mail:
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Haghighi L, Nasiri N, Ebrahimi A, Najmi Z, Moradi Y, Hashemi N. Predictive value of 4-, 8-, and 12-h urine protein and protein-to-creatinine ratio for detection of pre-eclampsia. Int J Gynaecol Obstet 2016; 134:62-5. [DOI: 10.1016/j.ijgo.2015.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 11/23/2015] [Accepted: 03/24/2016] [Indexed: 10/22/2022]
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Demirci O, Kumru P, Arınkan A, Ardıç C, Arısoy R, Tozkır E, Tandoğan B, Ayvacı H, Tuğrul AS. Spot protein/creatinine ratio in preeclampsia as an alternative for 24-hour urine protein. Balkan Med J 2015; 32:51-5. [PMID: 25759772 DOI: 10.5152/balkanmedj.2015.15447] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 11/26/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Proteinuria is a major component of preeclampsia. Urine protein measurement after 24-hour urine collection is the traditional standard method for the detection of proteinuria. It is time-consuming. As an alternative, random spot sampling for a urine protein to creatinine (P/C) ratio has been investigated. AIMS The aim of the study was to determine the diagnostic accuracy of the protein to creatinine ratio (P/C) compared with 24-hour urine collection for the detection of remarkable proteinuria and to evaluate the P/C ratio for different proteinuria ranges in patients with preeclampsia. STUDY DESIGN Case-control study. METHODS Two hundred and eleven pregnant women who met the criteria of preeclampsia comprised the study group and fifty three pregnant women were taken as the control group. Spot urine specimens for measuring P/C ratio were obtained taken immediately before 24-hour urine collection. The correlation between the P/C ratio in the spot urine samples and urinary protein excretion in the 24-hour collections was examined using the Spearman correlation test. RESULTS It was found a good positive correlation between the P/C ratio and 24-hour protein excretion, with a correlation coefficient (r) of 0.758. The best cut-off which gave the maximum area under the curve was 0.45 for 300 mg, 0.9 for 1000 mg, 1.16 for 2000 mg, 1.49 for 3000 mg, 2.28 for 4000 mg and 2.63 for 5000 mg per 24h. A P/C ratio above 0.9 strongly predicts significant proteinuria for more than 1 gram (AUC 0.97, 95% CI: 0.94-0.99 and sensitivity, specificity, positive and negative predictive value of 91%, 95.4%, 95.2%, and 91.2%, respectively). CONCLUSION The P/C ratio can be used as a screening test as a good predictor for remarkable proteinuria. The P/C ratio seems to be highly predictive for diagnosis to detect proteinuria over one gram and it could be used as a rapid alternative test in preeclamptic patients not to delay implementation treatment.
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Affiliation(s)
- Oya Demirci
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, İstanbul, Turkey
| | - Pınar Kumru
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, İstanbul, Turkey
| | - Arzu Arınkan
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, İstanbul, Turkey
| | - Cem Ardıç
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, İstanbul, Turkey
| | - Resul Arısoy
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, İstanbul, Turkey
| | - Elif Tozkır
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, İstanbul, Turkey
| | - Bülent Tandoğan
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, İstanbul, Turkey
| | - Habibe Ayvacı
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, İstanbul, Turkey
| | - Ahmet S Tuğrul
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, İstanbul, Turkey
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Random urine protein/creatinine ratio readily predicts proteinuria in preeclampsia. Obstet Gynecol Sci 2013; 56:8-14. [PMID: 24327974 PMCID: PMC3784101 DOI: 10.5468/ogs.2013.56.1.8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 06/27/2012] [Accepted: 06/27/2012] [Indexed: 11/10/2022] Open
Abstract
Objective To assess the diagnostic accuracy of random urine protein-creatinine (P/C) ratio for prediction of significant proteinuria in preeclampsia as an alternative to the time-consuming 24-hour urine protein collection. Methods Retrospective record analysis was performed on 140 pregnant women who were admitted with suspicion for preeclampsia from January 2006 to June 2011. Random urine protein and/or 24-hour urine protein levels were assessed and their correlation to random urine P/C ratio and 24-hour urine protein excretion was evaluated. Results Out of 140 patients, random urine P/C ratio or/and 24-hour urine protein was performed in 79 patients to evaluate significant proteinuria. Of 79 patients, 46 (58%) underwent both tests whereas in 33 women (42%) 24-hour urine collection was not available due to urgent delivery. In 39 cases (85%), significant proteinuria (≥300 mg/24 hr) was detected with 6 cases (13%) having values over 5,000 mg/24 hr, corresponding to the diagnosis of severe preeclampsia. Random urine P/C ratio highly correlated with 24-hour urine protein excretion (r=0.823, P<0.01). The optimal random urine P/C ratio cutoff points were 0.63 and 4.68 for 300 mg/24 hr and 5,000 mg/24 hr of protein excretion, respectively. with each sensitivity, specificity, and positive and negative predictive values of 87.1%, 100%, 100%, and 58.3%; and 100%, 85%, 50%, and 100%, for significant and severe preeclampsia, respectively. Conclusion Random urine P/C ratio is a reliable indicator of significant proteinuria in preeclampsia and may be better at providing earlier diagnostic information than the 24-hour urine protein excretion with more accuracy than the urinary dipstick test.
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Gasnier R, Valério EG, Vettorazzi J, Martins-Costa SH, Barros EG, Ramos JGL. Calcium-to-creatinine ratio in pregnancy-induced hypertension. Pregnancy Hypertens 2012; 2:59-64. [DOI: 10.1016/j.preghy.2011.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 10/09/2011] [Accepted: 10/31/2011] [Indexed: 10/15/2022]
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Milne F. Action on Pre-eclampsia: Crisis and recovery. Pregnancy Hypertens 2011; 1:117-28. [DOI: 10.1016/j.preghy.2010.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kuromoto K, Watanabe M, Adachi K, Ohashi K, Iwatani Y. Increases in urinary creatinine and blood pressure during early pregnancy in pre-eclampsia. Ann Clin Biochem 2010; 47:336-42. [PMID: 20511374 DOI: 10.1258/acb.2010.090290] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND It is important to predict the development of pre-eclampsia (PE) during early pregnancy to prevent its occurrence later on. In this study, we studied urinary biochemical parameters and blood pressure (BP) during and after pregnancy to find useful parameters for predicting PE. METHODS A case-control study was performed in 25 PE patients and 172 normotensive pregnant women. Twelve biochemical parameters were measured in spot urine, and the systolic and diastolic BPs were measured using an automated device during pregnancy and six to eight weeks after birth. RESULTS A multiple logistic regression analysis showed that the combinations of urinary creatinine (Cr) and systolic BP (SBP) in the first trimester of pregnancy (8.9 +/- 2.6 weeks), and of urinary inorganic phosphorus (IP)/Cr and SBP in the second trimester of pregnancy (19.0 +/- 1.6 weeks) were useful for predicting PE. The area under the curve in the receiver operator characteristic curve of the combination of urinary Cr and SBP in the first trimester was 0.85 (95% confidence interval [CI] 0.74-0.96), and that of the combination of urinary IP/Cr and SBP in the second trimester was 0.91 (95% CI: 0.86-0.97). When used 249 mg/dL in urinary Cr and 128 mmHg in SBP as their cut-off points, the combination in the first trimester increased the accuracy (sensitivity 75% and specificity 95%) in predicting PE, as compared with that of urinary Cr (29%, 99%) or SBP (50%, 98%). CONCLUSIONS Combination of urinary Cr and SBP in early pregnancy and that of urinary IP/Cr and SBP in mid-pregnancy are useful for the prediction of PE.
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Affiliation(s)
- Koichi Kuromoto
- Department of Biomedical Informatics, Division of Health Sciences, Graduate School of Medicine, Osaka University, Japan
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Interpreting abnormal proteinuria in pregnancy: the need for a more pathophysiological approach. Obstet Gynecol 2010; 115:365-375. [PMID: 20093912 DOI: 10.1097/aog.0b013e3181cb9644] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This review and opinion article focuses on the definitions and meanings of abnormal protein excretion in pregnancy, asking the following questions: Are our tests to determine abnormal proteinuria adequately performed? Are current guidelines for diagnosis of excessive proteinuria, especially when used to identify preeclampsia, supported by adequate data? Can the magnitude of proteinuria be used as a reliable clinical biomarker of the gravity of preeclampsia? Should timed urine collections, primarily 24-hour excretions, be supplanted by the urine protein/creatinine ratio in clinical practice? The answers to most of these questions are: We are not sure, or some guidelines are poorly supported by data and may prove erroneous. We suggest a more physiologic approach to assessment of proteinuria and believe that if clinicians and investigators looked at proteinuria in terms of how the kidney handles protein in health and disease it would lead to a more rational and evidence-based approach to proteinuria in pregnancy. Finally, we recommend that current cutoff for abnormal proteinuria be used to diagnose preeclampsia, but the level of proteinuria should not guide management. Other variables, such as status of blood pressure control, evidence of increasing organ damage in the liver and hematological systems, evidence of falling glomerular filtration rate, and signs of neurological involvement, are more reliable indicators of severity of preeclampsia.
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Periodic urinary protein creatinine ratio for predicting significant proteinuria in preeclampsia in different alternatives: time effectiveness analysis. Arch Gynecol Obstet 2009; 281:571-3. [PMID: 19568760 DOI: 10.1007/s00404-009-1167-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Accepted: 06/16/2009] [Indexed: 01/10/2023]
Abstract
Preeclampsia is a big problem in obstetrics. The diagnosis relies mainly on the detection of both hypertension and proteinuria. The gold standard for the determination of proteinuria is 24 h urinary protein creatinine ratio; however, this approach is inconvenient and it is a considerable time consuming process that might bring a delayed diagnosis which might result in delayed treatment. Although spot urine measurement can be done, it has very poor prediction. The use of periodic urinary protein creatinine ratio is proposed as a possible alternative to solve this problem. Here, the author tries to perform a time effectiveness analysis for reported models on periodical urinary protein creatinine ratio for predicting significant proteinuria in preeclampsia. Data from previously published reports on this topic are used for further analysis. It seems that the alternative, 4 h, gives the most effectiveness in the shortest period of turnaround time. Hence, this alternative is recommended for screening proteinuria.
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Evaluation of the Bayer® microalbumin/creatinine urinalysis dipstick. Clin Chim Acta 2008; 393:110-3. [DOI: 10.1016/j.cca.2008.03.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 03/17/2008] [Accepted: 03/18/2008] [Indexed: 11/15/2022]
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