Diagnosis of proteinuria using a random urine protein-creatinine ratio and its correlation with adverse outcomes in pregnancy with preeclampsia characterized by renal damage

Determining the relationship between severity of proteinuria and adverse maternal and neonatal outcomes in patients with preeclampsia

OBJECTIVES

To investigate the relationship between the severity of proteinuria and adverse maternal and neonatal outcomes in patients with preeclampsia (PE).

DESIGN

Prospective cohort study conducted in Gauteng, South Africaover 12 months. Patientswith PE 18 years or olderwith singleton pregnancieswere recruited. Weincluded248in the final analysis.

METHODS

Proteinuria was quantified using urine protein: creatinine ratio (UPCR). Preeclamptic patients' outcomeswere compared according to the UPCR values using regression models and by generating receiver operator characteristic (ROC) curves. Primary maternal outcomes were gestational age (GA) at diagnosis, GA at delivery, development of eclampsia, development of severe features and the need for more than one antihypertensiveagent. Neonatal outcomes were admission to neonatal unit, 5-min APGAR score, need for ventilatory support and early neonatal death.

RESULTS

There was a weak but significant negative correlation between GA at delivery and UPCR (Spearman's correlation coefficient (SCC) -0.191, p = 0.002). Most patients (77 %) required >1 agent to control their blood pressure, however there was no correlation between UPCR and the need for additional agents (SCC -0.014, p = 0.828). There was a statistically significant correlation between UPCR and severe features, especially the development of haemolysis, elevated liver enzymes and low platelet (HELLP) syndrome (p = 0.005). There was no significant correlation between neonatal outcomes and UPCR.

CONCLUSION

Severity of proteinuria correlated with earlier delivery and development of severe features, specifically HELLP syndrome and pulmonary oedema. There was no correlation between UPCR and requiring additional antihypertensiveagentsor neonatal outcomes.

Role of omega-3 fatty acids in reducing proteinuria: A systematic review and meta-analysis

BACKGROUND AND OBJECTIVES

Proteinuria, a hallmark of renal and systemic disorders, is associated with adverse outcomes, especially in chronic kidney disease and cardiovascular disease. Omega-3 fatty acids have garnered attention for their cardiovascular benefits and potential therapeutic effects on proteinuria. This systematic review and meta-analysis aimed to evaluate the impact of omega-3 fatty acid supplementation on proteinuria levels across various kidney-related conditions.

METHODS AND STUDY DESIGN

Studies published from 1989 to 2023 were systematically identified, including randomized controlled trials, cohort, case-control, and cross-sectional studies. Nine studies involving a total of 347 participants were included in the analysis.

RESULTS

The meta-analysis revealed a neutral overall effect size of omega-3 fatty acid supplementation on proteinuria levels, assessed under both common and random effect models. Despite the lack of statistically significant evidence supporting the efficacy of omega-3 fatty acids in reducing proteinuria, the variability in interventions and patient populations suggests potential individual responses.

CONCLUSIONS

The find-ings highlight the heterogeneity in responses to omega-3 fatty acid supplementation and emphasize the need for cautious interpretation. While no definitive conclusion can be drawn, the results underscore the importance of targeted research focusing on specific subgroups or conditions that may benefit from omega-3 supplementation. These findings contribute to the evolving understanding of personalized kidney health strategies and pave the way for further exploration and optimization of omega-3 fatty acids' therapeutic applications.

Urinary protein and coagulation-fibrinolysis indicators in preeclampsia: Expression and significance

This study investigates the expression and significance of urinary protein and coagulation-fibrinolysis indicators in preeclampsia, categorized into mild preeclampsia (109 cases) and severe preeclampsia (97 cases) based on disease severity. Additionally, 110 patients with gestational hypertension (gestational hypertension group) were included for comparative analysis. General information, laboratory indicators, urinary protein, and coagulation-fibrinolysis indicator levels were collected for each group. Significant differences were observed in blood pressure among groups (P < .05), while uric acid, serum creatinine, aspartate transaminase, alanine transaminase, and triglycerides showed no significant differences (P > .05). Total cholesterol, triglycerides, and low-density Lipoprotein levels in severe preeclampsia were higher than those in mild preeclampsia and gestational hypertension groups, whereas high-density lipoprotein, albumin, and platelet levels were lower in severe preeclampsia. No significant differences were observed in prothrombin time or D-dimer levels among groups (P > .05). Urinary protein, urinary protein quantification, activated partial thromboplastin time, thrombin time, and fibrinogen were identified as influencing factors for adverse maternal and infant outcomes in severe preeclampsia patients. The study concludes that urinary protein and coagulation-fibrinolysis indicators are elevated in preeclampsia, particularly in severe preeclampsia cases, suggesting their potential use as diagnostic influencing factors for severe preeclampsia.

Application value of serum S100B combined with glucose metabolism indexes in predicting adverse pregnancy outcomes of patients with severe preeclampsia

S100 calcium-binding protein B (S100B) and glucose control are reflective of maternal-fetal risks. We investigated the value of serum S100B combined with fasting blood glucose (FBG)/hemoglobin A1c (HbA1c) in evaluating the pregnancy outcomes of patients with severe preeclampsia (SPE). The clinical characteristics of SPE patients/controls were collected. FBG/HbA1c and serum S100B levels were measured, with their correlations analyzed. SPE patients were subdivided into adverse/non-adverse outcome groups based on follow-up results. The value of different indexes in predicting pregnancy outcomes was analyzed. SPE patients showed higher systolic blood pressure, diastolic blood pressure, urine protein, and body mass index and lower platelets, gestational age at delivery, and infant birth weight than healthy controls. FBG and HbA1c were positively correlated with serum S100B. SPE patients with adverse outcomes exhibited increased serum S100B and FBG/HbA1c levels. The area under the curve of serum S100B + FBG/HbA1c in evaluating adverse pregnancy outcomes of SPE patients was 0.8412 (77.05% sensitivity/84.21% specificity), higher than either alone. Serum S100B and FBG/HbA1c were independent risk factors for adverse outcomes of SPE patients. Overall, serum S100B positively-correlates with FBG/HbA1c in SPE patients. Serum S100B and FBG/HbA1c are independent risk factors, and their combination has high value on predicting adverse pregnancy outcomes of SPE patients.