Diagnostic accuracy of spot urinary protein/creatinine ratio for proteinurea in pregnancy induced hypertension (original) (raw)
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IOSR Journals , 2019
objective was to study the correlation between Protein-creatinine ratio of spot urine sample. Correlation of the values in hypertensive pregnant females Implications and correlation with clinical scenario. Patient would be selected according to criteria for gestational hypertension. blood pressure determined by mercury sphygmomanometer on two occasions at least 4 hrs apart. The sample collected would be the first morning urine sample/ midstream sample. The cut off value of P/C would be fixed determined by receiver operating characteristics (ROC) curve. Observation shows mean value of serum creatinine in normal and pregnant females whose values are 055±.0.14 mg /dl and 0.77±0.29 mg/dl.t value is 3.75 while p value is 0.03 and hence the value is significant in this case also. The level of serum creatinine in complicated pregnancy is more as compared to normal pregnancy. value of 24 hour urinary creatinine in normal pregnancy is 2.63±53,82 while in complicated pregnancy it is 1.66±35.36.The value is significant(t-value is 9.65 and p-value is 0.02) decrease in the urinary creatinine. This decrease is due to decrease in the normal functioning of the kidney. The glomerular filteration rate and renal plasma flow is decreased leading to decrease in creatinine. The parameters would be assessed and accordingly a criteria would be established to predict course of action in patients with proteinuria and gestational hypertension and an attempt would be made to determine clinical severity.
The protein:creatinine ratio in random, untimed urine samples correlates with 24-h protein excretion in pregnant women with and without hypertension. Nevertheless, whether this ratio is appropriate as a screening test for proteinuria is still unclear, in part because of the paucity of large studies. Methods: We measured protein:creatinine ratios in random urine samples and protein contents of 24-h urine samples in a cross-sectional study of 927 hospitalized pregnant women at >20-weeks of gestational age and in a 2nd cohort of 161 pregnant women. In the 2nd group, urine specimens were obtained before and after completion of the 24-h collections, avoiding 1st-morning void specimens. Results: Protein excretion was >300 mg/24 h in 282 patients (30.4%). The urine protein:creatinine ratio and the 24-h protein excretion were significantly correlated (r ؍ 0.98, P <0.001). The protein:creatinine ratio as an indicator of protein excretion >300 mg/24 h was >0.3. The sensitivity and specificity were 98.2% and 98.8%, respectively. Positive and negative predictive values were 97.2% and 99.2%, respectively, and positive and negative likelihood ratios were 79.2 and 0.02, respectively. The diagnostic accuracy of the urinary protein: creatinine ratio was corroborated in the 2nd cohort of patients, which also showed no statistically significant difference in protein:creatinine ratio between samples obtained >24 h apart. Conclusions: Random urinary protein:creatinine ratio is a reliable indicator of significant proteinuria (>300 mg/day) in nonambulatory pregnant women, irrespective of sampling time during the daytime. The protein: creatinine ratio may be reasonably used as an alternative to the 24-h urine collection method.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2019
Hypertensive disorder of pregnancy has complicated up to 10% of pregnancies in the world. It is one of the greatest causes of maternal and perinatal morbidity and mortality worldwide. 1 Estimated 50,000-60,000 deaths per year worldwide are due to preeclampsia. 2,3 The incidence of pre-eclampsia in India is 8-10%. In India, it contributes to about 24% of maternal deaths. 4 Preeclampsia is a multisystem disorder with widespread endothelial leak. One of the important signs of preeclampsia is proteinuria which occurs as a ABSTRACT Background: Gestational hypertension is defined as systolic BP level of > 140 mmHg or a diastolic BP of > 90 mmHg that occur after 20 weeks of gestation. Pre-eclampsia is the hypertensive disorder of pregnancy, associated with adverse fetomaternal complications. It is assosciated with proteinuria. 24 hours urine collection is cumbersome, time consuming and potentially misleading if collected inaccurately. The spot P/C ratio has been considered equivalent to 24-hour urinary protein for predicting proteinuria. Aim of study was to compare spot P/C ratio to 24 hours urinary protein in patients of pre-eclampsia and to determine the fetomaternal outcome in the patients admitted in Dayanand Medical College and Hospital, Ludhiana. Methods: A prospective simple random study. It included 100 hypertensive pregnant women being evaluated for preelampsia, regardless of the alerting signs or symptoms. The main measures were the urinalysis of patients which included urinary spot P/C and 24 hours urinary protein excretion and the fetomaternal outcome in these patients. The data was statistically analyzed. Results: A good positive correlation existed between the P/C ratio and 24 hours protein excretion, with a correlation coefficient (r) of 0.912. The sensitivity and specificity of 24 hours urinary protein versus spot P/C ratio ranged between 86.29%-99.51% and 8.35%-99.95% respectively. The positive and negative likelihood ratio of 24 hours urinary protein versus spot P/C ratio was 48 (ranged between 6.89-334) and 0.04 (ranged between 0.01-0.16) respectively. The positive and negative predictive value of 24 hours urinary protein versus spot P/C ratio was 97.96% and 96.08% respectively. Our data showed that urine spot P/C ratio above 3.9/mg strongly predicts significant proteinuria of more than 4 gram/day. Conclusions: Spot urinary P/C ratio with suspected preeclampsia can be used as a rapid alternative test to 24 hours urinary protein.
Quantifying proteinuria in hypertensive disorders of pregnancy
International journal of hypertension, 2014
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) showin...
Journal of Andrology and Gynaecology, 2018
Background: Although, twenty-four hour urine collection was considered the gold standard for quantification of proteinuria, it has many limitations. It is cumbersome for the patient and often inaccurate because of under collection and result availability is delayed for at least 24 hours. The spot albumin creatinine (A/C) ratio use in pregnancy has been extensively studied. Its use has been adopted by some authors as they found that it had been significantly correlated to 24 hour urinary protein estimation while others did not support its use as in cases of preeclampsia kidney function may deteriorate rapidly. Objective: To evaluate the accuracy of random urine albumin/ creatinine ratio as a diagnostic method for quantitative evaluation of proteinuria in hypertensive disorders in pregnant women. Methods: A total of 70 patients fulfilling inclusion criteria were evaluated with urine albumin/creatinine ratio performed on random voided sample. The entire 24 hour urine sample was collected and analyzed for daily protein excretion. A/C ratio was compared to the 24 hour results. Results: There was significant positive correlation detected between A/C ratio and 24 hour protein at a cutoff value of 347.35 mg/gm. Area under curve for A/C ratio was 0.730 (P<0.001) showing sensitivity 80.6% and specificity 51.2% to detect protein excretion of 300 mg/24 hr. While, there was significant negative correlation detected between A/C ratio and urine creatinine. Conclusion: Random A/C ratio could be used as a rapid, easy and reliable test for diagnosis of significant proteinuria in hypertensive disorders with pregnancy, so it can substitute 24 hour urinary protein collection.
Acta medica Iranica, 2011
To evaluate the value of random urinary protein creatinine ratio in prediction of 24h proteinuria in hypertensive pregnancies. Random urine samples and routine 24h urine collections were collected from hypertensive pregnant women (n=100). Reliability of random urinary protein-creatinine ratio was assessed by receiver operator characteristic (ROC) curve to detect significant proteinuria (≥300mg/day) using 24h. Urine protein as a gold standard. Forty six patients (46%) had significant proteinuria. The random protein creatinine ratio was correlated to 24h urine protein excretion (r(2)=0.777, P<0.001) Area under ROC curve to predict proteinuria was 0.926 (95% CI: 0.854-0.995, P<0.001). A cut off value of 0.22mg/mg for protein creatinine ratio best predicted significant proteinuria with sensitivity, specificity, positive and negative predictive values of 87%, 92.6%, 90.6% and 89.3% respectively. Random urinary protein creatinine ratio is a simple inexpensive and excellent alternati...
Random protein-creatinine ratio for the quantitation of proteinuria in pregnancy
Obstetrics and gynecology, 1997
To compare random urine protein-creatinine ratios with 24-hour urine protein excretion rates in patients hospitalized with hypertensive disorders in pregnancy. All hospitalized, hypertensive patients requiring 24-hour urine protein excretion collections were eligible for the study. During the 24-hour urine collection a separate 2-mL aliquot was taken for a protein and creatinine determination. Seventy-one samples were collected from patients with the following diagnoses: gestational hypertension (n = 56), preexisting hypertension and superimposed gestational hypertension (n = 11), and syndrome of hemolysis, elevated liver enzymes and low platelets (n = 4). The correlation coefficient between the random protein-creatinine ratio and the 24-hour urine protein excretion was 0.94. Calculated excretion rates with at least 300 mg protein in 24 hours had a sensitivity of 0.93, specificity of 0.90, and positive and negative predictive values of 0.87 and 0.95, respectively. For those samples ...
AIM-To evaluate the correlation of spot urinary proteincreatinine ratio in single voided urine sample in antenatal patients with hypertensive disorders for assessing the severity of preeclampsia, maternal organ dysfunction and its implication in perinatal outcomes. MATERIAL & METHODS: 150 cases of Pregnancy Induced Hypertension admitted in ward/Labour room of Department of Obstetrics & Gynaecology, SRMSIMS were studied and grouped into mild and severe pre-eclampsia depending upon blood pressure and clinical parameters. Midstream urine sample estimation for protein-creatinine ratio was done along with the biochemical parameters for renal and liver function tests. The correlation of spot urinary protein-creatinine ratio with severity of preeclampsia along with the derangements in fundoscopy, liver function and renal function tests with increasing severity of proteinuria using optimal protein-creatinine ratio of 0.3 and effects of Pre-eclampsia on perinatal outcomes were evaluated. RESULTS: Protein-Creatinine ratio of 0.3 can be used as an optimal cutoff to detect the severity of preeclampsia. On evaluation of organ dysfunction in relation to Protein-creatinine ratio, a statistically significant p value was observed between increasing grades of preeclampsia with abnormal fundoscopy, abnormal renal function tests and abnormal liver function tests. While studying the fetal parameter in terms of IUFD, prematurity, low birth weight, APGAR < 7 at 5 minutes, NICU admission no statistically significant result was found with respect to the value of protein-creatinine ratio but still it was seen that protein creatinine ratio could be used as a single parameter for early detection of maternal organ dysfunction and perinatal outcome and thereby helps in management and improve prognosis. CONCLUSION: The optimal spot Protein-creatinine ratio cut off point of 0.3 can be used to assess the disease severity in hypertensive disorders of pregnancy and early detection of maternal organ involvement, maternal and perinatal outcomes.