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Impact of random urine proteinuria on maternal and fetal outcomes of pregnancy: a retrospective case-control study

  • Bae, Eun Hui (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kim, Jong Woon (Department of Obsterics, Chonnam National University Medical School) ;
  • Choi, Hong Sang (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Ma, Seong Kwon (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kim, Soo Wan (Department of Internal Medicine, Chonnam National University Medical School)
  • Received : 2016.01.07
  • Accepted : 2016.05.06
  • Published : 2017.11.01

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 $33.0{\pm}4.7years$, and the mean gestational age was $235.6{\pm}50.6days$ 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.

Keywords

Acknowledgement

Supported by : National Research Foundation of Korea (NRF)

References

  1. Martins-Costa SH, Vettorazzi J, Valerio E, et al. Protein creatinine ratio in random urine sample of hypertensive pregnant women: maternal and perinatal outcomes. Hypertens Pregnancy 2011;30:331-337. https://doi.org/10.3109/10641950903454564
  2. Wikstrom AK, Wikstrom J, Larsson A, Olovsson M. Random albumin/creatinine ratio for quantification of proteinuria in manifest pre-eclampsia. BJOG 2006;113:930-934. https://doi.org/10.1111/j.1471-0528.2006.01007.x
  3. Lambers Heerspink HJ, Brantsma AH, de Zeeuw D, et al. Albuminuria assessed from first-morning-void urine samples versus 24-hour urine collections as a predictor of cardiovascular morbidity and mortality. Am J Epidemiol 2008;168:897-905. https://doi.org/10.1093/aje/kwn209
  4. Khazardoost S, Maryamnoorzadeh, Abdollahi A, Shafaat M. Comparison of 8-h urine protein and random urinary protein-to-creatinine ratio with 24-h urine protein in pregnancy. J Matern Fetal Neonatal Med 2012;25:138-140.
  5. Robert M, Sepandj F, Liston RM, Dooley KC. Random protein-creatinine ratio for the quantitation of proteinuria in pregnancy. Obstet Gynecol 1997;90:893-895. https://doi.org/10.1016/S0029-7844(97)00536-X
  6. Yamasmit W, Wongkitisophon K, Charoenvidhya D, Uerpairojkit B, Chaithongwongwatthana S. Correlation between random urinary protein-to-creatinine ratio and quantitation of 24-hour proteinuria in preeclampsia. J Med Assoc Thai 2003;86:69-73.
  7. Sibai BM. Treatment of hypertension in pregnant women. N Engl J Med 1996;335:257-265. https://doi.org/10.1056/NEJM199607253350407
  8. Chapter 1: definition and classification of CKD. Kidney Int Suppl (2011) 2013;3:19-62.
  9. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39(2 Suppl 1):S1-S266. https://doi.org/10.1016/S0272-6386(02)70081-4
  10. Qiu S. Clinical analysis of the outcome of pregnancy with chronic renal disease. Zhonghua Fu Chan Ke Za Zhi 1993;28:595-598.
  11. Haas DM, Sabi F, McNamara M, Rivera-Alsina M. Comparing ambulatory spot urine protein/creatinine ratios and 24-h urine protein measurements in normal pregnancies. J Matern Fetal Neonatal Med 2003;14:233-236. https://doi.org/10.1080/jmf.14.4.233.236
  12. Saudan PJ, Brown MA, Farrell T, Shaw L. Improved methods of assessing proteinuria in hypertensive pregnancy. Br J Obstet Gynaecol 1997;104:1159-1164. https://doi.org/10.1111/j.1471-0528.1997.tb10940.x
  13. Bell SC, Halligan AW, Martin A, et al. The role of observer error in antenatal dipstick proteinuria analysis. Br J Obstet Gynaecol 1999;106:1177-1180. https://doi.org/10.1111/j.1471-0528.1999.tb08144.x
  14. Rizk DE, Agarwal MM, Pathan JY, Obineche EN. Predicting proteinuria in hypertensive pregnancies with urinary protein-creatinine or calcium-creatinine ratio. J Perinatol 2007;27:272-277. https://doi.org/10.1038/sj.jp.7211689
  15. Somanathan N, Farrell T, Galimberti A. A comparison between 24-hour and 2-hour urine collection for the determination of proteinuria. J Obstet Gynaecol 2003;23:378-380. https://doi.org/10.1080/0144361031000119538
  16. Amirabi A, Danaii S. A comparison of 4- and 24-hour urine samples for the diagnosis of proteinuria in pregnancy. Iran J Med Sci 2011;36:167-171.
  17. Park JH, Chung D, Cho HY, et al. Random urine protein/creatinine ratio readily predicts proteinuria in preeclampsia. Obstet Gynecol Sci 2013;56:8-14. https://doi.org/10.5468/OGS.2013.56.1.8
  18. Boler L, Zbella EA, Gleicher N. Quantitation of proteinuria in pregnancy by the use of single voided urine samples. Obstet Gynecol 1987;70:99-100.
  19. Aggarwal N, Suri V, Soni S, Chopra V, Kohli HS. A prospective comparison of random urine protein-creatinine ratio vs 24-hour urine protein in women with preeclampsia. Medscape J Med 2008;10:98.
  20. Baba Y, Yamada T, Obata-Yasuoka M, et al. Urinary protein- to-creatinine ratio in pregnant women after dipstick testing: prospective observational study. BMC Pregnancy Childbirth 2015;15:331. https://doi.org/10.1186/s12884-015-0776-9
  21. James DK, Steer PJ, Weiner CP, Gonik B. High Risk Pregnancy: Management Options. 3rd ed. Philadelphia: Saunders/Elsevier, 2006:772-777.
  22. Gabbe SG, Niebyl JR, Simpson JL. Obstetrics: Normal and Problem Pregnancies. 5th ed. Philadelphia: Churchill Livingstone/Elsevier, 2007:863-865.
  23. ACOG Committee on Practice Bulletins: Obstetrics. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Obstet Gynecol 2002;99:159-167.
  24. Papanna R, Mann LK, Kouides RW, Glantz JC. Protein/creatinine ratio in preeclampsia: a systematic review. Obstet Gynecol 2008;112:135-144. https://doi.org/10.1097/AOG.0b013e3181778cfc
  25. Evans W, Lensmeyer JP, Kirby RS, Malnory ME, Broekhuizen FF. Two-hour urine collection for evaluating renal function correlates with 24-hour urine collection in pregnant patients. J Matern Fetal Med 2000;9:233-237.
  26. Adelberg AM, Miller J, Doerzbacher M, Lambers DS. Correlation of quantitative protein measurements in 8-, 12-, and 24-hour urine samples for the diagnosis of preeclampsia. Am J Obstet Gynecol 2001;185:804-807. https://doi.org/10.1067/mob.2001.117302

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