Gebelikte Proteinüri Tespitinde Spot İdrar Protein/Kreatinin Oranı ile 24 Saatlik İdrar Protein Atılımının Karşılaştırılması

Abstract

Amaç: Preeklampsi ve ilişkili durumlarda proteinüri tespiti önemlidir. Bu çalışmada, 24 saatlik idrarda protein atılımı ile spot idrar protein/kreatinin (P/K) oranının tanısal uyumu değerlendirilmiş ve spot testin alternatif olarak kullanılıp kullanılamayacağı araştırılmıştır. Ayrıca, tam idrar tahlilinde (TİT) dipstik ile protein pozitifliğinin tanısal performansı incelenmiştir. Araçlar ve Yöntem: Yüksek riskli gebelik nedeniyle (kronik hipertansiyon, gestasyonel hipertansiyon, diyabet, intrauterin gelişme geriliği) 24 saatlik idrar proteini ve eş zamanlı spot idrar P/K oranı ölçülen 105 gebe çalışmaya alındı. Proteinüri için altın standart ≥300 mg/gün olarak belirlendi. Spot P/K oranı ≥0,3 pozitif kabul edildi. TİT protein pozitifliği ≥1+ olarak tanımlandı. Pearson korelasyon, ROC analizi, McNemar testi ve duyarlılık/özgüllük analizleri yapıldı. Bulgular: Spot test ile 24 saatlik proteinüri arasında pozitif korelasyon vardı (r=0.76; p<0.001). Spot testin duyarlılığı %62.5, özgüllüğü %72.6; TİT’nin duyarlılığı %43.8, özgüllüğü %78.1 olarak bulundu. Spot test ve 24 saatlik test sonuçları arasında %69 oranında uyum mevcuttu (McNemar p=0.20). ROC eğrisi altında kalan alan 0.73 olarak belirlendi. Sonuç: Spot idrar P/K oranı, gebelikte proteinüri tespiti için pratik ve güvenilir bir yöntemdir. Özellikle dipstik yöntemine kıyasla daha yüksek duyarlılık sağlamaktadır. Spot test, preeklampsi şüphesi olan gebelerde hızlı tarama aracı olarak değerlendirilebilir, ancak yüksek şüphe durumlarında 24 saatlik test önerilmeye devam edilmelidir.

Keywords

• dipstik testi
• hipertansiyon
• preeklampsi
• proteinüri taramas

Comparison of Spot Urine Protein/Creatinine Ratio and 24-Hour Urine Protein Excretion in Detection of Proteinuria in Pregnancy

Abstract

Purpose: Detection of proteinuria is important in preeclampsia and related conditions. In this study, the diagnostic compatibility of 24-hour urine protein excretion and spot urine protein/creatinine (P/C) ratio was evaluated and it was investigated whether the spot test could be used as an alternative. In addition, the diagnostic performance of protein positivity with dipstick in complete urine analysis (CUT) was examined. Materials and Methods: 105 pregnant women who had 24-hour urine protein and simultaneous spot urine P/C ratio measured due to high-risk pregnancies (chronic hypertension, gestational hypertension, diabetes, intrauterine growth retardation) were included in the study. The gold standard for proteinuria was determined as ≥300 mg/day. Spot P/C ratio ≥0.3 was considered positive. CUT protein positivity was defined as ≥1+. Pearson correlation, ROC analysis, McNemar test and sensitivity/specificity analyses were performed. Results: There was a positive correlation between spot test and 24-hour proteinuria (r=0.76; p<0.001). The sensitivity of spot test was 62.5% and specificity was 72.6%; sensitivity of TIT was 43.8% and specificity was 78.1%. There was 69% agreement between spot test and 24-hour test results (McNemar p=0.20). The area under the ROC curve was determined as 0.73. Conclusion: Spot urine P/K ratio is a practical and reliable method for the detection of proteinuria in pregnancy. It provides higher sensitivity, especially compared to the dipstick method. Spot test can be considered as a rapid screening tool in pregnant women with suspected preeclampsia, but in cases of high suspicion, 24-hour test should continue to be recommended.

Keywords

• dipstick test
• hypertension
• preeclampsia
• proteinuria screening

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