The Role of the Urine Dipstick Test in the Detection of Abnormal Proteinuria Using Different Cut-off Levels in Hypertensive Pregnancies

Year 2022, Volume: 24 Issue: 1, 7 - 11, 30.04.2022

Taha Takmaz Irana Gorchiyeva Belfin Nur Arici Halici Ali Toprak Caglar Cetin Mehmet Serdar Kutuk

https://doi.org/10.18678/dtfd.939565

Abstract

Aim: The aim of this study was to determine the diagnostic accuracy of different urine dipstick protein threshold levels in predicting the presence of abnormal proteinuria in pregnant women with hypertension.
Material and Methods: A total of 326 singleton pregnant women who underwent 501 urine protein tests and who had suspected preeclampsia were included in this retrospective study. Patient data was taken including medical and obstetric history. The results of dipstick urinalysis and concurrent 24-hour urine protein excretion measurements were compared to determine the accuracy of urinalysis.
Results: A dipstick result of 1+ was found to be the best cut-off to predict 500 mg of protein excretion per day, with sensitivity and specificity of 62.09% and 88.97%, respectively. A 2+ proteinuria dipstick cut-off had high specificity and positive predictive value (PPV) (99.05% and 98.84%, respectively) for the prediction of 300 mg of protein excretion per day; this cut-off had low sensitivity (21.46%). A cut-off of 1+ also provided satisfactory specificity and PPV (91.43% and 94.48%, respectively) for the detection of 300 mg of protein excretion per day, but sensitivity was compromised (38.89%). Among 301 patients with negative dipstick results, 212 had a 24-hour urine protein extraction greater than 300 mg, with a false negative rate of 70.43%.
Conclusion: The results suggest that the urine protein dipstick measurement has limited quantitative ability for the prediction of abnormal proteinuria. Additionally, the use of 500 mg 24-hours protein excretion as a cut-off value for abnormal proteinuria may provide useful data.

Keywords

24-hour urine protein, dipstick urinalysis, preeclampsia, pregnancy, proteinuria

Supporting Institution

None

Thanks

None

Hipertansif Gebeliklerde Farklı Cut-off Düzeyleri Kullanılarak Anormal Proteinüri Saptanmasında Spot İdrar Protein Ölçümünün Rolü

Abstract

Amaç: Bu çalışmanın amacı, hipertansif gebelerde anormal proteinüri varlığını öngörmede farklı idrar ölçüm çubuğu protein eşik seviyelerinin tanısal doğruluğunu belirlemektir.
Gereç ve Yöntemler: Bu retrospektif çalışmaya, preeklampsiden şüphelenilen toplam 326 tekiz gebe kadından elde edilen 501 idrar protein testi sonucu dahil edilmiştir. Hastaların tıbbi ve obstetrik geçmiş verileri kaydedildi. İdrar tahlilinin doğruluğunu belirlemek için idrar ölçüm çubuğu protein tahlili ve eşzamanlı 24 saatlik idrar protein atılım ölçümlerinin sonuçları karşılaştırıldı.
Bulgular: 1+ spot idrar protein ölçüm sonucu, 500 mg günlük protein atılımını sırasıyla %62.09 duyarlılık ve %88.97 özgüllük ile öngörmede en iyi kesim değeri olarak bulundu. Spot idrarda 2+ proteinüri değeri; 300 mg günlük protein atılımını öngörmede yüksek özgüllük ve pozitif tahmin değerine (PTD) (sırasıyla %99.05 ve %98.84) sahipken, bu kesim değerinin duyarlılığı düşüktür (%21.46). 1+ kesim değeri; 300 mg günlük protein atılımının saptanması için tatmin edici özgüllük ve pozitif tahmin değerine sahipti (sırasıyla %91.43 ve%94.48), ancak duyarlılığı düşüktü (%38.89). Spot idrar protein ölçümü negatif olan 301 hastadan 212'sinde günlük 300 mg üzeri 24 saatlik idrar protein atılımı tespit edildi (%70,43 yanlış negatiflik).
Sonuç: Sonuçlar, spot idrar protein ölçümünün anormal proteinüriyi tahmin etmek için sınırlı niceliksel kabiliyete sahip olduğunu göstermektedir. Ek olarak, anormal proteinüri için kesme değeri olarak 500 mg 24 saatlik protein atılımının kullanılması yararlı veriler sağlayabilir.

Keywords

24 saatlik idrar proteini, daldırma çubuğu idrar tahlili, preeklampsi, gebelik, proteinüri

References

• Abalos E, Cuesta C, Grosso AL, Chou D, Say L. Global and regional estimates of preeclampsia and eclampsia: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2013;170(1):1-7.
• Stevens W, Shih T, Incerti D, Ton TGN, Lee HC, Peneva D, et al. Short-term costs of preeclampsia to the United States health care system. Am J Obstet Gynecol. 2017;217(3):237-48.e16.
• American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122(5):1122-31.
• American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020;135(6):e237-60.
• Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice. Hypertension. 2018;72(1):24-43.
• Homer CS, Brown MA, Mangos G, Davis GK. Non-proteinuric pre-eclampsia: a novel risk indicator in women with gestational hypertension. J Hypertens. 2008;26(2):295-302.
• Bramham K, Poli-de-Figueiredo CE, Seed PT, Briley AL, Poston L, Shennan AH, et al. Association of proteinuria threshold in pre-eclampsia with maternal and perinatal outcomes: a nested case control cohort of high risk women. PLoS One. 2013;8(10):e76083.
• Dong X, Gou W, Li C, Wu M, Han Z, Li X, et al. Proteinuria in preeclampsia: not essential to diagnosis but related to disease severity and fetal outcomes. Pregnancy Hypertens. 2017;8:60-4.
• Tanacan A, Fadiloglu E, Beksac MS. The importance of proteinuria in preeclampsia and its predictive role in maternal and neonatal outcomes. Hypertens Pregnancy. 2019;38(2):111-8.
• Higby K, Suiter CR, Phelps JY, Siler-Khodr T, Langer O. Normal values of urinary albumin and total protein excretion during pregnancy. Am J Obstet Gynecol. 1994;171(4):984-9.
• Amin SV, Illipilla S, Hebbar S, Rai L, Kumar P, Pai MV. Quantifying proteinuria in hypertensive disorders of pregnancy. Int J Hypertens. 2014;2014:941408.
• Kuo VS, Koumantakis G, Gallery ED. Proteinuria and its assessment in normal and hypertensive pregnancy. Am J Obstet Gynecol. 1992;167(3):723-8.
• Phillips JK, McBride CA, Hale SA, Solomon RJ, Badger GJ, Bernstein IM. Examination of prepregnancy and pregnancy urinary protein levels in healthy nulliparous women. Reprod Sci. 2017;24(3):407-12.
• Osmundson SS, Lafayette RA, Bowen RA, Roque VC, Garabedian MJ, Aziz N. Maternal proteinuria in twin compared with singleton pregnancies. Obstet Gynecol. 2014;124(2 Pt 1):332-7.
• Fishel Bartal M, Lindheimer MD, Sibai BM. Proteinuria during pregnancy: definition, pathophysiology, methodology, and clinical significance. Am J Obstet Gynecol. 2022;226(2S):S819-34.
• Meyer NL, Mercer BM, Friedman SA, Sibai BM. Urinary dipstick protein: a poor predictor of absent or severe proteinuria. Am J Obstet Gynecol. 1994;170(1 Pt 1):137-41.
• Saudan PJ, Brown MA, Farrell T, Shaw L. Improved methods of assessing proteinuria in hypertensive pregnancy. Br J Obstet Gynaecol. 1997;104(10):1159-64.
• Phelan LK, Brown MA, Davis GK, Mangos G. A prospective study of the impact of automated dipstick urinalysis on the diagnosis of preeclampsia. Hypertens Pregnancy. 2004;23(2):135-42.
• Waugh JJ, Bell SC, Kilby MD, Blackwell CN, Seed P, Shennan AH, et al. Optimal bedside urinalysis for the detection of proteinuria in hypertensive pregnancy: a study of diagnostic accuracy. BJOG. 2005;112(4):412-7.
• Dwyer BK, Gorman M, Carroll IR, Druzin M. Urinalysis vs urine protein-creatinine ratio to predict significant proteinuria in pregnancy. J Perinatol. 2008;28(7):461-7.
• Kyle PM, Fielder JN, Pullar B, Horwood LJ, Moore MP. Comparison of methods to identify significant proteinuria in pregnancy in the outpatient setting. BJOG. 2008;115(4):523-7.
• Stefańska K, Zieliński M, Zamkowska D, Adamski P, Jassem-Bobowicz J, Piekarska K, et al. Comparisons of dipstick test, urine protein-to-creatine ratio, and total protein measurement for the diagnosis of preeclampsia. Int J Environ Res Public Health. 2020;12;17(12):4195.
• Waugh JJ, Clark TJ, Divakaran TG, Khan KS, Kilby MD. Accuracy of urinalysis dipstick techniques in predicting significant proteinuria in pregnancy. Obstet Gynecol. 2004;103(4):769-77.