Preeklampsi ile komplike olmuş gebelerde 24 saatlik idrarda proteinüri değerlerinin maternal ve perinatal sonuçlar üzerine etkisi

Year 2021, Volume: 18 Issue: 1, 717 - 721, 01.04.2021

Mustafa Behram Süleyman Cemil Oğlak Gökhan Bolluk Salim Sezer Zeynep Gedik Özköse Sema Süzen Çaypınar Züat Acar Fatma Ölmez

https://doi.org/10.38136/jgon.801687

Abstract

Amaç: Bu çalışmada, 24 saatlik proteinüri (PU) düzeyinin maternal, perinatal ve fetal sonuçlar ile ilişkisinin değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: Preeklampsi tanısıyla yatırılan hastalar (n=92) 24 saatlik idrarda PU düzeylerine göre hafif (0,3-2 g), şiddetli (2-5 g) ve masif (≥5 g) PU olarak üç gruba ayrıldı. Hastalara ait bazı tanımlayıcı ve klinik bilgiler, doğum öncesi ve sonrası kan ve idrar biyokimyası sonuçları, doğum haftası ve hastaneye yatışlarına ait bilgiler, yenidoğanlara ait doğum bilgileri hasta dosyalarından elde edildi ve PU grupları arasında karşılaştırma ve ilişki analizleri yapıldı.
Bulgular: Hafif, şiddetli ve masif PU gruplarında sırasıyla 41, 17 ve 34 hasta vardı. Hastaların doğum öncesi 24 saatlik PU miktarı ortalaması 4776,4±5616,6 mg/dL idi. Ayrıca, doğum sonrası, annelerde %20 oranında komplikasyon gelişti. Hafif ve şiddetli PU grupları arasında yaş, RDW ve hastaneye yatış ile doğum arasında geçen süre parametrelerinde anlamlı farklar bulundu ve şiddetli PU grubunda her üç parametre de daha düşüktü. Masif PU grubunda, hafif PU grubuna göre AST ve kordon kanı pH’si daha düşük; BUN, kreatinin ve beyaz küre sayısı daha yüksek idi. Şiddetli ve masif PU grupları arasında ise yalnızca kreatinin düzeyinde istatistiksel olarak anlamlı bir yükselme gözlendi.
Sonuç: Şiddetli ve masif PU’da BUN, BK ve kreatinin seviyesi daha yüksek, kordon pH’si daha düşüktür. Böbrek fonksiyonlarını gösteren bu biyokimyasal testlerin uzun dönem maternal böbrek fonksiyonlarına etkisinin, ayrıca doğumdaki düşük kordon pH’sinin bebeklerin uzun dönem sonuçlarına etkisinin olup olmadığını belirleyebilmek için daha uzun süreli ve ileri araştırmalara ihtiyaç vardır.

Keywords

preeklampsi, proteinüri, maternal sonuçlar, perinatal sonuçlar

The effect of 24-hour urine protein values on maternal and perinatal outcomes in patients complicated with preeclampsia

Abstract

Aim: This study aimed to evaluate the relation of 24-hour proteinuria (PU) levels with maternal, perinatal, and fetal outcomes.
Material and Methods: Patients who were hospitalized with the diagnosis of preeclampsia (n=97) were divided into three groups as mild (0.3-2 g), severe (2-5 g), and massive (≥5 g) PU according to their 24-hour PU levels. Some descriptive and clinical data of the patients, prenatal, and postnatal blood and urine biochemistry results, inputs about the weeks of birth, and hospitalizations, birth information of the newborn were obtained from the patient files, and comparison and relationship analyzes were performed between three PU groups.
Results: There were 41, 17, and 34 patients in the mild, severe, and massive PU groups, respectively. The mean 24-hour PU amount of the patients before delivery was 4776.4±5616.6 (mg/dL). Besides, 20% of the mothers developed complications in the postpartum period. Significant differences were found in age, RDW, and duration between hospitalization and birth among mild and severe PU groups, and all three parameters were lower in the severe PU group. In the massive PU group, AST and cord pH were lower than in the mild PU group; but BUN, creatinine, and WBC were higher. A statistically significant increase was observed only in the creatinine level in the massive PU groups, in comparison with the severe PU group.
Conclusion: In severe and massive PU’s, BUN, WBC, and creatinine levels are higher, cord pH is lower. Long-term and further studies are needed to determine whether these biochemical tests that show renal function affect long-term maternal renal function, as well as the effect of low cord pH at birth on long-term outcomes of newborns.

Keywords

preeclamspia, proteinuria, maternal outcomes, perinatal outcomes

References

• 1. Ma'ayeh M, Rood KM, Kniss D, Costantine MM. Novel interventions for the prevention of preeclampsia. Curr Hypertens Rep. 2020;22(2):17. doi:10.1007/s11906-020-1026-8.
• 2. ACOG Practice Bulletin No. 202: Gestational hypertension and preeclampsia. Obstet Gynecol. 2019;133(1):e1-e25. doi:10.1097/AOG.0000000000003018.
• 3. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066–74.
• 4. Davey DA, MacGillivray I. The classification and definition of the hypertensive disorders of pregnancy. Am J Obstet Gynecol. 1988; 158(4): 892–8. doi:10.1016/0002-9378(88)90090-7
• 5. Guida JP, Parpinelli MA, Surita FG, Costa ML. The impact of proteinuria on maternal and perinatal outcomes among women with pre-eclampsia. Int J Gynecol Obstet. 2018; 143(1): 101–7.
• 6. Douglas KA, Redman CW. Eclampsia in the United Kingdom. BMJ. 1994; 309(6966): 1395–400. doi:10.1136/bmj.309.6966.1395 .
• 7. Thangaratinam S, Coomarasamy A, O’Mahony F, Sharp S, Zamora J, Khan KS, et al. Estimation of proteinuria as a predictor of complications of pre-eclampsia: a systematic review. BMC Med. 2009; 7: 10. doi: 10.1186/1741-7015-7-10.
• 8. Mateus J, Newman R, Sibai BM, Li Q, Barton JR, Combs CA, et al. Massive urinary protein excretion associated with greater neonatal risk in preeclampsia. AJP Rep. 2017; 7(1): e49-e58. doi: 10.1055/s-0037-1601866.
• 9. Parlakgümüş HA, Şimşek E, Çok T, Tarim E. The relationship between proteinuria in severe preeclampsia and maternal and fetal outcomes. Gynecology Obstet Reprod Med. 2012;18:7-11.
• 10. Tranquilli AL, Dekker G, Magee L, Roberts J, Sibai BM, Steyn W, et al. The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from the ISSHP. Pregnancy Hypertens. 2014; 4(2): 97–104. doi: 10.1016/j.preghy.2014.02.001.
• 11. Kane SC, Dennis A, da Silva Costa F, Kornman L, Brennecke S. Contemporary clinical management of the cerebral complications of preeclampsia. Obstet Gynecol Int. 2013; 2013: 985606. doi:10.1155/2013/985606.
• 12. Bouzari Z, Javadiankutenai M, Darzi A, Barat S. Does proteinuria in preeclampsia have enough value to predict pregnancy outcome? Clin Exp Obstet Gynecol. 2014; 41(2): 163–8.
• 13. Osmundson SS, Lafayette RA, Bowen RA, Roque VC, Garabedian MJ, Aziz N. Maternal proteinuria in twin compared with singleton pregnancies. Obstet Gynecol 2014; 124: 332-7. doi: 10.1097/AOG.0000000000000383.
• 14. Dekker GA. Management of preeclampsia. Pregnancy Hypertens. 2014; 4(3): 246–7.
• 15. English FA, Kenny LC, McCarthy FP. Risk factors and effective management of preeclampsia. Integr Blood Press Control. 2015; 8: 7–12. doi:10.2147/IBPC.S50641 .
• 16. Lindheimer MD, Kanter D. Interpreting abnormal proteinuria in pregnancy: the need for a more pathophysiological approach. Obstetrics Gynecol. 2010; 115(2): 365–75.
• 17. Payne B, Magee LA, Côté A-M, Hutcheon JA, Li J, Kyle PM, et al. PIERS proteinuria: relationship with adverse maternal and perinatal outcome. J Obstet Gynaecology Canada. 2011; 33(6): 588–97. doi: 10.1016/S1701-2163(16)34907-6.
• 18. Stillman IE, Karumanchi SA. The glomerular injury of preeclampsia. J Am Soc Nephrol. 2007;18(8):2281–2284.
• 19. 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.
• 20. Kim MJ, Kim YN, Jung EJ, Jang HR, Byun JM, Jeong DH, et al. Is massive proteinuria associated with maternal and fetal morbidities in preeclampsia? Obstet Gynecol Sci. 2017; 60(3): 260–5. doi:10.5468/ogs.2017.60.3.260.
• 21. 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. doi:10.1080/10641955.2019.1590718.
• 22. Wójtowicz A, Zembala-Szczerba M, Babczyk D, Kołodziejczyk-Pietruszka M, Lewaczyńska O, Huras H. Early- and late-onset preeclampsia: a comprehensive cohort study of laboratory and clinical findings according to the New ISHHP Criteria. Int J Hypertens. 2019; 2019: 4108271. doi:10.1155/2019/4108271.
• 23. Al-Jameil N, Aziz Khan F, Fareed Khan M, Tabassum H. A brief overview of preeclampsia. J Clin Med Res. 2014; 6(1): 1–7. doi:10.4021/jocmr1682w.
• 24. Redman CW, Sargent IL. Latest advances in understanding preeclampsia. Science. 2005; 308(5728): 1592–4. doi:10.1126/science.1111726.
• 25. Saito S, Shiozaki A, Nakashima A, Sakai M, Sasaki Y. The role of the immune system in preeclampsia. Mol Aspects Med. 2007; 28(2): 192-209.
• 26. Catov JM, Ness RB, Kip KE, Olsen J. Risk of early or severe pre-eclampsia related to pre-existing conditions. Int J Epidemiol. 2007; 36(2): 412-9.
• 27. Stergiotou I, Crispi F, Valenzuela-Alcaraz B, Bijnens B, Gratacos E. Patterns of maternal vascular remodeling and responsiveness in early- versus late-onset preeclampsia. Am J Obstet Gynecol. 2013; 209(6): 558.e1–558.e14. doi:10.1016/j.ajog.2013.07.030.
• 28. Aksornphusitaphong A, Phupong V. Risk factors of early and late onset pre-eclampsia. J Obstet Gynaecol Res. 2013; 39(3): 627–31. doi:10.1111/j.1447-0756.2012.02010.x.
• 29. Szczepanski J, Griffin A, Novotny S, Wallace K. Acute renal injury in pregnancies complicated with preeclampsia or HELLP syndrome. Front Med (Lausanne). 2020; 7: 22. doi:10.3389/fmed.2020.00022.
• 30. Kucukgoz Gulec U, Ozgunen FT, Buyukkurt S, Guzel AB, Urunsak IF, Demir SC, et al. Comparison of clinical and laboratory findings in early- and late-onset preeclampsia. J Matern Fetal Neonatal Med. 2013; 26(12): 1228–1233. doi:10.3109/14767058.2013.776533.
• 31. Eroğlu S, Seçkin KD, Başer E, Toğrul C, Gülşen P, Gürsoy AF, ve ark. Perinatal outcomes in women with preeclampsia: experience of a tertiary referral center. Journal of Clinical and Analytical Medicine. 2015; 6(Supp1):62-7. doi: 10.4328/jcam.3344
• 32. Sarno L, Maruotti GM, Saccone G, Sirico A, Mazzarelli LL, Martinelli P. Pregnancy outcome in proteinuria-onset and hypertension-onset preeclampsia. Hypertens Pregnancy. 2015; 34(3): 284–90. doi:10.3109/10641955.2015.1015731.