Comparison of methods used in the diagnosis of proteinuria in pregnant women

Yıl 2021, Cilt: 31 Sayı: 2, 116 - 119, 30.06.2021

Ersin Çintesun Mete Bertizlioğlu Mete Can Ateş , Abdül Hamid Güler , Cetin Celik

https://doi.org/10.15321/GenelTipDer.2021.296

Öz

Objectives

The aim of this study was to compare the total protein content in 24 hours urine with dipstic, protein / creatinine (P / K) ratio in spot urine in our pregnant women who were diagnosed with preeclampsia.

Material and Methods

In this study, 317 patients who underwent dipstick method, P / K ratio and total protein analysis in 24-hour urine were included in the study with a prediagnosis of preeclampsia at a university hospital gynecology and obstetrics clinic between January 2016 and December 2018. These three values ​​of patients were compared with each other.

Results

The sensitivity of the dipstik method was 67.5%; specificity 61.5%; accuracy was calculated as 64.3%. When the total proteinuria threshold in the 24-hour urine was 300 mg / day, the P-C ratio cut-off value was 0.34 mg protein / mg creatinine, the sensitivity was 68.9% and the specificity was 78.7%. A moderate, significant correlation was observed between total urinary P / K ratio and total proteinuria in 24-h urine (R: 0.629 p <0.001).

Conclusion

It can be used as an alternative test in the 24-hour urine total protein test of P / C ratio in spot urine in emergencies where there is not enough time for 24 hour total urine analysis.

Anahtar Kelimeler

proteinuria, preeclampsia, total protein content in 24-hour urine, protein/creatinine ratio in spot urine

Gebelerde proteinüri tanısında kullanılan yöntemlerin karşılaştırılması

Öz

Amaç

Kliniğimizde preeklampsi ön tanısı ile tetkik edilen gebelerde spot idrarda dipstik, protein/kreatinin (P/K) oranı ile 24 saatlik idrarda toplam protein miktarı değerlerinin karşılaştırılması amaçlanmıştır.

Gereç ve yöntem

Çalışmaya, Ocak 2016–Aralık 2018 tarihleri arasında bir ünivesite hastanesinde preeklampsi ön tanısı ile spot idrarda dipstik yöntemi, P/K oranı ve 24 saatlik idrarda toplam protein analizi yapılan 317 hasta çalışmaya dahil edildi. Hastaların bu üç değeri birbiri ile mukayese edildi.

Bulgular

Dipstik yönteminin sensitivitesi %67,5; spesifitesi %61,5; doğruluğu %64,3 olarak hesaplandı. 24 saatlik idrarda toplam proteinüri eşik değeri 300 mg/gün olduğunda P/K oranı cut-off değeri 0,34 mg protein/mg kreatinin, sensitivite %68,9, spesifite %78,7 olarak hesaplandı. Spot idrar P/K oranı ile 24 saatlik idrardaki toplam proteinüri değerleri arasında orta düzeyde, anlamlı bir korelasyon gözlendi (R: 0,629 p<0,001).

Sonuç

24 saatlik toplam idrar analizi için yeterli zamanın olmadığı acil durumlarda spot idrarda P/K oranının 24 saatlik idrarda toplam protein testine alternatif test olarak kullanılabilir.

Anahtar Kelimeler

proteinüri, preeklampsi, 24 saatlik idrarda toplam protein miktarı, spot idrarda protein/kreatinin oranı

Kaynakça

• von Dadelszen P, Magee LA. Preventing deaths due to the hypertensive disorders of pregnancy. Best practice & research Clinical obstetrics & gynaecology. 2016;36:83-102.
• Harmon QE, Huang L, Umbach DM, Klungsoyr K, Engel SM, Magnus P, et al. Risk of fetal death with preeclampsia. Obstetrics and gynecology. 2015;125(3):628-35.
• Higby K, Suiter CR, Phelps JY, Siler-Khodr T, Langer O. Normal values of urinary albumin and total protein excretion during pregnancy. American journal of obstetrics and gynecology. 1994;171(4):984-9.
• Sibai BM. Eclampsia. VI. Maternal-perinatal outcome in 254 consecutive cases. American journal of obstetrics and gynecology. 1990;163(3):1049-54; discussion 54-5.
• Thornton CE, Makris A, Ogle RF, Tooher JM, Hennessy A. Role of proteinuria in defining pre-eclampsia: clinical outcomes for women and babies. Clinical and experimental pharmacology & physiology. 2010;37(4):466-70.
• Roberts M, Lindheimer MD, Davison JM. Altered glomerular permselectivity to neutral dextrans and heteroporous membrane modeling in human pregnancy. The American journal of physiology. 1996;270(2 Pt 2):F338-43.
• Waugh JJ, Clark TJ, Divakaran TG, Khan KS, Kilby MD. Accuracy of urinalysis dipstick techniques in predicting significant proteinuria in pregnancy. Obstetrics and gynecology. 2004;103(4):769-77.
• Cote AM, Firoz T, Mattman A, Lam EM, von Dadelszen P, Magee LA. The 24-hour urine collection: gold standard or historical practice? American journal of obstetrics and gynecology. 2008;199(6):625.e1-6.
• Alkan O, Ozkok A, Ozportakal H, Bulut AS, Isman F, Odabas AR. Spot urine protein/creatinine ratio is associated with 24-hour proteinuria and serum albumin. Medeniyet Medical Journal. 2016;31(4):241-4.
• Higby K, Suiter CR, Phelps JY, Siler-Khodr T, Langer O. Normal values of urinary albumin and total protein excretion during pregnancy. American journal of obstetrics and gynecology. 1994;171(4):984-9.
• Harlow FH, Brown MA. The diversity of diagnoses of preeclampsia. Hypertension in pregnancy. 2001;20(1):57-67.
• Baba Y, Yamada T, Obata-Yasuoka M, Yasuda S, Ohno Y, Kawabata K, et al. Urinary protein-to-creatinine ratio in pregnant women after dipstick testing: prospective observational study. BMC pregnancy and childbirth. 2015;15:331.
• Baba Y, Furuta I, Zhai T, Ohkuchi A, Yamada T, Takahashi K, et al. Effect of urine creatinine level during pregnancy on dipstick test. J Obstet Gynaecol Res. 2017;43(6):967-73.
• Kayatas S, Erdogdu E, Cakar E, Yilmazer V, Arinkan SA, Dayicioglu VE. Comparison of 24-hour urinary protein and protein-to-creatinine ratio in women with preeclampsia. European journal of obstetrics, gynecology, and reproductive biology. 2013;170(2):368-71.
• Boyd C, Wood K, Whitaker D, Ashorobi O, Harvey L, Oster R, et al. Accuracy in 24-hour Urine Collection at a Tertiary Center. Reviews in urology. 2018;20(3):119-24.
• Kucukgoz Gulec U, Sucu M, Ozgunen FT, Buyukkurt S, Guzel AB, Paydas S. Spot Urine Protein-to-Creatinine Ratio to Predict the Magnitude of 24-Hour Total Proteinuria in Preeclampsia of Varying Severity. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC. 2017;39(10):854-60.
• Waugh J, Hooper R, Lamb E, Robson S, Shennan A, Milne F, et al. Spot protein-creatinine ratio and spot albumin-creatinine ratio in the assessment of pre-eclampsia: a diagnostic accuracy study with decision-analytic model-based economic evaluation and acceptability analysis. Health technology assessment (Winchester, England). 2017;21(61):1-90.
• Price CP, Newall RG, Boyd JC. Use of protein:creatinine ratio measurements on random urine samples for prediction of significant proteinuria: a systematic review. Clinical chemistry. 2005;51(9):1577-86.
• Shahbazian N, Hosseini-Asl F. A comparison of spot urine protein-creatinine ratio with 24-hour urine protein excretion in women with preeclampsia. Iranian journal of kidney diseases. 2008;2(3):127-31.
• Cote AM, Brown MA, Lam E, von Dadelszen P, Firoz T, Liston RM, et al. Diagnostic accuracy of urinary spot protein:creatinine ratio for proteinuria in hypertensive pregnant women: systematic review. BMJ (Clinical research ed). 2008;336(7651):1003-6.
• Morris RK, Riley RD, Doug M, Deeks JJ, Kilby MD. Diagnostic accuracy of spot urinary protein and albumin to creatinine ratios for detection of significant proteinuria or adverse pregnancy outcome in patients with suspected pre-eclampsia: systematic review and meta-analysis. BMJ (Clinical research ed). 2012;345:e4342.
• Visintin C, Mugglestone MA, Almerie MQ, Nherera LM, James D, Walkinshaw S. Management of hypertensive disorders during pregnancy: summary of NICE guidance. BMJ (Clinical research ed). 2010;341:c2207.
• Gillon TE, Pels A, von Dadelszen P, MacDonell K, Magee LA. Hypertensive disorders of pregnancy: a systematic review of international clinical practice guidelines. PloS one. 2014;9(12):e113715.
• Eknoyan G, Hostetter T, Bakris GL, Hebert L, Levey AS, Parving HH, et al. Proteinuria and other markers of chronic kidney disease: a position statement of the national kidney foundation (NKF) and the national institute of diabetes and digestive and kidney diseases (NIDDK). Am J Kidney Dis. 2003;42(4):617-22.