Does Proteinuria Measured by Dipstick Method Reflect Reality in Patients with Preeclampsia?

Yıl 2024, Cilt: 34 Sayı: 3, 283 - 288, 30.06.2024

Cenk Soysal Mehmet Murat Işıkalan

https://doi.org/10.54005/geneltip.1361235

Öz

Aim: The aim of our study is to compare the proteinuria levels measured by dipstick in complete urine analysis at admission with the proteinuria levels measured in 24-hour collected urine for patients hospitalized with a presumptive diagnosis of preeclampsia. By doing so, we intend to review the reliability of the widely used dipstick proteinuria in patients with preeclampsia.
Material ve Metod: Urine specimens were obtained from 70 pregnant women visiting high-risk maternity centers at a third-level healthcare institution. Patients were divided into four groups based on their urine dipstick screening test results: negative, +1, +2, +3, and higher. Proteinuria was considered to be present if the urinary dipstick test showed +1 or higher, while protein levels measured in the 24-hour urine collection were considered to indicate proteinuria if they exceeded 300 mg. The degree of correlation between the urine dipstick test and both 24-hour urine samples and spot urine protein-to-creatinine ratio (Pr/Cr) was compared.
Results: The mean age of the 70 preeclampsia patients in the study group was 31.7±6.2, and the mean gestational age was 32.5±4.6. The dipstick test was found to have a sensitivity of 81.4% and a specificity of 85.2%. The dipstick test results were grouped as 0, +1, +2, +3, and higher. Statistically significant differences were detected among the groups in terms of systolic blood pressure, diastolic blood pressure, the amount of protein in the 24-hour urine, and spot urine Pr/Cr (p=0.001, p<0.001, p<0.001, p<0.001, respectively). When examining the correlation between the urine dipstick test and both 24-hour urine samples and spot urine Pr/Cr, a moderate correlation was found (r=0.65, p<0.001, r=0.55, p<0.001, respectively).
Conclusion: In hypertensive pregnant individuals, urine dipstick tests demonstrated inadequate performance in ruling out preeclampsia. Consequently, according to our investigation, we posit that the dipstick urine test can be employed as a routine and dependable diagnostic tool for preeclampsia due to its rapid results and cost-effectiveness.

Anahtar Kelimeler

Diagnostic test accuracy, dipstick, preeclampsia, proteinuria, sensitivity, specificity.

Preeklampsili Hastalarda Dipstick Yöntemiyle Ölçülen Proteinüri Gerçeği Yansıtıyor mu?

Öz

Amaç: Çalışmamızın amacı, preeklampsi tanısı ile hastaneye yatırılan hastalarda başvuru sırasında tam idrar analizinde dipstick ile ölçülen proteinüri düzeyleri ile 24 saatlik toplanan idrarda ölçülen proteinüri düzeylerini karşılaştırmaktır. Bunu yaparak, preeklampsili hastalarda yaygın olarak kullanılan dipstick proteinürinin güvenilirliğini gözden geçirmeyi amaçlıyoruz.
Materyal ve Metod: İdrar örnekleri, üçüncü düzey bir sağlık kurumundaki yüksek riskli doğum merkezlerini ziyaret eden 70 hamile kadından elde edilmiştir. Hastalar idrar dipstick tarama testi sonuçlarına göre negatif, +1, +2, +3 ve üzeri olmak üzere dört gruba ayrıldı. İdrar çubuğu testi +1 veya daha yüksek çıkarsa proteinüri var kabul edilirken, 24 saatlik idrar koleksiyonunda ölçülen protein seviyeleri 300 mg'ı aşarsa proteinüri olduğu kabul edildi. İdrar çubuğu testi ile hem 24 saatlik idrar örnekleri hem de spot idrar protein-kreatinin oranı (Pr/Cr) arasındaki korelasyon derecesi karşılaştırılmıştır.Bulgular: Çalışma grubundaki 70 preeklampsi hastasının ortalama yaşı 31.7±6.2 ve ortalama gebelik yaşı 32.5±4.6 idi. Dipstick testinin duyarlılığı %81,4 ve özgüllüğü %85,2 olarak bulundu. Yağ çubuğu testi sonuçları 0, +1, +2, +3 ve üzeri olarak gruplandırıldı. Gruplar arasında sistolik kan basıncı, diyastolik kan basıncı, 24 saatlik idrardaki protein miktarı ve spot idrar Pr/Cr açısından istatistiksel olarak anlamlı farklılıklar tespit edildi (sırasıyla p=0.001, p<0.001, p<0.001, p<0.001). İdrar dipstick testi ile hem 24 saatlik idrar örnekleri hem de spot idrar Pr/Cr arasındaki korelasyon incelendiğinde, orta düzeyde bir korelasyon bulunmuştur (sırasıyla r=0.65, p<0.001, r=0.55, p<0.001).
Sonuç: Hipertansif gebe bireylerde, idrar çubuğu testleri preeklampsiyi ekarte etmede yetersiz performans göstermiştir. Sonuç olarak, araştırmamıza göre, hızlı sonuçları ve maliyet etkinliği nedeniyle dipstick idrar testinin preeklampsi için rutin ve güvenilir bir tanı aracı olarak kullanılabileceğini düşünüyoruz.

Anahtar Kelimeler

Diagnostik test, dipstick, proteinüri, preeklampsi, sensitivite, spesifite

Kaynakça

• Duley L. The global impact of pre-eclampsia and eclampsia. Seminars in perinatology. 2009;33(3):130-7.
• Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet (London, England). 2005;365(9461):785-99.
• Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice. Hypertension (Dallas, Tex : 1979). 2018;72(1):24-43.
• Özkara A, Kaya AE, Başbuğ A, Ökten SB, Doğan O, Çağlar M, et al. Proteinuria in preeclampsia: is it important? Ginekologia polska. 2018;89(5):256-61.
• Dwyer BK, Gorman M, Carroll IR, Druzin M. Urinalysis vs urine protein-creatinine ratio to predict significant proteinuria in pregnancy. Journal of perinatology : official journal of the California Perinatal Association. 2008;28(7):461-7.
• 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 : an international journal of obstetrics and gynaecology. 2005;112(4):412-7.
• Côté 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.
• Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, et al. Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG : an international journal of obstetrics and gynaecology. 2011;118 Suppl 1:1-203.
• Correa ME, Côté AM, De Silva DA, Wang L, Packianathan P, von Dadelszen P, et al. Visual or automated dipstick testing for proteinuria in pregnancy? Pregnancy hypertension. 2017;7:50-3.
• Gordijn SJ, Beune IM, Thilaganathan B, Papageorghiou A, Baschat AA, Baker PN, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2016;48(3):333-9.
• Kuo VS, Koumantakis G, Gallery ED. Proteinuria and its assessment in normal and hypertensive pregnancy. American journal of obstetrics and gynecology. 1992;167(3):723-8.
• Meyer NL, Mercer BM, Friedman SA, Sibai BM. Urinary dipstick protein: a poor predictor of absent or severe proteinuria. American journal of obstetrics and gynecology. 1994;170(1 Pt 1):137-41.
• Gerth-Guyette E, Adu-Gyasi D, Tawiah Agyemang C, Bansil P, Barney R, Knudson S, et al. Evaluation of a protein-to-creatinine dipstick diagnostic test for proteinuria screening in selected antenatal care clinics in three Districts in the Bono-East Region of Ghana. Pregnancy hypertension. 2022;30:21-30.
• Huang Q, Gao Y, Yu Y, Wang W, Wang S, Zhong M. Urinary spot albumin:creatinine ratio for documenting proteinuria in women with preeclampsia. Reviews in obstetrics & gynecology. 2012;5(1):9-15.
• Teeuw HM, Amoakoh HB, Ellis CA, Lindsley K, Browne JL. Diagnostic accuracy of urine dipstick tests for proteinuria in pregnant women suspected of preeclampsia: A systematic review and meta-analysis. Pregnancy hypertension. 2022;27:123-30.
• Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin Summary, Number 222. Obstetrics and gynecology. 2020;135(6):1492-5.
• Phelan LK, Brown MA, Davis GK, Mangos G. A prospective study of the impact of automated dipstick urinalysis on the diagnosis of preeclampsia. Hypertension in pregnancy. 2004;23(2):135-42.
• 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.
• 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. International journal of environmental research and public health. 2020;17(12).
• Yamada T, Kojima T, Akaishi R, Ishikawa S, Takeda M, Kawaguchi S, et al. Problems in methods for the detection of significant proteinuria in pregnancy. The journal of obstetrics and gynaecology research. 2014;40(1):161-6.
• Fishel Bartal M, Lindheimer MD, Sibai BM. Proteinuria during pregnancy: definition, pathophysiology, methodology, and clinical significance. American journal of obstetrics and gynecology. 2022;226(2s):S819-s34.
• Geneen LJ, Webster KE, Reeves T, Eadon H, Maresh M, Fishburn S, et al. Protein-creatinine ratio and albumin-creatinine ratio for the diagnosis of significant proteinuria in pregnant women with hypertension: Systematic review and meta-analysis of diagnostic test accuracy. Pregnancy hypertension. 2021;25:196-203.