RESUMO
ANTECEDENTES: La evaluación precisa de la proteinuria constituye un pilar importante para el diagnóstico del síndrome hipertensivo del embarazo (SHE). El estándar dorado para esta medición es la recolección de orina en 24 horas, pero debido a la duración de la toma de la muestra, alternativas como la albuminuria semicuantitativa se utiliza con mayor frecuencia en los servicios de urgencia de nuestro país. OBJETIVO: Evaluar el rendimiento diagnóstico de la albuminuria semicuantitativa y su asociación con proteinuria de 24 horas en pacientes con SHE. MÉTODOS: Estudio retrospectivo de 145 pacientes con sospecha de SHE atendidas en el Hospital Padre Hurtado, Chile. A todas las pacientes se le realizó albuminuria semicuantitativa (categorizada entre 0+ y 4+) y proteinuria de 24 horas (positivo si >0,3 gramos/24 horas). Se realizó análisis por grupos compuestos de albuminuria semicuantitativa y resultado positivo en proteinuria de 24 horas. RESULTADOS: Se evidenció una sensibilidad de 50%, especificidad de 100%, VPP de 100%, VPN de 65,7%, LR+ de 50 y un LR- de 0,5. CONCLUSIÓN: La albuminuria semicuantitativa ≥2+ muestra una fuerte asociación con proteinuria ≥0,3 g/24 horas y es un método rápido para evaluar SHE.
BACKGROUND: One of the basis for the diagnosis of pregnancy induced hypertension syndrome (PIHS), includes the precise evaluation of proteinuria. The gold standard for its evaluation is the collection of a 24-hour urine specimen, but because it is a slow method, other alternatives, such as semi-quantitative albuminuria have been used more frequently on our emergency rooms. OBJECTIVE: To assess the diagnostic performance of semi-quantitative albuminuria and its association with proteinuria measured in a 24-hour urine specimen collection, in patients with PIHS. METHODS: Retrospective study of 145 patients with clinical suspicion of PIHS who assisted to Hospital Padre Hurtado, Chile. Semi-quantitative albuminuria (categorized as 0 to 4+) and proteinuria measured in a 24-hour urine specimen collection was measured on every patient. Abnormal values of proteinuria were considered when values exceeded 0.3 g/24 hours. Composite outcomes analysis was done between albuminuria groups and positive proteinuria in 24 hrs. RESULTS: Sensibility and specificity of semi-quantitative albuminuria was of 50% and 100%, respectively, with a PPV: 100%, NPV: 65.7%, LR+: 50 and a LR-: 0.5. CONCLUSION: semi-quantitative albuminuria ≥2+ shows a strong association with proteinuria ≥0.3 g/24 hours and it could be used as a fast method to assess PIHS.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Adulto Jovem , Urinálise/métodos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/urina , Albuminúria/urina , Proteinúria/urina , Síndrome , Fatores de Tempo , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
Objective. To compare protein/creatinine ratio (PCR) in random urine sample levels and adverse outcomes in hypertensive pregnant women. Methods. A total of 370 medical charts from hypertensive pregnant women were reviewed and stratified into three groups according to different PCR in random urine sample levels (group 1: PCR < 0.3 mg/mg; group 2: PCR 0.3-1.99 mg/mg; group 3: PCR ≥ 2.0 mg/mg) and compared with composite maternal and perinatal outcomes. Those outcomes were severe hypertension, thrombocytopenia, high lactate dehydrogenase count, disseminated intravascular coagulation, abruptio placentae, HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, eclampsia, perinatal death, newborn cerebral hemorrhage, respiratory distress syndrome of newborn, neonatal sepsis, and newborn small for gestational age. Results. To obtain a composite maternal adverse outcome the odds ratio [ORs] between PCR groups were 1.8 (95% confidence interval [CI]: 1.1-3.2) between groups 1 and 2, and 3.1 (95% CI: 1.5-6.3) between groups 1 and 3; for composite perinatal adverse outcomes, the ORs were 3.0 (95% CI: 1.5-5.9) between groups 1 and 2, and 3.4 (95% CI: 1.6-7.5) between groups 1 and 3. Conclusions. Hypertensive pregnant women with a PCR ≥ 0.3 mg/mg, had worse maternal and perinatal outcomes than those with PCR < 0.3 mg/mg. Above the cut-off of 0.3 mg/mg, higher PCRs are not associated with a significant increase in maternal and perinatal morbidity.
Assuntos
Creatinina/urina , Hipertensão Induzida pela Gravidez/urina , Proteinúria/urina , Adulto , Feminino , Humanos , Gravidez , Resultado da Gravidez , Estudos RetrospectivosRESUMO
OBJECTIVE: To evaluate associations between maternal serum uric acid (UA) levels, maternal status, and fetal outcome. METHODS: Maternal UA, urinary protein-creatinine ratio (P/C), blood pressure (BP), gestational age at delivery, and birth weight were evaluated in hypertensive pregnant women (n = 58). These were divided into two groups: high UA (> or =357 micromol/L) or normal UA (<357 micromol/L). RESULTS: Maternal diastolic BP and P/C ratio were higher in pregnant women with elevated UA levels. Systolic BP, gestational age and birth weight were not significantly different. CONCLUSION: UA equal or above 357 micromol/L in pregnant hypertensive women was associated with proteinuria and diastolic BP, but not with fetal outcome.
Assuntos
Peso ao Nascer , Pressão Sanguínea , Hipertensão Induzida pela Gravidez/sangue , Proteinúria/urina , Ácido Úrico/sangue , Adulto , Creatinina/urina , Feminino , Idade Gestacional , Humanos , Hipertensão Induzida pela Gravidez/fisiopatologia , Hipertensão Induzida pela Gravidez/urina , Recém-Nascido , Recém-Nascido Prematuro , Gravidez , Nascimento Prematuro/sangue , Nascimento Prematuro/urina , Adulto JovemRESUMO
OBJECTIVE: To assess the urine protein/creatinine ratio in urine samples of pregnant women with hypertension in regard to: 1) the presence of significant variation at different periods of the day; 2) the differences if they exist, to identify the most reliable period of the day for sampling; and 3) whether the first sample, obtained when the patient arrives at the clinic, correlates with the same accuracy, with the 24-hour proteinuria. DESIGN: Cross-sectional study. PLACE: Obstetrics Emergency Department, Hospital de Clínicas de Porto Alegre, a teaching hospital in Porto Alegre, Brazil. POPULATION: Seventy-five women with hypertension with 20-week gestation or over. METHODS: Urine samples for determination of the protein/creatinine ratio were obtained on arrival (first specimen) and every 6 hours thereafter, totaling four samples in 24 hours. Four sampling periods were established: 1) from 8 am to 2 pm, 2) from 2 pm to 8 pm, 3) from 8 pm to 2 am, and 4) from 2 am to 8 am. The protein/creatinine ratio in the four different day periods were compared with the 24-hour proteinuria obtained simultaneously. The results were analyzed by the Spearman correlation and the receiver-operator characteristic (ROC) curve. RESULTS: The urine protein/creatinine ratio is strongly correlated (Spearman correlation equal to 0.8 or greater) with the 24-hour proteinuria at all four periods of the day (p<0.001), as well as the first sample obtained on arrival (p=0.003). These findings were corroborated by the ROC curve in which the values of four day periods and that of the first sample were equal to or greater than 0.930. CONCLUSION: In hypertensive pregnant women, the single voided urine sample protein/creatinine ratio, irrespective of sampling time, is strongly correlated with the 24-hour proteinuria, as is the sample obtained on arrival.