Clinical features of isolated gestational proteinuria progressing to pre-eclampsia: retrospective observational study

Abstract

ObjectivesSome women with isolated gestational proteinuria (IGP) later develop hypertension and are diagnosed with pre-eclampsia (PE). This study was performed to determine whether clinical features of such proteinuria preceding PE (P-PE) differ from those of other PE (O-PE).DesignRetrospective observational study after approval of the institutional review board of ethics.SettingA single university hospital. Proteinuria was defined as a protein-to-creatinine ratio (mg/mg; P/Cr) of ≥0.27 in the spot urine specimen. IGP was defined as proteinuria in the absence of hypertension. P-PE was defined as PE in which proteinuria preceded hypertension by more than 2 days.ParticipantsAll of 10 and 18 consecutive women with P-PE and O-PE, respectively, who gave birth between January 2008 and August 2013.ResultsProteinuria appeared earlier (at 30.2±3.0 vs 35.3±4.3 weeks, p=0.001), the P/Cr level was greater at birth (7.28±2.14 vs 3.19±2.49, p<0.001), net maternal weight gain during the last antenatal 1 week was greater (3.1±1.8 vs 1.3±1.7 kg, p=0.023) and length of pregnancy was shorter (32.5±1.9 vs 36.1±3.6 weeks, p=0.001) in women with P-PE than in O-PE. The duration of IGP was 10.0±5.9 days (range 3–20), and the time interval until delivery after diagnosis of PE was 6.1±8.2 days (range 0–23) in 10 women with P-PE. The P/Cr levels at birth were significantly inversely correlated with the antenatal lowest antithrombin activity and fibrinogen levels among the 28 women with PE.ConclusionsWomen with P-PE were likely to exhibit greater proteinuria in the urine, greater water retention in the interstitial space and more enhanced coagulation–fibrinolysis, thus suggesting that they may constitute a more severe form of PE than women with O-PE do.

Second-trimester urine nephrin:creatinine ratio versus soluble fms-like tyrosine kinase-1:placental growth factor ratio for prediction of preeclampsia among asymptomatic women

“…As FPR was consistently predictive of later PE in most studies6789101112131415161718192021222324, FPR has been accepted as a diagnostic aid for PE in conjunction with other clinical findings26. This was also confirmed in the present study; women with FPR >90 th percentile value had RR of PE = 4.98 (1.91–13.0) compared to women with FPR <90 th percentile value.…”

“…Some patients with PE first develop significant proteinuria in pregnancy (SPIP) defined as urine protein:creatinine ratio (PCR, mg/mg) >0.27 and subsequently hypertension1213. Isolated gestational proteinuria defined as SPIP in the absence of hypertension is a strong risk factor for PE13 and a 2 nd trimester cut-off level of PCR < 0.27 can differentiate between women with higher and lower risks of later developing PE6.…”

Characterization of Atypical Preeclampsia

“…Previous studies [9,22,23] have reported that patients with gestational proteinuria are more likely to develop PE in relation to non-proteinuric pregnant women, which is consistent with the findings of our study. However, proteinuria has been questioned as being an indicator of PE morbidity according to the different studies that have shown similar perinatal outcomes in severe PE group compared to pregnant women with severe gestational hypertension [20] .…”

Association between nephrinuria, podocyturia, and proteinuria in women with pre‐eclampsia

“…However, to our knowledge, there have been no reports regarding an association between nephrinuria (urine nephrin concentration) and podocyturia (density of urine podocytes) in patients with podocytopathies, including diseases other than PE. As PE women exhibit a gradual increase in proteinuria, 22,23 investigation of a longitudinal series of urine samples from PE women enabled analysis of this issue in this study. The degree of nephrinuria reflected the degree of podocyturia monitored by urine sediment Pod-mRNA and Nep-mRNA expression levels in this study in PE women.…”