Comparison of methods to identify significant proteinuria in pregnancy in the outpatient setting

“…ACR, as determined by an automated analyser (DCA 2000, Bayer), has also been shown to eff ectively identify signifi cant proteinuria in pregnancy. Use of this method could provide rapid point-of-care testing in antenatal clinics (Kyle et al 2008).…”

Section: Implications For Clinical Practice and Future Researchmentioning

confidence: 99%

Spot urinary protein analysis for excluding significant proteinuria in pregnancy

Wilkinson¹,

Lappin

Vellinga

et al. 2012

Journal of Obstetrics and Gynaecology

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The aim of this research was to compare the accuracy of urinary protein/creatinine ratio (PCR) and albumin/creatinine ratio (ACR) in defining optimal cut-off points to rule-out significant proteinuria (>300 mg/24 h) in pregnancy. The secondary outcome measure was to determine the investigation of choice to evaluate proteinuria used by maternity units in the UK. PCR and ACR were calculated on first (PCR1, ACR1) void urine samples of the 24-hour urinary protein collection (24UP). Sensitivity and specificity was calculated for different cut-off points for PCR1 and ACR1 to rule-out significant proteinuria. An online survey was sent to RCOG members questioning them on their investigation of choice to evaluate proteinuria. We concluded from our results that both PCR and ACR are good rule-out tests for significant proteinuria in pregnancy using cut-off points of <20 mg/mmol and <2.5 mg/mmol. PCR is the investigation of choice in 56% of UK units studied.

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“…1,2 Options for quantifying proteinuria include dipstick testing, spot urinary protein to creatinine ratio, and various timed urine collections for estimation of protein excretion, the most common being the 24-hour collection. There are insuf cient data to de ne an abnormal albumin to creatinine ratio in pregnancy 3,4 and there is no information about its prognostic signi cance related to adverse pregnancy outcomes.…”

mentioning

confidence: 99%

PIERS Proteinuria: Relationship With Adverse Maternal and Perinatal Outcome

Payne¹,

Côté²,

Hutcheon³

et al. 2011

Journal of Obstetrics and Gynaecology Canada

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Objective: To examine the ability of three different proteinuria assessment methods (urinary dipstick, spot urine protein:creatinine ratio [Pr/Cr], and 24-hour urine collection) to predict adverse pregnancy outcomes Methods:We performed a prospective multicentre cohort study, PIERS (Preeclampsia Integrated Estimate of RiSk), in seven academic tertiary maternity centres practising expectant management of preeclampsia remote from term in Canada, New Zealand, and Australia Eligible women were those admitted with preeclampsia who had at least one antenatal proteinuria assessment by urinary dipstick, spot urine Pr/Cr ratio, and/or 24-hour urine collection Proteinuria assessment was done either visually at the bedside (by dipstick) or by hospital clinical laboratories for spot urine Pr/Cr and 24-hour urine collection We calculated receiver operating characteristic area under the curve (95% CI) for each proteinuria method and each of the combined adverse maternal outcomes (within 48 hours) or adverse perinatal outcomes (at any time) Models with AUC ≥ 070 were considered of interest Analyses were run for all women who had each type of proteinuria assessment and for a cohort of women ("ALL measures") who had all three proteinuria assessmentsResults: More women were proteinuric by urinary dipstick (≥ 2+, 614%) than by spot urine Pr/Cr (≥ 30g/mol, 504%) or 24-hour urine collection (≥ 03g/d, 347%) Each proteinuria measure evaluated had some discriminative power, and dipstick proteinuria (categorical) performed as well as other methods No single method was predictive of adverse perinatal outcome Conclusion:The measured amount of proteinuria should not be used in isolation for decision-making in women with preeclampsia Dipstick proteinuria performs as well as other methods of assessing proteinuria for prediction of adverse events

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Comparison of methods to identify significant proteinuria in pregnancy in the outpatient setting

Cited by 42 publications

References 4 publications

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

Spot urinary protein analysis for excluding significant proteinuria in pregnancy

PIERS Proteinuria: Relationship With Adverse Maternal and Perinatal Outcome

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