Determination of Urinary Calcium/Creatinine Ratio in a Spot Sample of Urine For Early Prediction of Pre-Eclampsia

Abstract

Abstract:Based on the fact that urinary hypocalciuria in pre-eclampsia this study was designed to determine the predictive value of calcium to creatinine ratio in a spot urine sample in second trimester of pregnancy. The calcium to creatinine ratio Calcium/creatinine ratio has been considered for early detection of pre-eclamptic toxaemia (PET) Keywords: Pre-eclampsia, calcium/creatinine ratio Introduction: Pre-eclampsia (PET) is one of the fatal complication of pregnancy. It is a pregnancy induced auto-intoxication with multi-system disorder of unknown etiology which is associated with triad of oedema, hypertension and proteinuria occurs mostly in nullipara after 20th week of gestation and most frequently near term. 1,2 Early test for prediction of PET previously reported are platelet count,hematocrit,serum uric acid and microalbuminuria are poor predictor of PET. Fibrinectin, urinary calcium excretion, roll over test, Doppler ultrasound showed contradictory and non-conclusive. Isometric exercise test showed predictive value but only two studies performed. Angiotensin II sensitivity test best predictive value but clinically not practiced. There is no test that fulfils all criteria established to be a good predictor of PET. 3 It has been found that increased urinary albumin and decreased calcium excretion may be an early marker for pre-peclampsia. 4 Urinary calcium/creatinine ratio less than or equal to 0.04 which may be an early marker for useful screening tool in predicting the subsequent development of pre-eclampsia. 5 So determination of calcium/creatinine ratio may easily predict the case of PET because previously it was reported that 24 hrs. urine samples can be replaced by a single voided urine. 6,7,8,9 But no data is available on this aspect in our country. Therefore this study was conducted to determine the relationship between PET, hypocalciurea and calcium to creatinine ratio for early prediction of PET in a spot urine sample. Materials And Methods:This is a non-interventional perspective cross sectional study that was approved by the institutional thesis review board of Rajshahi Medical College and it was also carried out on total number of 60 women with age ranged from 17-39 years of the m 30 normotensive gravid women and 30 suspected PET women were taken as study population. All the subjects were selected from department of obstetrics and gynecology, outdoor and indoor, Rajshahi Medical College Hospital. A complete obstetrical history, clinical examination and necessary investigations were done to exclude other conditions affecting urinary calcium/creatinine ratio. All the subjects were taken from middle and lower middle socioeconomic classes. Urinary calcium, urinary creatinine and urinary calcium/creatinine ratio were determined by using reagent kits Human and Tradesworth Germany. Calcium was measured by o-cresolpthelein complexions method & creatinine was measured by alkaline picrate method of Jaffe 10,11 in the department of Pharmacology, Rajshahi Medical College, Rajshahi. The signific...

Calcium Deficiency in Bangladesh

“…6 Local substantiation of the link between calcium and preeclampsia in Bangladesh is provided by a recent series of independent hospital-based cross-sectional and case-control studies (Supplemental Table 2). [65][66][67][68][69][70][71][72][73][74][75] Most studies have involved selection of cases with preeclampsia and eclampsia and matched normotensive controls, for whom paired serum or urinary calcium measurements were taken at either the same gestational duration or within the same time frame before delivery. Collectively, these studies suggest a decrease in total serum calcium during the third trimester, a cross-sectional association between lower calcium status and preeclampsia, and a doseresponse relationship between severity of deficiency and severity of disease.…”