Evaluation of urinary calcium-creatinine ratio as a diagnostic tool in the management of preeclampsia

Abstract

Background: Preeclampsia has a complex pathophysiology in which several studies have reported derangement in calcium metabolism. The decrease in urinary calcium and calcium-creatinine ratio (CCR) could be considered as a risk factor for development of preeclampsia. This ratio is easily measurable, most effective even with spot urine sample. Objective: To study the levels of urinary CCR and to correlate with proteinuria in preeclamptic patients and to assess the role of CCR in urine as a diagnostic marker in preeclampsia. Materials and Methods: This cross-sectional study was carried out in 30 cases of pregnant women diagnosed with preeclampsia and 30 age-matched controls in MS Ramaiah Teaching Hospital, Bangalore over a period of 2 months. Random urine samples were collected from the cases and controls, and urinary calcium, creatinine, and protein were measured using their corresponding methods. The urinary CCR was studied and correlated with proteinuria. All the quantitative variables were described in terms of mean and standard deviation. The differences in the mean values between cases and controls were tested through Student's t-test or oblique propriate nonparametric test of significance. To test for differences in the proportion between cases and controls, c 2 test of significance was employed. Result: It was found that urinary calcium was significantly increased in cases compared with the controls, whereas there was no significant difference in CCR. The CCR had a sensitivity and specificity of 40% and 86.67%, respectively. Conclusion: Although significant numbers of pregnant women with gestational hypertension and preeclampsia did not have decreased ratio, the urinary calcium levels had decreased in preeclamptic patients.

Estimation of Urinary Calcium as a Predictor of Pregnancy Induced Hypertension

“…Hypertension affects 5 to 10% of pregnant patients, making it the leading cause of maternal death in and around the world. Preeclampsia is diagnosed when a pregnant woman has high blood pressure (>140/90 mmHg) after the 20 th week of pregnancy (without a previous history of arterial hypertension) together with other symptoms [6,7]. These symptoms are now thought to be a late symptom of an illness that has been present since the first trimester of pregnancy.…”

Predicting adverse outcomes in hypertensive obstetric cases by using spot urine calcium: Creatinine ratio

“…Calcium-to-creatinine ratio has been suggested by many to be a good screening test for preeclampsia [6] . Creatinine clearance is an indicator of the renal damage in pregnancy hypertension J Kar et al [7] noted that the ~ 159 ~ CCR had a Sensitivity of 75%, Specificity of 94.4%, PPV of 64.2%, NPV of 96.5%, Vahdat et al [8] noted that the Sensitivity of 77%, Specificity of 78% 54%, Dutt et al [9] , Sensitivity of 40% Specificity of 86.7%. Munge AM et al [10] noted that the CCR had a Sensitivity of 63.6, Specificity of 94.9% < PPV of 77.8 and NPV 90.2.…”

Estimation of serum uric acid, urinary calcium-creatinine ratio and microalbuminuria in prediction of pre-eclampsia

“…In another study undertaken by Izumi et al 12 during less than or equal to 12 weeks of gestation revealed measurement of calcium creatinine ratio to be of limited use in predicting preeclampsia, as 12weeks is too early for changes to appear. Dutt V et al 13 studied that pre-eclamptics admitted to the labor room for safe confinement have a significant hypocalciuria, however they found calcium creatinine ratio to have a low sensitivity and positive predictive value. Another study by Amandeep Kaur et al 14 found calcium creatinine ratio in the third trimester of pregnancy to be an effective predictor of the disease.…”