Proteinuria in pregnancy - Just what is significant?

Fetal and Maternal Medicine Review

Volumn 16, Issue 1, 2005, Pages 71-95

  Maybury, Helena ^a   Waugh, Jason ^a,b  

^a UNIVERSITY OF LEICESTER   (United Kingdom)

^b LEICESTER ROYAL INFIRMARY   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

AUTOMATION; BLOOD PRESSURE MEASUREMENT; CORRELATION ANALYSIS; CREATININE URINE LEVEL; DIAGNOSTIC ACCURACY; DIAGNOSTIC VALUE; DISEASE COURSE; GLOMERULUS FILTRATION; GLOMERULUS FILTRATION RATE; HEMODYNAMIC MONITORING; HISTOPATHOLOGY; HUMAN; INTRAUTERINE GROWTH RETARDATION; KIDNEY FUNCTION; LABORATORY TEST; MATERNAL HYPERTENSION; NEWBORN MORBIDITY; OBSERVER VARIATION; ONCOTIC PRESSURE; PATHOPHYSIOLOGY; PREECLAMPSIA; PREGNANCY COMPLICATION; PROTEIN CONTENT; PROTEINURIA; REFERENCE VALUE; REVIEW; SCREENING TEST; STILLBIRTH; ULTRAFILTRATION; URINALYSIS; URINARY EXCRETION; URINE OSMOLALITY; URINE PH;

EID: 20044387647     PISSN: 09655395     EISSN: None     Source Type: Journal    
DOI: 10.1017/S0965539504001445     Document Type: Review

References (91)

1. National Collaborating Centre for Women's and Children's Health. Commissioned by the National Institute for clinical excellence. Antenatal Care: routine care for the healthy pregnant woman. RCOG Press October 2003.
2. Davey DA, MacGillivray I. The classification and definition of the hypertensive disorders of pregnancy. Am J Obstet Gynaecol 1988; 158: 892-98.
3. Redman CWG, Jefferies M. Revised definition of pre-eclampsia. Lancet 1988; 1: 809-12.
4. Perry IJ, Beevers DG. The definition of pre-eclampsia. Br J Obstet Gynaecol 1994; 101: 587-91.
5. Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM. The classification and diagnosis of the hypertensive disorders of pregnancy: Statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregnancy 2001; 20: ix-xiv.
6. Chappell L, Poulton L, Halligan AWF, Shennan AH. Lack of consistency in research papers over the definition of pre-eclampsia. Br J Obstet Gynaecol 1999; 106: 983-85.
7. Kumar, S, Muchmore A. Tamm-Horsfall protein uromodulin (1950-1990). Kid Int 1990; 37: 1395.
8. Abbate, M, Benigni, A, Bertani, T, Remuzzi, G. Nephrotoxicity of increased glomerular protein traffic. Nephrol Dial Transplant 1999; 14: 304-31.
9. Lindheimer MD, Katz AI. The Kidney in pregnancy. In: B.M. Brenner BM and Rector FC Jr. (eds) The Kidney (3rd Ed). WB Saunders, Philidelphia; 1986; 1253-295.
10. Davison JM. Renal function during normal pregnancy and the effect of renal disease and pre-eclampsia. In: Andreucci VE (ed). The kidney in pregnancy. Martinus Nijhoff, Boston; 1986; 65-80.
11. Girling JC. Re-evaluation of plasma creatinine concentration in normal pregnancy. J Obstet Gynecol 2000; 20: 128-31.
12. Higby K, Suiter CR, Phelps JY, Siler-Khodr T, Langer O. Normal values of urinary albumin and total protein excretion during pregnancy. Am J Obstet Gynaecol 1994; 171: 984-89.
13. Kuo VS, Koumanantakis G, Gallery EDM. Proteinuria and its assessment in normal and hypertensive pregnancy. Am J Obstet Gynaecol 1992; 167: 723-28.
14. Bernard A, Thielemans N, Lauwerys R, van Lierde M. Selective increase in the excretion of protein 1 (Clara cell protein) and other low molecular weight proteins during normal pregnancy. Scand J Clin Lab Invest 1992; 52: 871-78.
15. Spargo BH, McCartney C, Winemiller R. Glomerular Capillary Endotheliosis in toxaemia of pregnancy. Arch Pathol 1959; 13: 593-99.
16. Sheehan HL. Renal morphology in pre-eclampsia. Kid Int 1980; 18: 241-52.
17. Sheehan HL, Lynch JB. Pathology of Toxaemia of Pregnancy. Baltimore: Williams and Williams 1973.
18. Nochy D, Birembaut P, Hinglais N, Freund M, Idatte JM, Jacquot C, et al. Renal lesions in the hypertensive disorders of pregnancy: immunomorphological and ultrasrtuctural changes in 114 cases. Clin Nephrol 1980; 13: 155-62.
19. Foidart JM, Nochy D, Nusgens B, Foidart JB, Machieu PR, Lapier CM, et al. Accumulation of several basement membrane type proteins in the glomeruli of patients with pre-eclampsia and other hypertensive syndromes of pregnancy: possible roles of renal prostaglandins and fibronectin. Lab Invest 1983; 49: 250-59.
20. Suzuki S, Gejyo F, Ogino S, Maruyama Y, Ueno M, Nishi S et al. Postpartum renal lesions in women with pre-eclampsia. Nephrol Dial Transplant 1997; 12: 2488-493.
21. Furukawa T, Shigematsu H, Aizawa T, Oguchi H, Furuta S. Residual glomerular lesions in postpartum women with toxaemia of pregnancy. Acta Pathologica Japanoica 1983; 33: 1159-169.
22. Fisher KA, Luger A, Spargo BH, Lindheimer MD. Hypertension in pregnancy: clinical-pathological correlations and late prognosis. Medicine 1981; 60: 267-78.
23. Conrad KP, Lindheimer MD. Renal and cardiovascular alterations. In: Lindheimer MD, Roberts JM, Cunningham FG (eds) Chesley's hypertensive disorders of pregnancy, 2nd edition. Appleton and Lange, 1999; 263-326.
24. Roberts M, Lindheimer MD, Davison JM. Glomerular dynamics and membrane porosity in gravidas with renal disease and pre-eclampsia. Am J Obstet Gynecol 1998; 176: 361A.
25. Davison, JM. Renal function during normal pregnancy and the effect of renal disease and pre-eclampsia. in: VE Andreucci (ed). The kidney in pregnancy. Boston, Martinus Nijhoff; 1986: 65-80.
26. Redman CW, Jefferies M. Revised definition of pre-eclampsia. Lancet 1988; 1: 809-12.
27. Garner PR, D'Alton ME, Dudley DK, Huard P, Hardie M. Preeclampsia in diabetic pregnancies. Am J Obstet Gynecol 1990; 163: 505-508.
28. Dekker GA, de Vries JI, Doelitzsch PM, Huijgens PC, von Blomberg BM, Jakobs C et al. Underlying disorders associated with severe early-onset preeclampsia. Am J Obstet Gynecol 1995; 173: 1042-1048.
29. Page EW, Christianson R. Influence of blood pressure changes with and without proteinuria upon outcome of pregnancy. Am J Obstet Gynaecol 1976; 126: 821-29.
30. Chesley LC. Superimposed pre-eclampsia or eclampsia. In: Chesley LC (ed) Hypertensive disorders in Pregnancy. New York: Appleton-Century-Crofts, 1978.
31. Sibae BM, Abdella TN, Anderson GD. Pregnancy outcome in 211 patients with mild chronic hypertension. Obstet Gynaecol 1983; 61: 571-76.
32. Sibae BM, Anderson GD. Pregnancy outcome of intensive therapy in severe hypertension in the first trimester. Obstet Gynecol 1986; 67: 517-22.
33. Ferrazzani S, Caruso A, De Carolis S, Martino IV, Mancuso S. Proteinuria and outcome of 444 pregnancies complicated by hypertension. Am J Obstet Gynecol 1990; 162: 366-71.
34. Page EW, Christianson R. Influence of blood pressure changes with and without proteinuria upon outcome of pregnancy. Am J Obstet Gynecol 1976; 126: 821-29.
35. Brown MA, Buddle ML. Inadequacy of dipstick proteinuria in hypertensive pregnancy. Aust NZ J Obstet Gynaecol 1995; 35: 366-69.
36. Chua S, Redman CWG. Prognosis for pre-eclampsia complicated by 5g or more of proteinuria in 24 hours. Eur J Obstet Gynaecol Reprod Biol 1992; 43: 9-12.
37. North RA, Taylor RS, Schellenberg JC. Evaluation of a definition of pre-eclampsia. Br J Obstet Gynaecol 1999; 106: 767-74.
38. Halligan AWF, Bell SC, Taylor DJ. Dipstick proteinuria: caveat emptor. Br J Obstet Gynaecol 1999; 106: 1113-115.
39. Waugh J, Bell SC, Kilby MD, Blackwell CN, Seed P, Shennan AH et al. Bedside urine albumin creatinine ratio testing in hypertensive pregnancy. Hypertens Pregnancy 2002; 21: Supplement 1, P103.
40. Waugh JJS, Bell SC, Kilby MD, Lambert P, Shennan A, Halligan A. Urine protein estimation in hypertensive pregnancy: Which thresholds and laboratory assay best predicts clinical outcome. Hypertens Pregnancy In Press.
41. Schiff E, Friedman SA, Kao L, Sibai BM. The importance of urinary protein excretion during conservative management of severe pre-eclampsia. Am J Obstet Gynaecol 1996; 175: 1313-316.
42. Meyer NL, Mercer BM, Friedman SA, Sibai BM. Urinary dipstick protein: a poor predictor of absent or severe proteinuria. Am J Obstet Gynecol 1994; 170: 137-41.
43. Waugh JJS, Bell SC, Kilby MD, Shennan AH, Halligan AWF. Effect of urine concentration and biochemical assay on dipstick accuracy in hypertensive pregnancy. Hypertens Pregnancy 2001; 20: 205-17.
44. Waugh JJS, Clark TJ, Divakaran TG, Khan KS, Kilby MD. Accuracy of urinalysis dipstick techniques in predicting significant proteinuria in pregnancy. Obstet Gynecol 2004; 103: 769-77.
45. Bell SC, Halligan AWF, Martin A, Ashmore J, Shennan AH, Lambert PC et al. The role of observer error in antenatal dipstick proteinuria analysis. Br J Obstet Gynaecol 1999; 106: 1177-180.
46. Saudan PJ, Brown MA, Farrell T, Shaw L. Improved methods of assessing proteinuria in hypertensive pregnancy. Br J Obstet Gynaecol 1997; 104: 1159-164.
47. Peele JD, Gadsden RH, Crews R. Evaluation of Ames 'Clini-Tek'. Clin Chem 1977; 23: 2238-241.
48. Bell SC, Armstrong CA, Shennan AH, Boyce T, Halligan AWF. Reliable urine analysis in the management of hypertensive pregnancies. Eur J Obstet Gynaecol Reprod Biol 2000; 93: 181-83.
49. Nebelhut T, Rath W, Grospietsch G, Weber MH, Kuhn W. Urinary protein electrophoresis profile in normal and hypertensive pregnancies. Arch Gynaecol Obstet 1989; 246: 97-105.
50. Waugh JJS, Bell SC, Kilby MD, Blackwell CN, Seed P, Shennan AH et al. Optimal bedside urinalysis for the detection of proteinuria in hypertensive pregnancy. Br J Obstet Gynaecol (In press).
51. Waugh J, Jacobs M, Shennan AH, Bell SC, Halligan AWF, Kilby MD. Time of urine void and urine concentration: pitfalls with dipstick urinalysis. J Soc Gynecol Investig 2003; 10: 168A.
52. McElderry LM, Tarbit IF, Cassells-Smith AJ. Six methods for urinary protein compared. Clin Chem 1982; 28: 356-60.
53. McDowell TL. Benzethonium Chloride method for proteins adapted for centrifugal analysis. Clin Chem 1985; 31: 864-66.
54. Bradford MM. A rapid and sensitive method for the quantification of microgram quantities using the principle of protein dye binding. Analytical Biochemistry 1976; 72: 248-54.
55. Waugh JJS, Bell SC, Kilby MD, Shennan AH, Halligan AWF. Effect of urine concentration and biochemical assay on dipstick accuracy in hypertensive pregnancy. Hypertens Pregnancy 2001; 20: 205-17.
56. Quaas L, Wilhelm CH, Klosa W, Hillemanns HG, Thaiss F. Urinary protein patterns and EPH-gestosis. Clin Nephrol 1987; 27: 107-10.
57. Yamamoto T, Yoshimura S, Sasamori Y. Analysis of urinary protein by immunoblot method using concentrated urine in pre-eclampsia. Asia-Oceania J Obstet Gynecol 1989; 246: 177-85.
58. Witlin AG, Saade GR, Mattar F, Sibai BM. Risk factors for abruptio placentae and eclampsia: Analysis of 445 consecutively managed women with severe pre-eclampsia and eclampsia. Am J Obstet Gynecol 1999; 180: 1322-329.
59. Douglas K, Redman C. Eclampsia in the United Kingdom. Br Med J 1994; 26: 1395-400.
60. Ginsberg JM, Chang BS, Matarese RA, Garella S. Use of single voided urine samples to estimate quantitative proteinuria. N Eng J Med 1983; 309: 1543-546.
61. Steinhauslin F, Wauters JP. Quantitation of proteinuria in kidney transplant patients: accuracy of the protein/creatinine ratio. Clin Nephrol 1995; 43: 110-15.
62. Brodby RA, Rohde RD, Zeev S, Pohl MA, Bain RP, Lewis EJ. The urine protein to creatinine ratio as a predictor of 24 hour urine protein excretion in Type 1 diabetic patients with nephropathy. Am J Kid Dis 1995; 26: 904-909.
63. Quadri KHM, Bernardini J, Greenberg A, Laifer S, Syed A, Holley JL. Assessment of renal function during pregnancy using a random protein to creatinine ratio and Cockcroft Gault formula. Am J Kid Dis 1994; 24: 416-20.
64. Jaschevatzky OE, Rosenberg P, Shalit A, Zonder HB, Grunstein S. Protein/creatinine ratio in random urine specimens for quantitation of proteinuria in pre-eclampsia. Obstet Gynecol 1990; 75: 604-606.
65. Ramos JG, Martins-Costa SH, Mathias MM, Guerin YL, Barros EG. Urinary Protein/creatinine ratio in hypertensive pregnant women. Hypertens Pregn 1999; 18: 209-18.
66. Lindow SW, Davey DA. The variability of urinary protein and creatinine excretion in patients with gestational hypertension. Br J Obstet Gynaecol 1992; 99: 869-72.
67. Marshall SM. Screening for microalbuminuria: Which measurement? Diabetic Med 1991; 8: 249-62.
68. Winocour PH, Harland J, Millar JP, Laker MF, Alberti KGMM. Microalbuminuria and associated risk factors in the community. Atherosclerosis 1992; 93: 71-81.
69. Allawi J, Reo PV, Gilbert R, Scott G, Jarrett RJ, Keen H, et al. Microalbuminuria in non-insulin dependent diabetes mellitus: its prevalence in Indian compared to European subjects. Br Med J 1988; 296: 462-64.
70. Mogensen CE, Christensen CK. Predicting diabetic nephropathy in insulin dependent diabetics. N Engl J Med 1984; 311: 89-93.
71. Viberti GC, Hill RD, Jarrett RJ, Argyropoulos A, Mahmud U, Keen H. Microalbuminuria as a predictor of clinical nephropathy in diabetes mellitus. Lancet 1982; 2: 1430-432.
72. Eshoj O, Feldt-Rasmussen B, Larsen ML, Mogensen EF. Comparison of overnight, morning and 24-hour urine collections in the assessment of diabetic microalbuminuria. Diabetic Med 1987; 4: 531-33.
73. Mogensen CE, Solling K. Studies on renal tubular protein reabsorption: partial and near complete inhibition by certain amino acids. Scand J Clin Lab Invest 1977; 37: 477-86.
74. Davison JM. The effect of pregnancy on kidney function in renal allograft recipients. Kidney Int 1985; 27: 74-79.
75. Douma CE, Van der post JAM, Van Acker BAC, Boer K, Koopman MG. Circadian variation of albumin excretion in pregnancy. Br J Obstet Gyanecol 1995; 102: 107-10.
76. Waugh JJS, Bell SC, Kilby MD, Lambert P, Blackwell CN Shennan. AH Urinary microalbumin creatinine ratio: reference range in uncomplicated pregnancy. Clin Sci 2003; 104: 103-107.
77. Lopez-Espinosa I, Dhar H, Humphreys S, Redman CWG. Urinary albumin excretion in pregnancy. Br J Obstet Gynaecol 1986; 93: 176-81.
78. Wright A, Steele P, Bennett JR, Watts G, Polak A. The urinary excretion of albumin in normal pregnancy. Br J Obstet Gynaecol 1987; 94: 408-12.
79. Erman A, Neri A, Sharoni R, Rabinov M, Kaplan B, Rosenfeld JB et al. Enhanced urinary albumin excretion after 35 weeks gestation and during labour in normal pregnancy. Scand J Clin Lab Invest 1992; 52: 409-13.
80. Konstantin-Hansen KF, Hesseldahl H, Pederson SM. Microalbuminuria as a predictor of pre-eclampsia. Acta Obstet Gynaecol Scand 1992; 71: 343-46.
81. Beetham R, Dawnay A, Menebawy M, Silver A. Urinary excretion of albumin and retinol binding protein during normal pregnancy. J Clin Pathol 1988; 41: 1089-1092.
82. Chesley LC. Hypertensive disorders of pregnancy. New York: Century Appleton-Crofts, 1978: 157-62.
83. Butler NR, Bonham DG. Perinatal Mortality: First report of the British Perinatal Mortality Survey. Edinburgh: Livingstone, 1963: 86-100.
84. Rodriguez MH, Masaki DI, Mestman J, Kumar D, Rude R. Calcium/creatinine ratio and microalbuminuria in the prediction of preeclampsia. Am J Obstet Gynecol 1988; 159: 1542-545.
85. Holm J, Hemmingsen L, Irgens-Moller L. Diagnostic value of hyperuricemia and microalbuminuria in preeclampsia. Med Sci Res 1988; 16: 123-24.
86. Thong KJ, Howie AF, Smith AF, Greer IA, Johnstone FD. Microalbuminuria in random daytime specimens in pregnancy induced hypertension. J Obstet Gynaecol 1991; 11: 324-27.
87. Nakamura T, Ito M, Yoshimura T, Mabe K, Okamura H. Usefulness of the urinary microalbumin/ creatinine ratio in predicting pregnancy-induced hypertension. Int J Gynaecol Obstet 1992; 37: 99-103.
88. Bar J, Hod M, Erman A, Friedman S, Gelerenter I, Kaplan B et al. Microalbuminuria as an early predictor of hypertensive complications in pregnant women at high risk. Am J Kidney Dis 1996; 28: 220-25.
89. Higby K, Suiter CR, Siler-Khodr T. A comparison between two screening methods for detection of microproteinuria. Am J Obstet Gynecol 1995; 173: 1111-114.
90. Das V, Bhargava T, Das SK, Pandey S. Microalbuminuria: a predictor of pregnancy-induced hypertension. Br J Obstet Gynaecol 1996; 103: 928-30.
91. Waugh JJS, Kilby MD, Lambert P, Bell SC, Blackwell CN, Shennan AH. Validation of the DCA 2000 Microalbumin: creatinine urinanalyser for its use in pregnancy and pre-eclampsia. Hypertens Pregnancy 2003; 22: 97-113.