PREEKLAMPSİ TANISINDA SPOT İDRAR PROTEİN / KREATİNİN ORANININ SENSİTİVİTESİNİN İDRAR VERME ZAMANI VE BEKLEME SÜRESİ GİBİ DEĞİŞKENLER İLE BİRLİKTE BELİRLENMESİ
Yıl 2022,
Cilt: 23 Sayı: 4, 364 - 371, 17.10.2022
Kemal Hansu
,
Halis Özdemir
,
Merih Bayram
Öz
AMAÇ: Bu çalışmada 24 saatlik idrar proteinürisini öngörmede spot idrar protein / kreatinin oranının başarısını, idrarın verilme zamanı ve idrarın bekleme süresi gibi farklı değişkenler ile karşılaştırmayı amaçladık.
GEREÇ VE YÖNTEM: Çalışmaya Mart 2014 - Aralık 2017 tarihleri arasında tansiyon yüksekliği nedeniyle kliniğimize başvuran, 24 saatlik idrarda protein çalışılan ve eş zamanlı spot idrarda protein/kreatinin oranı bakılan 100 gebe dahil edilmiştir. Çalışmaya katılan gebeler 24 saatlik idrar proteinürisi normal sınırlarda olanlar ve olmayanlar olarak ikiyi ayrılmıştır. Spot idrarın veriliş zamanı, bekleme süresi ve hastaların demografik verileriyle; spot idrar kreatinin oranın 24 saatlik idrar proteinürisini öngörmedeki başarısı karşılaştırılmıştır.
BULGULAR: Spot idrar protein / kreatinin oranının 24 saatlik idrarda proteinürisi olan ve olmayan gruplara ait en iyi kestirim noktası 0.315 olarak belirlenmiştir. İdrar verilme zamanı ve idrar bekleme süreleri karşılaştırılmış ancak istatistiksel olarak anlamlı bir fark olmadığı görülmüştür.
SONUÇ: Preeklampsi şüphesi olan gebelerde spot idrar protein/kreatinin oranı bakılması, 24 saatlik idrarda proteinüri bakılmasının yerini alabilir ancak çalışmamıza göre idrar verilme zamanı ve analiz öncesi idrar bekleme süresi testin duyarlılığını etkilememiştir.
Kaynakça
- 1. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165-241.
- 2. Garovic VD, White WM, Vaughan L, et al. Incidence and Long-Term Outcomes of Hypertensive Disorders of Pregnancy. J Am Coll Cardiol. 2020;75(18):2323-34.
- 3. Webster K, Fishburn S, Maresh M, et al. Diagnosis and management of hypertension in pregnancy: summary of updated NICE guidance. Bmj.
2019;366.
- 4. Rydzewska-Rosołowska A, Kakareko K, Naumnik B, Hryszko T. Comparison of different methods of urinary protein excretion measurement: is the
king really dead? Kidney and Blood Pressure Research. 2019;44(5):993-1001.
- 5. Morton A, Burke M, Jarvis E, Kumar S. Changes in proteinuria and diagnosing preeclampsia in CKD pregnancy. Pregnancy Hypertens.
2020;20:92-5.
- 6. Dogan S, Sel G, Arikan I, et al. Accuracy of the 24-h urine protein excretion value in patients with preeclampsia: correlation with instant and 24-
h urine protein/creatinine and albumin/creatinine ratios. J Obstet Gynaecol. 2019;39(8):1075-80.
- 7. Stefanska K, Zielinski M, Zamkowska D, et al. Comparisons of Dipstick Test, Urine Protein-to-Creatine Ratio, and Total Protein Measurement for
the Diagnosis of Preeclampsia. Int J Environ Res Public Health. 2020;17(12):4195.
- 8. Aggarwal N, Suri V, Soni S, et al. A prospective comparison of random urine protein-creatinine ratio vs 24-hour urine protein in women with
preeclampsia. Medscape J Med. 2008;10(4):98.
- 9. Al RA, Baykal C, Karacay O, et al. Random urine protein-creatinine ratio to predict proteinuria in new-onset mild hypertension in late
pregnancy. Obstet Gynecol. 2004;104(2):367-71.
- 10. Haas DM, Sabi F, McNamara M, Rivera-Alsina M. Comparing ambulatory spot urine protein/creatinine ratios and 24-h urine protein
measurements in normal pregnancies. J Matern Fetal Neonatal Med. 2003;14(4):233-6.
- 11. Durnwald C, Mercer B. A prospective comparison of total protein/creatinine ratio versus 24-hour urine protein in women with suspected
preeclampsia. Am J Obstet Gynecol. 2003;189(3):848-52.
- 12. Tranquilli AL, Dekker G, Magee L, et al. The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised
statement from the ISSHP. Pregnancy Hypertens. 2014;4(2):97-104.
- 13. Kamińska J, Dymicka-Piekarska V, Tomaszewska J, et al. Diagnostic utility of protein to creatinine ratio (P/C ratio) in spot urine sample within
routine clinical practice. Critical Reviews in Clinical Laboratory Sciences. 2020;57(5):345-64.
- 14. Rupakala B, Hiremath AS. Comparative study of 24-hour urinary protein and spot urine protein creatinine ratio in pre-eclamptic women.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2021;10(7):2734-9.
- 15. Pasternak Y, Lifshitz D, Shulman Y, et al. Diagnostic accuracy of random urinary protein-to-creatinine ratio for proteinuria in patients with
suspected pre-eclampsia. Archives of Gynecology and Obstetrics. 2021;304(1):109-15.
- 16. Fuller CE TG, Henry JB. Basic Examination of Urine. In John Bernard Henry editors. Clinical Diagnosis and Management by Laboratory Methods
20th Edition. 2001:373-6.
- 17. Burtis CA AE, Bruns DE. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 4th Edition, Missori, Elsevier Saunders 2006: pp.812-8.
- 18. Kocabaş RN, Başol G. Proteinüri ve laboratuvar değerlendirmesi. Türk Klinik Biyokimya Derg. 2006;4:133-45.
- 19. Geneen LJ, Webster KE, Reeves T, et al. Protein-creatinine ratio and albumin-creatinine ratio for the diagnosis of significant proteinuria in
pregnant women with hypertension: Systematic review and meta-analysis of diagnostic test accuracy. Pregnancy Hypertens. 2021;25:196-203.
- 20. Demirci O, Kumru P, Arinkan A, et al. Spot protein/creatinine ratio in preeclampsia as an alternative for 24-hour urine protein. Balkan Med J.
2015;32(1):51-5.
- 21. Cote AM, Brown MA, Lam E, et al. Diagnostic accuracy of urinary spot protein:creatinine ratio for proteinuria in hypertensive pregnant women:
systematic review. BMJ. 2008;336(7651):1003-6.
- 22. Rodriguez-Thompson D, Lieberman ES. Use of a random urinary protein-to-creatinine ratio for the diagnosis of significant proteinuria during
pregnancy. Am J Obstet Gynecol. 2001;185(4):808-11.
- 23. Robert M, Sepandj F, Liston RM, et al. Random protein-creatinine ratio for the quantitation of proteinuria in pregnancy. Obstet Gynecol.
1997;90(6):893-5.
- 24. Jaschevatzky OE, Rosenberg RP, Shalit A, et al. Protein/creatinine ratio in random urine specimens for quantitation of proteinuria in
preeclampsia. Obstet Gynecol. 1990;75(4):604-6.
- 25. Kayatas S, Erdogdu E, Cakar E, et al. Comparison of 24-hour urinary protein and protein-to-creatinine ratio in women with preeclampsia. Eur J
Obstet Gynecol Reprod Biol. 2013;170(2):368-71.
- 26. Lindow SW, Davey DA. The variability of urinary protein and creatinine excretion in patients with gestational proteinuric hypertension. Br J Obstet Gynaecol. 1992;99(11):869-72.
- 27. Quadri KH, Bernardini J, Greenberg A, et al. Assessment of renal function during pregnancy using a random urine protein to creatinine ratio
and Cockcroft-Gault formula. Am J Kidney Dis. 1994;24(3):416-20.
- 28. Verdonk K, Niemeijer IC, Hop WC, et al. Variation of urinary protein to creatinine ratio during the day in women with suspected pre-eclampsia.
BJOG. 2014;121(13):1660-5.
DETERMINING SPOT URINE PROTEIN / CREATININE RATIO SENSITIVITY IN THE DIAGNOSIS OF PREECLAMPSIA WITH VARIABLES SUCH AS URINE SAMPLING TIME AND WAITING TIME
Yıl 2022,
Cilt: 23 Sayı: 4, 364 - 371, 17.10.2022
Kemal Hansu
,
Halis Özdemir
,
Merih Bayram
Öz
OBJECTIVE: The present study aims to compare the success of spot urine protein/creatinine ratio in predicting 24-h proteinuria with different variables such as urine sampling time and urine wait time before analysis.
MATERIAL AND METHODS: The study included 100 pregnant women who were tested for their 24-h urine protein levels and simultaneously checked for spot urine protein/creatinine ratio upon admission to our clinic with a complaint of high blood pressure between March 2014 and December 2017. The pregnant women included in the study were divided into two groups: those with a normal range for the level of 24-h proteinuria and those with an abnormal range for 24-h proteinuria. The success of spot urine protein/creatinine level in predicting 24-h urine proteinuria was assessed in relation to spot urine sampling time, wait time, and patients’ demographic data.
RESULTS: The optimal cut-off value of spot urine protein / creatinine ratio for groups with and without proteinuria in 24-h urine was determined to be 0.315 (cut-off). Urine sampling time and wait time before analysis were compared but no statistically significant difference was found.
CONCLUSIONS: The spot urine protein/creatinine ratio in pregnant women with suspected preeclampsia may replace testing patients for proteinuria in their 24-h urine. However, according to our study, urine sampling time and wait time before analysis did not affect the sensitivity of the test.
Kaynakça
- 1. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165-241.
- 2. Garovic VD, White WM, Vaughan L, et al. Incidence and Long-Term Outcomes of Hypertensive Disorders of Pregnancy. J Am Coll Cardiol. 2020;75(18):2323-34.
- 3. Webster K, Fishburn S, Maresh M, et al. Diagnosis and management of hypertension in pregnancy: summary of updated NICE guidance. Bmj.
2019;366.
- 4. Rydzewska-Rosołowska A, Kakareko K, Naumnik B, Hryszko T. Comparison of different methods of urinary protein excretion measurement: is the
king really dead? Kidney and Blood Pressure Research. 2019;44(5):993-1001.
- 5. Morton A, Burke M, Jarvis E, Kumar S. Changes in proteinuria and diagnosing preeclampsia in CKD pregnancy. Pregnancy Hypertens.
2020;20:92-5.
- 6. Dogan S, Sel G, Arikan I, et al. Accuracy of the 24-h urine protein excretion value in patients with preeclampsia: correlation with instant and 24-
h urine protein/creatinine and albumin/creatinine ratios. J Obstet Gynaecol. 2019;39(8):1075-80.
- 7. Stefanska K, Zielinski M, Zamkowska D, et al. Comparisons of Dipstick Test, Urine Protein-to-Creatine Ratio, and Total Protein Measurement for
the Diagnosis of Preeclampsia. Int J Environ Res Public Health. 2020;17(12):4195.
- 8. Aggarwal N, Suri V, Soni S, et al. A prospective comparison of random urine protein-creatinine ratio vs 24-hour urine protein in women with
preeclampsia. Medscape J Med. 2008;10(4):98.
- 9. Al RA, Baykal C, Karacay O, et al. Random urine protein-creatinine ratio to predict proteinuria in new-onset mild hypertension in late
pregnancy. Obstet Gynecol. 2004;104(2):367-71.
- 10. Haas DM, Sabi F, McNamara M, Rivera-Alsina M. Comparing ambulatory spot urine protein/creatinine ratios and 24-h urine protein
measurements in normal pregnancies. J Matern Fetal Neonatal Med. 2003;14(4):233-6.
- 11. Durnwald C, Mercer B. A prospective comparison of total protein/creatinine ratio versus 24-hour urine protein in women with suspected
preeclampsia. Am J Obstet Gynecol. 2003;189(3):848-52.
- 12. Tranquilli AL, Dekker G, Magee L, et al. The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised
statement from the ISSHP. Pregnancy Hypertens. 2014;4(2):97-104.
- 13. Kamińska J, Dymicka-Piekarska V, Tomaszewska J, et al. Diagnostic utility of protein to creatinine ratio (P/C ratio) in spot urine sample within
routine clinical practice. Critical Reviews in Clinical Laboratory Sciences. 2020;57(5):345-64.
- 14. Rupakala B, Hiremath AS. Comparative study of 24-hour urinary protein and spot urine protein creatinine ratio in pre-eclamptic women.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2021;10(7):2734-9.
- 15. Pasternak Y, Lifshitz D, Shulman Y, et al. Diagnostic accuracy of random urinary protein-to-creatinine ratio for proteinuria in patients with
suspected pre-eclampsia. Archives of Gynecology and Obstetrics. 2021;304(1):109-15.
- 16. Fuller CE TG, Henry JB. Basic Examination of Urine. In John Bernard Henry editors. Clinical Diagnosis and Management by Laboratory Methods
20th Edition. 2001:373-6.
- 17. Burtis CA AE, Bruns DE. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 4th Edition, Missori, Elsevier Saunders 2006: pp.812-8.
- 18. Kocabaş RN, Başol G. Proteinüri ve laboratuvar değerlendirmesi. Türk Klinik Biyokimya Derg. 2006;4:133-45.
- 19. Geneen LJ, Webster KE, Reeves T, et al. Protein-creatinine ratio and albumin-creatinine ratio for the diagnosis of significant proteinuria in
pregnant women with hypertension: Systematic review and meta-analysis of diagnostic test accuracy. Pregnancy Hypertens. 2021;25:196-203.
- 20. Demirci O, Kumru P, Arinkan A, et al. Spot protein/creatinine ratio in preeclampsia as an alternative for 24-hour urine protein. Balkan Med J.
2015;32(1):51-5.
- 21. Cote AM, Brown MA, Lam E, et al. Diagnostic accuracy of urinary spot protein:creatinine ratio for proteinuria in hypertensive pregnant women:
systematic review. BMJ. 2008;336(7651):1003-6.
- 22. Rodriguez-Thompson D, Lieberman ES. Use of a random urinary protein-to-creatinine ratio for the diagnosis of significant proteinuria during
pregnancy. Am J Obstet Gynecol. 2001;185(4):808-11.
- 23. Robert M, Sepandj F, Liston RM, et al. Random protein-creatinine ratio for the quantitation of proteinuria in pregnancy. Obstet Gynecol.
1997;90(6):893-5.
- 24. Jaschevatzky OE, Rosenberg RP, Shalit A, et al. Protein/creatinine ratio in random urine specimens for quantitation of proteinuria in
preeclampsia. Obstet Gynecol. 1990;75(4):604-6.
- 25. Kayatas S, Erdogdu E, Cakar E, et al. Comparison of 24-hour urinary protein and protein-to-creatinine ratio in women with preeclampsia. Eur J
Obstet Gynecol Reprod Biol. 2013;170(2):368-71.
- 26. Lindow SW, Davey DA. The variability of urinary protein and creatinine excretion in patients with gestational proteinuric hypertension. Br J Obstet Gynaecol. 1992;99(11):869-72.
- 27. Quadri KH, Bernardini J, Greenberg A, et al. Assessment of renal function during pregnancy using a random urine protein to creatinine ratio
and Cockcroft-Gault formula. Am J Kidney Dis. 1994;24(3):416-20.
- 28. Verdonk K, Niemeijer IC, Hop WC, et al. Variation of urinary protein to creatinine ratio during the day in women with suspected pre-eclampsia.
BJOG. 2014;121(13):1660-5.