A prospective post-partum evaluation of renal function in preeclampsia

Background: Hypertensive disorder comprises one of the leading causes of maternal and perinatal morbidity and mortality across the globe. Because women with preeclampsia are at risk of cardiovascular disease and end-stage renal disease, proper follow-up after delivery for resolution of proteinuria and hypertension is required and investigations should be conducted to find out and adequately treat any underlying cardiovascular or renal disease.Methods: This was a prospective study and included as participants pregnant women with preeclampsia who met the inclusion and exclusion criteria and who subsequently delivered at Government Medical College Hospital, Thrissur, Kerala, India. For each eligible participant, clinical and laboratory data were collected from third trimester of antenatal period, and six weeks and three months after delivery.Results: In this study, it is found that 26.2% and 4.23% patients had persistence of systolic blood pressure at 6 weeks and 3 months postpartum where as 19.4% and 3.38% had persistence of diastolic blood pressure at 6 weeks and 3 months post-partum. Serum creatinine was persistently high in 14.4% and 6.77% after 6 weeks and 3 months postpartum respectively. Proteinuria resolved completely in non-severe preeclampsia by 6 weeks postpartum itself. In severe preeclampsia group, 65% and 25% of patients had persisting proteinuria after 6 weeks and 3 months postpartum.Conclusions: Hypertension that persists more than 6 weeks postpartum usually represents a pathology not directly associated with pregnancy such as essential hypertension or underlying endocrine, neurological, or renal disease. Proteinuria that persists beyond 6-12 weeks postpartum may also warrant further investigation, particularly in early onset preeclampsia, the group of women most likely to have underlying renal disease.

Correlación entre el cociente proteinuria/creatininuria en una orina al azar y la proteinuria de 24 horas

Introducción: la cuantificación de proteínas en orina es un estudio que evalúa la afectación renal por ciertas enfermedades. Su medición puede realizarse también a través del cociente proteinuria/creatininuria. Objetivo: determinar la correlación entre el cociente proteinuria/creatininuria y la proteinuria de 24 horas. Metodología: se realizó un estudio descriptivo observacional, prospectivo con componente analítico de corte transverso, de muestreo no probabilístico. Se incluyó a 60 pacientes con factores de riesgo de padecer enfermedad renal crónica, que acudieron al Hospital Nacional (Itauguá) en el año 2014. Todos se realizaron análisis de orina de 24 horas y de una muestra de orina al azar para estimar el cociente proteinuria/creatininuria. Resultados: se observó que existe una correlación muy significativa (r= 0,9 p < 0,001) entre los valores del cociente de proteinuria/creatininuria en una orina al azar y la proteinuria de 24 horas, con una sensibilidad 94,1% (IC95% 79-100), especificidad 100% (IC95% 98-100%), valor predictivo positivo 100% (IC95% 96-100) y valor predictivo negativo 97,7% (IC95% 92-100). Conclusiones: el cociente proteinuria/creatininuria es útil para detectar proteinuria en rango no nefrótico.

Introduction: The quantification of proteins in urine is a study that evaluates kidney involvement in some diseases. The measurement can be made through the urine protein-creatinine ratio. Objective: To determine the correlation between the urine protein-creatinine ratio and 24-hour urine protein. Methodology: A cross-sectional prospective observational descriptive study with analytical component and non-probabilistic sampling was performed. Sixty patients who had risk factors of chronic renal disease and attended the National Hospital (Itauguá) in 2014 were included. Twenty four-hour urine and a random urine sample were analyzed to estimate the protein-creatinine ratio. Results: A very significant correlation (r= 0.9 p < 0.001) was observed between the values of the protein-creatinine ratio in a random urine and 24-hour urine protein with a sensitivity of 94.1% (IC95% 79-100), specificity of 100% (IC95% 98-100%), positive predictive value of 100% (IC95% 96-100) and negative predictive value of 97.7% (IC95% 92-100). Conclusion: The protein-creatinine ratio is useful to detect proteinuria in a non-nephrotic range.

Correlation of Spot Urine Protein:Creatinine Ratio with 24-hour Urinary Protein in Preeclampsia: A Cross Sectional Study.

Aims: The present study was undertaken to evaluate the diagnostic value of protein:creatinine ratio in spot voided urine sample for detection of proteinuria as compared to those of 24 hour urine sample in patients with preeclampsia, and also to determine the optimal cut-off value of protein:creatinine ratio with best sensitivity and specificity for the prediction of significant proteinuria. Study Design: Cross sectional study. Place and Duration of the Study: The study was conducted at teaching hospital in North Karnatak, India. The study was conducted from Jan 2012 to February 2013. Methods: This study was conducted on 52 preeclampsia patients. The 24 hour urine protein and random urine protein:creatinine ratio was determined. Pearson’s correlation, sensitivity and specificity were determined using 24-hour urinary protein as a gold standard for spot urine protein:creatinine ratio. Receiver operators characteristic (ROC) curve and area under curve was also determined using SPSS (11.5) software. All the results were expressed in mean±SD. Results: Fifty two preeclampsia patients participated in this study. The average 24 hour urinary protein was 1643.3±2079.5 mg/day. The spot urine protein:creatinine ratio was 1.47±1.68. There was a positive correlation between 24 hour urinary protein and spot urine protein:creatinine ratio (r = 0.86, P<0.0001). The area under the receiver operators characteristic curve for urine protein:creatinine ratio at various cut-off was 0.914 (95% confidence interval: 0.800-0.975, P<0.0001). The sensitivity and specificity was 71.5% and 100% respectively at protein:creatinine ratio cut-off of 0.66. Conclusion: The random urine protein:creatinine ratio predicts the amount of 24-hour urinary protein excretion with high accuracy. Hence it can be used as a faster diagnostic substitute for 24- hour urinary protein estimation in preeclampsia.

Effect of renin inhibition on an experimental glomerulonephritis - a preliminary report / 소아과

PURPOSE: We performed this study in order to investigate the effect of direct renin inhibition on an experimental animal model with nephrotoxic serum nephritis and tried to give useful information for clinical research and renin inhibitor treatment. METHODS: Thirty BALB/c 6-week-old male mice were divided into 4 groups: control group (CO, n=5), control-treatment group with aliskiren (CT, n=5), disease group (DO, n=10), and disease treatment group with aliskiren (DT, n=10). Nephritis was induced by an intravenous injection of 0.25 mg/g weight of rabbit anti-GBM immunoglobulin G. Model 2002 Alzet mini-osmotic pumps (Durect Corp.) for aliskiren infusion were implanted into CT and DT. Each group strain was sacrificed serially one at a time on day 14. We estimated the protein-creatinine ratio in 12-hour-collected urine (UP/Cr) and measured the mesangial matrix score in the PAS-stained kidney of each strain. RESULTS: One strain at CT and DT died on day 6 and 7, respectively. Each group strain was sacrificed serially at a time on day 10 because DO were seriously ill. The UP/Cr of each group is as follows: CO, 31.24+/-6.54 mg/mg, CT, 23.38+/-13.60 mg/mg, DO, 112.72+/-10.97 mg/mg, DT 114.07+/-32.30 mg/mg. There was no significant difference between DO and DT. The mesangial matrix score of each group was CO, 0.23+/-0.10; CT, 0.13+/-0.03; DO, 1.90+/-0.48; and DT, 1.28+/-0.41, respectively, and there was a significant difference between DO and DT in the extent of mesangial matrix expansion (P=0.008). CONCLUSION: We found that renin inhibition was able to suppress the mesangial matrix expansion in experimental mice with acute nephritis, although there were no significant differences in UP/Cr.

The Factors Affecting Accurate Quantitaion of Proteinuria Using Spot Urine Protein/Creatinine Ratio in Children

PURPOSE: Many results have reported a correlation between the spot urine protein/creatinine ratio(P/C ratio) and 24-hour urinary protein(24UP) amount. This study was designed to evaluated correlation between 24UP amounts and P/C ratio in children and to find the factors that affect this correlation. METHODS: 210 patients who visited the Department of Pediatrics in Busan Paik Hospital from september 2003 to december 2007 were included in this study. All the patients were divided into I, II, III/A, B, C group[I:24UP(mg/m2/day)] or =1,000, A: Cr excretion(mg/kg) or =25)]. Pearson correlation analysis was performed between 24UP and P/C ratio to evaluate the relationship. We defined fractional difference between 24UP and P/C ratio, and then performed multiple regression analysis. RESULTS: There was a strong positive linear correlation between 24UP and P/C ratio in all patients, and the correlation was also good in each group. The factors affecting accurate quantitation of proteinuria using spot urine P/C ratio was creatinine excretion. CONCLUSION: Spot urine P/C ratio is a useful test to predict proteinuria roughly. Therefore, we expect that urine P/C ratio can be used as parameter instead of 24UP, if we set cutoff value of P/C ratio considered to creatinine excretion according to age and sex in large pediatric population.

The Usefulness of Spot Urine Protein/Creatinine Ratio in Evaluating Proteinuria in Children and the Correlation between 24-hour Urinary Protein Amount and Spot Urine Protein/Creatinine Ratio

PURPOSE: Recently, different results about factors affecting accurate quantitation of 24-hr urinary protein(24UP) amount using spot urine protein/creatinine ratio(PCR) have been reported. The current study was designed to evaluate correlation between 24UP amounts and PCR in children, and the effect of 24UP amounts, age, sex, and glomerular filtration rate(GFR) on this correlation. METHODS: Among 94 patients who visited the department of pediatrics in Busan Paik Hospital from March 2002 to August 2002, 68 patients whose urinary creatinine excretion was > or = 15 mg/kg/day were included in this study. All the patients were divided into I, II/A, B group(I : 24UP or = 500 mg/day, A : or = 10 years of age). Pearson correlation analysis was performed between 24UP and PCR to evaluate the relationship. We defined fractional difference between 24UP and PCR, and then performed multiple regression analysis with 24UP amount, age, GFR and fractional difference. RESULTS: There was a strong positive linear correlation between 24UP and PCR(R=0.936, P or = 500 mg. The factors affecting accurate quantitation of proteinuria using spot urine PCR was age, not 24UP amount, GFR or sex. CONCLUSION: Spot urine PCR is a useful test but has limitations in predicting 24UP amount. Therefore, it should be used only as screening method. Age-adjusted PCR cutoff values may be necessary to predict 24UP amount in children with proteinuria.