Use of a random urinary protein-to-creatinine ratio for the diagnosis of significant proteinuria during pregnancy.

OBJECTIVE: The purpose of this study was to evaluate whether a random urinary protein-to-creatinine ratio is a clinically useful predictor of significant proteinuria (300 mg/24 hour). STUDY DESIGN: The medical records of 138 women who completed both a random urinary protein-to-creatinine ratio and a 24-hour urine collection for the evaluation of preeclampsia were reviewed. Urine samples for the random protein-to-creatinine ratio were collected before the 24-hour urine collection. With the use of a protein level of at least 300 mg in the 24-hour urine sample as the gold standard, the sensitivity and specificity of the random protein-to-creatinine ratio for the diagnosis of significant proteinuria were determined with a range of cutoffs. RESULTS: Fifty percent of the study population had significant proteinuria. The data suggest that a cutoff below 0.14 ruled out significant proteinuria. The best cutoff of > or = 0.19 yields a sensitivity of 90% and a specificity of 70%. All of the false-negative test results had 24-hour urine protein levels below 400 mg; 13 of the 21 false-positive results had levels that ranged from 250 to 300 mg. CONCLUSION: The random urinary protein-to-creatinine ratio is strongly associated with the 24-hour total protein excretion. A level below 0.14 can rule out significant proteinuria. A best cutoff of > or = 0.19 is a good predictor of significant proteinuria. With further study, the random urinary protein-to-creatinine ratio could replace the 24-hour urine collection as a simpler, faster, more useful method for the diagnosis of significant proteinuria.

Chemotherapy for a patient with advanced non-small-cell lung cancer during pregnancy: a case report and a review of chemotherapy treatment during pregnancy.

BACKGROUND: Lung cancer is the most common cause of cancer death in women in the USA. Lung cancer arising during pregnancy is rare and has been reported only 15 times since the 1950s. However, the use of chemotherapy for lung cancer during pregnancy has not previously been reported. METHODS: The history, treatment and outcome of a patient with stage IV non-small-cell lung carcinoma (NSCLC) diagnosed during pregnancy is presented. Previous published reports on lung cancer were retrieved by a literature search of Medline and Cancerlit. RESULTS: A 31-year-old woman was diagnosed as having stage IV NSCLC with bilateral pulmonary involvement when 26 weeks pregnant. Her shortness of breath progressed to dyspnea at rest on 100% inspired oxygen. Therefore, she was treated with systemic chemotherapy using cisplatin and vinorelbine. Despite this treatment, her oxygenation declined further over the next 4 days and thus the baby was delivered via cesarean section after 27 weeks of gestation. Four cycles of vinorelbine and cisplatin have now been administered. Following this treatment, the patient has experienced a significant clinical improvement and no longer requires supplemental oxygen. No chemotherapy-related adverse effects have been noted in the baby. In the 15 previously reported patients with concurrent lung cancer and pregnancy, chemotherapy administration during pregnancy has not been described. CONCLUSIONS: Treatment of lung cancer with chemotherapy during pregnancy should be considered on an individual basis with regard to the stage of the cancer and the maturity of the fetus. To our knowledge, the case presented here is the first report of a woman receiving chemotherapy for lung cancer while pregnant.