Abstract

Background: Proteinuria is a significant marker of preeclampsia. Urinary protein in a 24-hour urine collection is conventionally considered as the standard for detection of proteinuria. However, it is tedious and is associated with collection errors. The role of urine protein/ creatinine ratio (UPCR) in a random urine sample is being proposed as an alternative. Aims: To compare accuracy of dipstick and random UPCR vis-a-vis 24-hour urine protein for prediction of significant proteinuria in preeclampsia. Study Design: Prospective cross-sectional study. Methods/Materials: Two hundred pregnant women with gestational age more than 20 weeks of pregnancy with blood pressure ≥ 140/90 mm Hg were recruited in the study. For each patient, the proteinuria was estimated by dipstick, random UPCR and 24-hour urine protein. Considering the 24-hour urinary protein analysis to be gold standard, the results of the other two methods were compared for their diagnostic accuracy. Data was compared by using Pearson’s correlation coefficient (r). Receiver operating characteristic curve was plotted for spot UPCR value for detecting significant proteinuria (≥ 300 mg/day). Results: The quantification of proteinuria by spot UPCR strongly correlated with 24-hour urinary protein (r = 0.857 with p value < 0.001). The most discriminant value for the same was 1.16. Area under Receiver operating characteristic for spot UPCR (0.96) was significantly more than that Background: Proteinuria is a significant marker of preeclampsia. Urinary protein in a 24-hour urine collection is conventionally considered as the standard for detection of proteinuria. However, it is tedious and is associated with collection errors. The role of urine protein/ creatinine ratio (UPCR) in a random urine sample is being proposed as an alternative. Aims: To compare accuracy of dipstick and random UPCR vis-a-vis 24-hour urine protein for prediction of significant proteinuria in preeclampsia. Study Design: Prospective cross-sectional study. Methods/Materials: Two hundred pregnant women with gestational age more than 20 weeks of pregnancy with blood pressure ≥ 140/90 mm Hg were recruited in the study. For each patient, the proteinuria was estimated by dipstick, random UPCR and 24-hour urine protein. Considering the 24-hour urinary protein analysis to be gold standard, the results of the other two methods were compared for their diagnostic accuracy. Data was compared by using Pearson’s correlation coefficient (r). Receiver operating characteristic curve was plotted for spot UPCR value for detecting significant proteinuria (≥ 300 mg/day). Results: The quantification of proteinuria by spot UPCR strongly correlated with 24-hour urinary protein (r = 0.857 with p value < 0.001). The most discriminant value for the same was 1.16. Area under Receiver operating characteristic for spot UPCR (0.96) was significantly more than that for dipstick urine analysis (0.766), thus making spot UPCR more accurate predictor of significant proteinuria. Spot UPCR also came out to be better predictor of adverse feto-maternal outcome. Conclusion: Spot UPCR is an appropriate rapid alternative method for quantification of proteinuria in preeclampsia. It can also be used as an adjunct to predict the risk of adverse feto-maternal outcome.

Authors: Ankita Nigam, Renu Arora, Charanjeet Kaur
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