Spot urine protein measurements in normotensive pregnancies, pregnancies with isolated proteinuria and preeclampsia
Spot urine protein measurements in normotensive pregnancies, pregnancies with isolated proteinuria and preeclampsia
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DOI：
10.1152/ajpregu.00508.2016
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发表时间：
2017-10-01
影响因子：
2.8
通讯作者：
Garovic, Vesna
中科院分区：
文献类型：
--
作者：
Kattah, Andrea;Milic, Natasa;Garovic, Vesna
我们对首次产科就诊的孕妇进行了一项前瞻性、纵向研究，以描述血压正常的孕妇的点尿蛋白-肌酐（UPCR）和白蛋白-肌酐比值（UACR）的变化，并确定与孤立性蛋白尿和先兆子痫相关的临床特征。我们在第一次产前检查、第二个三个月结束时和分娩时测量了尿白蛋白、蛋白质和肌酐。在血压正常的孕妇中（n =142），我们发现从怀孕开始到分娩，UACR的中位数[四分位距（IQR）]增加了14.7 mg/g Cr（3.74-51.8），UPCR增加了60 mg/g Cr（30-130）（两种变化均P < 0.001）。在19/142例（13.4%）血压正常的妊娠中发现了单独的蛋白尿（定义为无高血压时UPCR > 300 mg/g Cr）。收缩压和舒张压从孕早期到分娩的升高以及UACR从孕早期到孕中期的升高与分娩时的孤立性蛋白尿相关。12名妇女发展为先兆子痫。未产、孕早期和孕中期舒张压与先兆子痫的发生密切相关，但UACR的早期变化与先兆子痫的发生无关。总之，分娩时发生孤立性蛋白尿的妇女比没有蛋白尿的妇女血压升高更大，并且在妊娠早期有一个“微量白蛋白尿”阶段，这与发生先兆子痫的妇女不同。这些发现表明，与先兆子痫女性相比，单纯性蛋白尿女性的尿蛋白排泄机制不同，先兆子痫女性的蛋白尿发病更突然。
We performed a prospective, longitudinal study of pregnant women presenting to their first obstetrics visits to characterize the changes in spot urine protein-to-creatinine (UPCR) and albumin-to-creatinine ratios (UACR) in normotensive pregnancies, as well as identify clinical characteristics associated with isolated proteinuria and preeclampsia. We measured spot urinary albumin, protein, and creatinine at the first prenatal visit, end of the second trimester, and at delivery. In the normotensive pregnancies (n =142), we found that from the beginning of pregnancy to delivery, UACR increased by a median [ interquartile range (IQR)] of 14.7 mg/g Cr (3.74-51.8) and UPCR by 60 mg/g Cr (30-130) (P < 0.001 for both changes). Isolated proteinuria (defined as UPCR > 300 mg/g Cr in the absence of hypertension) was identified in 19/142 (13.4%) normotensive pregnancies. Increases in systolic and diastolic blood pressure from early pregnancy to delivery and increases in UACR from early to midpregnancy were associated with isolated proteinuria at delivery. Twelve women developed preeclampsia. Nulliparity, early, and midpregnancy diastolic blood pressures were strongly associated with the development of preeclampsia, but early changes in UACR were not. In conclusion, women who develop isolated proteinuria at delivery have a larger increase in blood pressure than women without proteinuria and have a "microalbuminuric" phase earlier in gestation, unlike women who develop preeclampsia. These findings suggest a different mechanism of urine protein excretion in women with isolated proteinuria as compared with women with preeclampsia, where proteinuria has a more abrupt onset.