OJOG  Vol.5 No.14 , December 2015
Increased Spot Urinary Protein-to-Creatinine Ratio Can Be a Useful Predictor of Preeclampsia
Abstract: Objectives: Preeclampsia is a major cause of maternal and perinatal morbidity and mortality. Early diagnosis of preeclampsia is important to help patients with preeclampsia. However, 24-hour urine collection is the gold standard diagnostic method at present. Recently, the spot urinary protein-to-creatinine ratio (P/C ratio) has been used to detect suspected preeclampsia, because it can be used to estimate the amount of 24-hour urinary protein. The aim of this study is to investigate whether an increase in P/C ratio precedes emergence of hypertension among inpatients with preeclampsia. Method: The P/C ratio in normotensive (systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg) pregnant women was measured during regular prenatal checkups and in inpatients with preeclampsia between April 1, 2013 and March 31, 2014. Results: We included in this study 4074 normotensive pregnant women. The 95th percentile values for the trimester of pregnancy were 0.100, 0.157, and 0.195, respectively. The 95th percentile value for each trimester of pregnancy and gestational age were determined as criterion (Y) and predictive variables (X), respectively. In a simple regression analysis, the regression line was calculated as Y = 0.0035X + 0.0849 (R2 = 0.9913). Twenty-one women were diagnosed with preeclampsia. In 14 patients with preeclampsia, the timing of the increase in P/C ratio to higher than the regression line preceded the emergence of hypertension. Six patients had no data on P/C ratio, and 1 patient had hypertension before the increase in P/C ratio. Conclusions: An increase in P/C ratio to higher than the 95th percentile value can be a useful predictor of preeclampsia.
Cite this paper: Nishimura, M. , Nakashima, A. , Kushimoto, T. , Goto, M. , Yoshida, S. , Sato, O. , Shikado, K. and Ogita, K. (2015) Increased Spot Urinary Protein-to-Creatinine Ratio Can Be a Useful Predictor of Preeclampsia. Open Journal of Obstetrics and Gynecology, 5, 808-812. doi: 10.4236/ojog.2015.514114.

[1]   Cunningham, G. (2014) Hypertensive Disorders, Williams Obstetrics. 24th Edition, McGraw-Hill, New York

[2]   Lamb, E.J., MacKenzie, F. and Stevens, P.E. (2009) How Should Proteinuria Be Detected and Measured? Annals of Clinical Biochemistry, 46, 205-217.

[3]   Yamada, T., Yamada, T., Morikawa, M., Takeda, M., Nishida, R., Akaishi, R. and Minakami, H. (2011) Isolated Proteinuria as an Initial Sign of Severe Preeclampsia. Open Journal of Obstetrics and Gynecology, 1, 13-16.

[4]   The American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy (2013) Hypertension in Pregnancy. Obstetrics & Gynecology, 122, 1122-1131.

[5]   Morris, R.K., Riley, R.D., Doug, M., Deeks, J.J. and Kilby, M.D. (2012) Diagnostic Accuracy of Spot Urinary Protein and Albumin to Creatinine Ratios for Detection of Significant Proteinuria or Adverse Pregnancy Outcome in Patients with Suspected Preeclampsia: Systematic Review and Meta-Analysis. BMJ, 345, e4342-e4353.

[6]   Coté, A.M., Firoz, T., Mattman, A., Lam, E.M., von Dadelszen, P. and Magee, L.A. (2008) The 24-Hour Urine Collection: Gold Standard or Historical Practice? American Journal of Obstetrics & Gynecology, 199, 625e1-625e6.

[7]   Robert, M., Sepandj, F., Liston, R.M. and Dooley, K.C. (1997) Random Protein-Creatinine Ratio for the Quantitation of Proteinuria in Pregnancy. Obstetrics & Gynecology, 90, 893-895.

[8]   Neithardt, A.B., Dooley, S.L. and Borensztajn, J. (2002) Prediction of 24-Hour Protein Excretion in Pregnancy with a Single Voided Urine Protein-to-Creatinine Ratio. American Journal of Obstetrics & Gynecology, 186, 883-886.

[9]   Coté, A.M., Brown, M.A., Lam, E., von Dadelszen, P., Firoz, T., Liston, R.M. and Magee, L.A. (2008) Diagnostic Accuracy of Urinary Spot Protein: Creatinine Ratio for Proteinuria in Hypertensive Pregnant Women: Systematic Review. BMJ, 336, 1003-1006.

[10]   Papanna, R., Mann, L.K., Kouides, R.W. and Glantz, J.C. (2008) Protein/Creatinine Ratio in Preeclampsia: A Systematic Review. Obstetrics & Gynecology, 112, 135-144.

[11]   Morikawa, M., Yamada, T., Yamada, T., Cho, K., Yamada, H., Sakuragi, N. and Minakami, H. (2008) Pregnancy Outcome of Women who Developed Proteinuria in the Absence of Hypertension after Mid-Gestation. Journal of Perinatal Medicine, 36, 419-424.

[12]   Holston, A.M., Qian, C., Yu, K.F., Epstein, F.H., Karumanchi, S.A. and Levine, R.J. (2009) Circulating Angiogenic Factors in Gestational Proteinuria without Hypertension. American Journal of Obstetrics & Gynecology, 200, 392.e1-392.e10.