A urinary albumin:creatinine ratio value of 155.6 mg/mmol was identified as the best threshold to detect a urine protein excretion of > 2 g/24 h, with a sensitivity … Discussion Preeclampsia (gestational proteinuric hypertension) remains a major cause of maternal morbidity and mortality selleck chemical worldwide.1,2 In Latin America and the Caribbean, hypertensive disorders are responsible for almost 26% of maternal deaths, whereas in Africa and Asia they contribute to only 9% of deaths. Even in developed countries such as the United Kingdom and the United States, although the absolute risk of maternal mortality is far lower, around 16% of maternal deaths can be attributed to hypertensive disorders.7,10 Prior studies have shown that proteinuric hypertension (preeclampsia) has worse maternal and fetal outcomes than nonproteinuric hypertension (gestational hypertension) in pregnancy.
11�C13 Significant proteinuria is one of the prerequisites for the diagnosis of preeclampsia.7 For many years, a 24-hour urine collection has been regarded as the gold standard for proteinuria, but it is cumbersome for both patients and staff and is subject to error due to inaccurate timing and/or incompleteness. Waiting for the results of protein estimation in a 24-hour urine collection can delay the diagnosis of preeclampsia unnecessarily and potentially put the mother and fetus at risk.14,15 As such, the ability to substitute a spot urine ACR for a 24-hour urine collection could have significant clinical implications, including the facilitation of prompt clinical decision making and more expeditious delivery.
Such an approach could also impact healthcare costs and improve patient outcome and satisfaction.16 With easier collection and results available within hours, a spot ACR would be a more efficient test than a 24-hour collection for proteinuria assessment. Moreover, because, by definition, the ACR corrects urinary protein concentrations for creatinine, it is independent of the degree of dilution of the urine. There is extensive literature in the nonpregnant population suggesting that a spot ACR performs just as well at assessing proteinuria as a 24-hour urine collection in patients with systemic lupus erythematosus (SLE), underlying glomerular disease, and following renal transplant.
17�C19 Dacomitinib Indeed, the US National Kidney Foundation has suggested that spot urine samples rather than 24-hour urine collections be used to detect and monitor proteinuria in both children and adults.20 Such recommendations have not as yet been made by US consensus organizations with regard to proteinuria in pregnancy.7,8 In our study, we found a strong correlation (r = .938) between the spot ACR ratio and the 24-hour urine protein estimation. According to the ROC curve analysis, an ACR of 22.8 mg/mmol was identified as the best threshold to detect urine protein excretion of > 0.3 g/24 h, with a sensitivity and specificity of 82.