Feasibility of nephrinuria as a screening tool for the risk of pre-eclampsia: prospective observational study

BMJ Open - Tập 6 Số 8 - Trang e011229 - 2016
Tianyue Zhai1, Itsuko Furuta1, Rina Akaishi1, K. Kawabata1, Kentaro Chiba1, Takeshi Umazume1, Satoshi Ishikawa1, Takahiro Yamada1, Mamoru Morikawa1, Hisanori Minakami1
1Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan

Tóm tắt

ObjectivesTo investigate the possibility of nephrinuria as a screening tool for the risk of pre-eclampsia (PE).DesignProspective observational study.SettingA single university hospital. Changes in urinary nephrin:creatinine ratio (NCR, ng/mg) and protein:creatinine ratio (PCR, mg/mg) in pregnancy were determined. Significant proteinuria in pregnancy (SPIP) was defined as PCR>0.27. PE was diagnosed in women with both SPIP and hypertension.Participants89 pregnant women in whom neither hypertension nor SPIP was present at enrolment, providing 31, 125 and 93 random urine samples during first, second and third trimesters, respectively.ResultsPE developed in 14 of the 89 women. NCR increased with increasing PCR in 14 women with PE (correlation coefficient, 0.862; p<0.0001). In contrast, NCR did not change significantly despite significant increases in PCR in 75 women with normotensive pregnancies defined as neither SPIP nor hypertension, indicating that there was little increase in nephrinuria over the physiological range of proteinuria in pregnancy. Relative risk of later development of PE among asymptomatic second and third trimester women with NCR (ng/mg) >122 (95th centile value for 75 women with normotensive pregnancies) was 5.93 (95% CI 2.59 to 13.6; 60% (6/10) vs 10% (8/79)) and 13.5 (95% CI 3.31 to 55.0; 75% (6/8) vs 5.5% (2/36)), respectively, compared with women with NCR≤122 at that time.ConclusionsNephrinuria was unlikely to increase in normal pregnancy. A certain NCR cut-off may efficiently differentiate women at higher risk of PE.

Từ khóa


Tài liệu tham khảo

10.1073/pnas.96.14.7962

10.1097/01.ASN.0000039661.06947.FD

10.1056/NEJMra052131

10.1038/nrneph.2013.78

10.1161/HYPERTENSIONAHA.112.201681

10.1186/2050-7771-2-21

10.1016/j.ajog.2007.02.007

Konieczny, 2013, Podocytes in urine, a novel biomarker of preeclampsia?, Adv Clin Exp Med, 22, 145

10.1161/HYPERTENSIONAHA.113.01115

10.1093/ndt/gfl711

10.1177/1933719109338630

10.1152/ajprenal.00597.2011

10.5468/OGS.2013.56.1.22

10.1016/j.ejogrb.2012.10.011

10.1371/journal.pone.0101445

Smith, 2010, Protein:creatinine ratio in uncomplicated twin pregnancy, Am J Obstet Gynecol, 203, 381.e1, 10.1016/j.ajog.2010.06.013

10.1136/bmj.39532.543947.BE

10.1081/PRG-100104165

NICE Clinical Guideline 107. Hypertension in Pregnancy; The Management of Hypertensive Disorders During Pregnancy. Issued 2010, last modified: January 2011. https://www.nice.org.uk/guidance/cg107/resources/guidance-hypertension-in-pregnancy-pdf (accessed 26 Sep 2015).

10.1097/01.AOG.0000437382.03963.88

Magee, 2014, Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary, J Obstet Gynaecol Can, 36, 575, 10.1016/S1701-2163(15)30533-8

10.1515/JPM.2008.062

10.1136/bmjopen-2014-004870

Morikawa, 2013, Effect of nulliparity, maternal age, and pre-pregnancy body mass index on the development of gestational hypertension and preeclampsia, Hypertensin Res Pregnancy, 1, 75, 10.14390/jsshp.1.75

Krotz, 2002, Hypertensive disease in twin pregnancies: a review, Twin Res, 5, 8, 10.1375/twin.5.1.8

Beneventi, 2016, Connective tissue diseases and autoimmune thyroid disorders in the first trimester of pregnancy, J Reprod Immunol, 114, 32, 10.1016/j.jri.2016.02.004

Thông tin
Thông tin xuất bản

BMJ Open

Tập 6 Số 8

e011229

Thông tin tác giả