The evaluation of tests to differentiate pre-eclampsia from hypertensive disease

Chesley, Leon C.; Valenti, Catherine

doi:10.1016/0002-9378(58)90700-2

Cited by 26 publications

(3 citation statements)

References 20 publications

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“…sometimes associated with marked increases in maternal serum uric acid levels; these increases too are unlikely to be caused by any change in purine metabolism (Seitchik et al 1958) but are related to an increase in net reabsorption (Chesley & Williams 1945: Chesley & Valenti 1958Dunlop et al 1978).…”

Section: Patientsmentioning

confidence: 99%

Changes in serum uric acid concentrations during normal pregnancy

Lind

Godfrey

Otun

et al. 1984

BJOG

129

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Serial changes in serum uric acid concentrations have been studied in a group of healthy women before conception, at regular intervals throughout pregnancy and finally 12 weeks after delivery. Compared with pre-pregnancy values uric acid concentrations decreased significantly by 8 weeks gestation and this reduced level was maintained until about 24 weeks. Thereafter the concentrations increased such that by term they were greater than the pre-pregnancy values in the majority of patients and remained elevated until a t least 12 weeks after delivery. If clinical management during the second half of pregnancy is to be based on increases in serum uric acid concentrations then such increases will have to be carefully interpreted against the background of rising concentrations which occur as part of the physiological response t o normal pregnancy.Modern clinicians rely increasingly on laboratory tests for the management of patients; for some the stage has been reached when deviation from an accepted range of laboratory values is in itself sufficient reason to justify treatment. The principle is not intrinsically unreasonable but clinical management based solely, or even largely, on such tests implies a confidence in the 'normality' of any given range of laboratory values that is seldom justified.During pregnancy progressive maternal physiological adaptations occur and many biochemical measurements deviate conspicuously from the normal range for males and nonpregnant females. Laboratory ranges specific to pregnancy need to be defined and ideally would be determined in healthy women having uncomplicated pregnancies resulting in the birth of live healthy children; such data are relatively scarce.This paper describes the changes in serum uric acid concentrations throughout normal pregnancy and reports two clinically important aspects. First the values decrease significantly below non-pregnant levels by 8 weeks gestation; second serum uric acid concentrations are not only increased above non-pregnant values by term in many women but remain elevated for as long as 12 weeks after delivery. Such postpartum values should not therefore be used as representative of non-pregnant concentrations. Patients and methods PatientsThirty-one healthy women have been studied; the mean age was 28 (range 23-37) years and each was without any adverse medical, surgical or obstetric history. In five of the women uric acid determinations were repeated during a subsequent pregnancy so that data were obtained from a total of 36 pregnancies. Nine women were primigravidae and 27 were multiparae of whom five had had a previous spontaneous abortion and 22 a successful pregnancy. During the time of this study none of the patients developed medical or obstetric complications or required pharmacological agents including salicylates; all gave birth to live, healthy infants. 128

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Section: Patientsmentioning

confidence: 99%

Changes in serum uric acid concentrations during normal pregnancy

Lind

Godfrey

Otun

et al. 1984

BJOG

129

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“…We have re-examined capillary permeability in pregnancy because of the frequency of clinical oedema and because PAH has been seen as an oedema-producing pathologic state. Abnormalities in PAH in the level of prostaglandin and angiotensin I1 (Gant et al, 1980), noradrenaline (Zuspan, 1977 or in the sensitivity to vasopressin (Chesley & Valenti, 1958). may influence capillary fluid filtration (Richardson, Granger & Taylor, 1979).…”

Section: Introductionmentioning

confidence: 99%

Capillary Permeability in Normal and Hypertensive Human Pregnancy

Hunyor¹,

McEniery²,

Roberts³

et al. 1983

Clin Exp Pharma Physio

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“…Above .a critical serum level of 350~mol/l there is significant perinatal mortality in hypertensive patients (Redman et al 1976). Physiological variability, however, is such that concentrations below this value are of little prognostic significance (Dunlop & Davison 1978) and, furthermore, a single random measurement of serum level (Hill et al 1977), clearance (Chesley & Valenti 1958) or net reabsorption (Dunlop et al 1978b) is of no value. Serial measurements may be of value in monitoring progress in pre-eclampsia (Beilin et al 1974).…”

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confidence: 99%

The Kidney in Pregnancy: A Review

Davison

1983

J R Soc Med

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Nephrological reviews are usually accolades to progress in the field. Advances pertaining to renal structure and function, techniques to study them, and understanding renal disease and its treatment by dialysis and transplantation are examples. Unfortunately, the area of nephrology which relates to pregnancy has not advanced similarly and when clinicians are asked to advise whether or not women with kidney disease, a renal transplant or a history of previous pregnancies marred by severe hypertension, should conceive or if pregnant continue the gestation, it becomes obvious that data are scarce and opinions vary. This neglect is unfortunate as renal and hypertensive complications of pregnancy remain an important cause of morbidity and mortality in mother and fetus. This review focuses on (a) the renal changes which occur during normal pregnancy, stressing the relevance to clinical practice; (b) controversies surrounding some of the urinary tract problems encountered in pregnancy; (c) detection and management of chronic renal disease and the effect of pregnancy 'on remote prognosis; (d) the kidney in pre-eclampsia; (e) pregnancy in renal transplant and haemodialysis patients; and (f) acute renal failure in obstetric practice.

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The evaluation of tests to differentiate pre-eclampsia from hypertensive disease

Cited by 26 publications

References 20 publications

Changes in serum uric acid concentrations during normal pregnancy

Changes in serum uric acid concentrations during normal pregnancy

Capillary Permeability in Normal and Hypertensive Human Pregnancy

The Kidney in Pregnancy: A Review

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