The role of observer error in antenatal dipstick proteinuria analysis

Bell, Steven; Halligan, Aidan; Martin, A; Ashmore, Jill; Shennan, Andrew; Lambert, Paul C.; Taylor, David

doi:10.1111/j.1471-0528.1999.tb08144.x

Cited by 44 publications

(9 citation statements)

References 11 publications

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“…Bell et al used five albumin samples to look at the accuracy of testing and reported a high false positive rate for the two non-proteinuric samples (nursing auxiliaries; 40% and 55% and midwives; 5% and 30%). For the three positive samples both groups recorded false negative rates of between 10-45% [19]. While automated readers had higher sensitivity, they also produced a lower specificity, i.e.…”

Section: Comparison With Previous Workmentioning

confidence: 91%

The feasibility and acceptability of self-testing for proteinuria during pregnancy: A mixed methods approach

Tucker

Bowen

Crawford

et al. 2018

Pregnancy Hypertension

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A B S T R A C TObjective: To investigate feasibility and acceptability of self-testing for proteinuria during pregnancy. Study design: Mixed methods approach which included: an accuracy study where pregnant women (n = 100) and healthcare professionals (n = 96) tested seven synthetic protein samples and completed a questionnaire, a feasibility study where pregnant women who were self-monitoring their blood pressure were asked to self-test for proteinuria (n = 30), and an online questionnaire about women's experiences of self-testing (n = 200). Main outcome measures: Sensitivity and specificity of testing and questionnaire results. Results: There were no significant differences in the accuracy of synthetic sample testing by pregnant women (sensitivity 0.81 (95% confidence intervals (CI) 0.78-0.85), specificity 0.93 (95% CI 0.91-0.95)) and healthcare professionals: (sensitivity 0.83 (95% CI 0.79-0.86), specificity 0.92 (95% CI 0.90-0.94)). Automated readers had significantly better sensitivity (0.94 (0.91-0.97) (p ≤ .001 in each case), but worse specificity 0.78 (0.69-0.85). Similar results were gained using self-tested urine samples compared to staff-testing using a reference standard of laboratory urine protein-creatinine ratio (uPCR). Women who completed the online survey with experience of self-testing (n = 39, 20%) generally found it easy, and with support from healthcare professionals felt it improved involvement in their care and reduced anxiety. Conclusions: Self-testing for proteinuria by pregnant women had similar accuracy to healthcare professional testing and was acceptable to both groups. Self-testing of urine combined with self-monitoring of blood pressure could provide a useful adjunct to clinic-based surveillance for the detection of pre-eclampsia. Such novel strategies warrant further research.

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Section: Comparison With Previous Workmentioning

confidence: 91%

The feasibility and acceptability of self-testing for proteinuria during pregnancy: A mixed methods approach

Tucker

Bowen

Crawford

et al. 2018

Pregnancy Hypertension

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“…Despite the fact that the reagent stick is the most commonly used proteinuria screening test for preeclampsia, after the assessment of blood pressure (13), its use has been challenged by several authors (2,6,13,14). Meyer et al (2), in 1994, reported that a cutoff point of '' + '' or greater had positive of 92%, with negative predictive value of only 34%.…”

Section: Discussionmentioning

confidence: 96%

“…Assuming no protein and trace amounts as true negative tests, they failed to identify one in every 11 cases (6). Other studies have analyzed the factors causing errors in reagent stick test results, such as urine concentration, urine pH, examiner error (in nonautomated reading), radio-contrast, and glycosuria (4,13,14). The urine PCR proved to be an accurate method for the diagnosis of preeclampsia when correlated with the 24-hour proteinuria (used as gold standard) (1,6,8,15).…”

Section: Discussionmentioning

confidence: 98%

Variation in the Urinary Protein/Creatinine Ratio at Four Different Periods of the Day in Hypertensive Pregnant Women

Valério

Ramos

Costa

et al. 2005

Hypertension in Pregnancy

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“…Some of these patients, however, probably had ªpre-eclampsiaº with minimal or no increase in blood pressure. The remainder showed only pregnancy-induced proteinuria, which is known to occur occasionally in normal healthy subjects [13,14]. It was not possible to separate these two groups from one another due to the wellknown limitations in any definition of pre-eclampsia [15±18].…”

Section: Resultsmentioning

confidence: 99%

Glycaemic control is associated with pre-eclampsia but not with pregnancy-induced hypertension in women with Type I diabetes mellitus

2000

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It has long been known that Type I (insulin-dependent) diabetes mellitus considerably increases the risk of pre-eclampsia and maternal and fetal co-morbidity [1±3]. The most important risk factor of pre-eclampsia in women with diabetes is nephropathy (White's class F) [1]. Even incipient nephropathy substantially increases the risk [4]. In addition, retinopathy and long duration of diabetes also increase the risk of pre-eclampsia [5±8].Although an association between poor glycaemic control in early pregnancy and pre-eclampsia has been reported [4, 7±11], it has not been observed by all [12]. It is not clear to what extent glycaemic control in early pregnancy might exert an effect on the occurrence of pre-eclampsia. Diabetic women with HbA 1 c values greater than 8 % could be at a greater risk of pre-eclampsia than those with values less than 8 % [10]. It is not known whether the risk of pre-eclampsia in diabetic women with relatively good gly- Abstract Aims/hypothesis. To investigate the association between glycaemic control and hypertensive pregnancy complications. Methods. From 1988 to 1997, we followed up 683 consecutive non-selected pregnancies in women with Type I (insulin-dependent) diabetes mellitus. Glycaemic control was assessed by assay of HbA 1 c . Pre-eclampsia was defined as diastolic blood pressure of 90 mmHg or more at the end of pregnancy after an increase of 15 mmHg or more, combined with proteinuria of 0.3 g or more for 24 h. Pregnancy-induced hypertension was defined similarly but without proteinuria. The same criteria were applied to a control group of 854 non-selected non-diabetic women. Results. Pre-eclampsia developed in 12.8 % of the women with diabetes (excluding those with nephropathy before pregnancy) and in 2.7 % of the control women (odds ratio 5.2; 95 % CI 3.3±8.4). In multiple logistic regression, glycaemic control, nulliparity, retinopathy and duration of diabetes emerged as statistically significant independent predictors of pre-eclampsia. The adjusted odds ratios for pre-eclampsia were 1.6 (95 % CI 1.3±2.0) for each 1 % increment in the HbA 1 c value at 4±14 (median 7) weeks of gestation and 0.6 (0.5±0.8) for each 1 % decrement achieved during the first half of pregnancy. Changes in glycaemic control during the second half of pregnancy did not significantly alter the risk of pre-eclampsia. Unlike pre-eclampsia, the risk of pregnancy-induced hypertension was not associated with glycaemic control. Conclusion/interpretation. In women with Type I diabetes, poor glycaemic control is associated with an increased risk of pre-eclampsia but not with a risk of pregnancy-induced hypertension. [Diabetologia (2000

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The role of observer error in antenatal dipstick proteinuria analysis

Cited by 44 publications

References 11 publications

The feasibility and acceptability of self-testing for proteinuria during pregnancy: A mixed methods approach

The feasibility and acceptability of self-testing for proteinuria during pregnancy: A mixed methods approach

Variation in the Urinary Protein/Creatinine Ratio at Four Different Periods of the Day in Hypertensive Pregnant Women

Glycaemic control is associated with pre-eclampsia but not with pregnancy-induced hypertension in women with Type I diabetes mellitus

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