Urinary dipstick protein: A poor predictor of absent or severe proteinuria

Meyer, Norman; Mercer, Brian M.; Friedman, Steven A.; Sibai, Baha M.

doi:10.1016/s0002-9378(94)70398-1

Cited by 150 publications

(54 citation statements)

References 13 publications

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“…Nevertheless, this method has high false positive and false negative result rates associated with fluctuations throughout the day due to water intake, exercise, diet, posture, or improperly trained laboratory staff [16-18]. The urinary dipstick test values of 3+ to 4+ are also not valid for diagnosis of severe preeclampsia because of their very low positive predictive value, which can be as low as 36% [2]. For this reason, a more rapid and accurate diagnostic test that is capable of predicting 24-hour urine protein excretion would be valuable.…”

Section: Discussionmentioning

confidence: 99%

“…In comparison, the urinary dipstick test may be a quicker and simpler method but its drawbacks are its inconsistency and poor correlation with 24-hour urine protein excretion level [2], because of its susceptibility to patients' hydration status. In this respect, an alternative method that is as simple and rapid as the dipstick test but with better accuracy in predicting the amount of secreted urinary protein would be valuable.…”

Section: Introductionmentioning

confidence: 99%

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Random urine protein/creatinine ratio readily predicts proteinuria in preeclampsia

et al. 2013

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ObjectiveTo assess the diagnostic accuracy of random urine protein-creatinine (P/C) ratio for prediction of significant proteinuria in preeclampsia as an alternative to the time-consuming 24-hour urine protein collection.MethodsRetrospective record analysis was performed on 140 pregnant women who were admitted with suspicion for preeclampsia from January 2006 to June 2011. Random urine protein and/or 24-hour urine protein levels were assessed and their correlation to random urine P/C ratio and 24-hour urine protein excretion was evaluated.ResultsOut of 140 patients, random urine P/C ratio or/and 24-hour urine protein was performed in 79 patients to evaluate significant proteinuria. Of 79 patients, 46 (58%) underwent both tests whereas in 33 women (42%) 24-hour urine collection was not available due to urgent delivery. In 39 cases (85%), significant proteinuria (≥300 mg/24 hr) was detected with 6 cases (13%) having values over 5,000 mg/24 hr, corresponding to the diagnosis of severe preeclampsia. Random urine P/C ratio highly correlated with 24-hour urine protein excretion (r=0.823, P<0.01). The optimal random urine P/C ratio cutoff points were 0.63 and 4.68 for 300 mg/24 hr and 5,000 mg/24 hr of protein excretion, respectively. with each sensitivity, specificity, and positive and negative predictive values of 87.1%, 100%, 100%, and 58.3%; and 100%, 85%, 50%, and 100%, for significant and severe preeclampsia, respectively.ConclusionRandom urine P/C ratio is a reliable indicator of significant proteinuria in preeclampsia and may be better at providing earlier diagnostic information than the 24-hour urine protein excretion with more accuracy than the urinary dipstick test.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Random urine protein/creatinine ratio readily predicts proteinuria in preeclampsia

et al. 2013

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“…However, 24-hour collections are cumbersome, often requiring hospitalization, subject to error and compliance issues and result in delay in diagnosis. Several studies attempting to provide evidence in support of random proteinuria after normalization for creatinine (protein-to creatinine ratio) as a quick surrogate measure of proteinuria of preeclampsia have yielded mixed results 35, 36. Despite this, this test is now accepted by the International Society for the Study of Hypertension in Pregnancy (ISSHP) as reliable measure of proteinuria of preeclampsia.…”

Section: Discussionmentioning

confidence: 99%

Proteomic profiling of urine identifies specific fragments of SERPINA1 and albumin as biomarkers of preeclampsia

Buhimschi

Zhao

Funai

et al. 2008

American Journal of Obstetrics and Gynecology

123

105

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Objective The cause of preeclampsia remains unknown and the diagnosis can be uncertain. We used proteomic-based analysis of urine to improve disease classification and extend the pathophysiological understanding of preeclampsia. Study design Urine samples from 284 women were analyzed by mass spectrometry-based proteomics (SELDI). In the exploratory phase, 59 samples were used to extract the proteomic fingerprint characteristic of severe preeclampsia requiring mandated delivery and develop a diagnostic algorithm. In the challenge phase we sought to prospectively validate the algorithm in 225 women screened for a variety of high and low-risk conditions, including preeclampsia. Of these, 19 women were followed longitudinally throughout pregnancy. Presence of biomarkers was interpreted relative to clinical classification, need for delivery and other urine laboratory measures (ratios of protein-to-creatinine and soluble fms-like tyrosine kinase-1-to-placental growth factor). In the translational phase biomarker identification by tandem mass spectrometry and validation experiments in urine, serum and placenta were employed to identify, quantify and localize the biomarkers or related proteins. Results We report that women with preeclampsia appear to present a unique urine proteomic fingerprint which predicts preeclampsia in need for mandated delivery with highest accuracy. This characteristic proteomic profile also has the ability to distinguish preeclampsia from other hypertensive or proteinuric disorders in pregnancy. Pregnant women followed longitudinally who developed preeclampsia displayed abnormal urinary profiles >10 weeks prior to clinical manifestation. Tandem mass spectrometry followed by de-novo sequencing identified the biomarkers as non-random cleavage products of SERPINA-1 and albumin. Of these, the 21-aminoacid C-terminus fragment of SERPINA-1 was highly associated with severe forms of preeclampsia requiring early delivery. In preeclampsia, increased and aberrant SERPINA-1 immunoreactivity was found in urine, serum and placenta where it localized predominantly to placental villi and placental vascular spaces adherent to the endothelium. In addition, significant perivascular deposits of misfolded SERPINA-1 aggregates were exclusively identified in preeclamptic placentas. Conclusion Proteomics-based characterization of urine in preeclampsia identified a proteomic fingerprint composed of SERPINA-1 and albumin fragments which can accurately diagnose preeclampsia and shows promise to discriminate it from other hypertensive proteinuric diseases. These findings provide insight into a novel pathophysiological mechanism of preeclampsia related to SERPINA-1 misfolding which may offer new therapeutic opportunities in the future.

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“…39 However, a dipstick result of ≥1+ has a positive-predictive value of 82–92% for predicting 24 h urinary protein levels of ≥300 mg. 35,36 By contrast, the negative predictive value of a negative or trace dipstick result was low (34–60%). 40,41 The assessment of proteinuria by protein:creatinine ratios is recommended in several guidelines, with the most commonly used cut-off value being ≥30 mg/mmol. 7 However, protein:creatinine ratios can vary depending on the time of day the measurement is taken 42 and this parameter might, therefore, be unreliable for the diagnosis of proteinuria.…”

Section: Diagnosis Of Pre-eclampsiamentioning

confidence: 99%

Pre-eclampsia part 1: current understanding of its pathophysiology

et al. 2014

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Pre-eclampsia is characterized by new-onset hypertension and proteinuria at ≥20 weeks of gestation. In the absence of proteinuria, hypertension together with evidence of systemic disease (such as thrombocytopenia or elevated levels of liver transaminases) is required for diagnosis. This multisystemic disorder targets several organs, including the kidneys, liver and brain, and is a leading cause of maternal and perinatal morbidity and mortality. Glomeruloendotheliosis is considered to be a characteristic lesion of pre-eclampsia, but can also occur in healthy pregnant women. The placenta has an essential role in development of this disorder. Pathogenetic mechanisms implicated in pre-eclampsia include defective deep placentation, oxidative and endoplasmic reticulum stress, autoantibodies to type-1 angiotensin II receptor, platelet and thrombin activation, intravascular inflammation, endothelial dysfunction and the presence of an antiangiogenic state, among which an imbalance of angiogenesis has emerged as one of the most important factors. However, this imbalance is not specific to pre-eclampsia, as it also occurs in intrauterine growth restriction, fetal death, spontaneous preterm labour and maternal floor infarction (massive perivillous fibrin deposition). The severity and timing of the angiogenic imbalance, together with maternal susceptibility, might determine the clinical presentation of pre-eclampsia. This Review discusses the diagnosis, classification, clinical manifestations and putative pathogenetic mechanisms of pre-eclampsia.

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Urinary dipstick protein: A poor predictor of absent or severe proteinuria

Cited by 150 publications

References 13 publications

Random urine protein/creatinine ratio readily predicts proteinuria in preeclampsia

Random urine protein/creatinine ratio readily predicts proteinuria in preeclampsia

Proteomic profiling of urine identifies specific fragments of SERPINA1 and albumin as biomarkers of preeclampsia

Pre-eclampsia part 1: current understanding of its pathophysiology

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