Comparative efficacy of protein creatinine ratio and calcium creatinine ratio in determining organ dysfunction in ante-natal patients with pre-eclampsia
Abstract
Aim: To evaluate the biochemical parameters in determining the severity of pre-eclampsia and compare the efficacy between protein creatinine ratio and calcium creatinine ratio in determining organ dysfunction in ante-natal women with pregnancy-induced hypertension.
Material and Methods: 150 cases of pregnancy-induced hypertension admitted in the labour room were studied in the Department of Obstetrics and Gynaecology, SRMSIMS and were divided into two groups mild and severe pre-eclampsia depending on blood pressure, clinical and biochemical parameters. Various parameters for renal function and liver function were evaluated along with fundoscopy.
Results: On the evaluation of various parameters of renal function test and liver function test, a statistically significant p-value was observed with increase in grade of pre-eclampsia. When abnormal organ functions were compared, it was observed that PCR ≥ 0.3 is associated with 85%, 75.6% and 81.25% cases of abnormal fundoscopy, deranged renal function test and deranged liver function test compared to CCR ≤ 0.04 which was associated with 77%, 78.6% and 65% cases of abnormal fundoscopy, deranged renal function test and deranged liver function test respectively.
Conclusion: The degree of derangement among biochemical parameters increases as the disease progresses. Early determination by a single test helps to predict organ involvement and correlates with disease severity.
Downloads
References
Gemechu KS, Assefa N, Mengistie B. Prevalence of hypertensive disorders of pregnancy and pregnancy outcomes in Sub-Saharan Africa: A systematic review and meta-analysis. Womens Health (Lond). 2020 Jan-Dec;16:1745506520973105. doi: 10.1177/1745506520973105.
American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 203: Chronic Hypertension in Pregnancy. Obstet Gynecol. 2019 Jan;133(1):e26-e50. doi: 10.1097/AOG.0000000000003020.
Wheeler TL 2nd, Blackhurst DW, Dellinger EH, Ramsey PS. Usage of spot urine protein to creatinine ratios in the evaluation of preeclampsia. Am J Obstet Gynecol. 2007 May;196(5):465. e1-4. doi: 10.1016/j.ajog.2006.10.892.
Khandelwal, Smriti, Surekha Tayade, and Chetan Gode. "Prediction of Pre-Eclampsia by Urinary Calcium and Creatinine Ratio." International Journal of Current Research and Review 12 (2020): 19-22.
Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr. 2016 Mar-Apr;27(2):89-94. doi: 10.5830/CVJA-2016-021.
Burton GJ, Redman CW, Roberts JM, Moffett A. Pre-eclampsia: pathophysiology and clinical implications. BMJ. 2019 Jul 15;366:l2381. doi: 10.1136/bmj.l2381.
Kasraeian M, Asadi N, Vafaei H, Zamanpour T, Shahraki HR, Bazrafshan K. Evaluation of serum biomarkers for detection of preeclampsia severity in pregnant women. Pak J Med Sci. 2018 Jul-Aug;34(4):869-873. doi: 10.12669/pjms.344.14393.
Al-Malt, A. M., Petrulis, A. S., Amini, S. B., & Mann, L. I. Hypocalciuria can differentiate preeclampsia from chronic hypertension in the third trimester. Journal of Maternal-Fetal Medicine, 2.6 (1993): 300-304.
Hojo, M., and P. August. "Calcium Metabolism in Preeclampsia: Supplementation May Help." Medscape women's health 2.1 (1997): 5-5.
Tsuda K. Calcium metabolism and its relation to blood pressure during pregnancy. Am J Hypertens. 2015 Feb;28(2):283. doi: 10.1093/ajh/hpu207.
Ray J, Vasishta K, Kaur S, Majumdar S, Sawhney H. Calcium metabolism in pre-eclampsia. Int J Gynaecol Obstet. 1999 Sep;66(3):245-50. doi: 10.1016/s0020-7292(99)00096-x.
Fishel Bartal M, Lindheimer MD, Sibai BM. Proteinuria during pregnancy: definition, pathophysiology, methodology, and clinical significance. Am J Obstet Gynecol. 2020 Sep 1:S0002-9378(20)30989-3. doi: 10.1016/j.ajog.2020.08.108.
Hazari, N. R., V. S. Hatolkar, and S. M. Munde. "Study of serum hepatic enzymes in preeclampsia." International Journal of Current Medical and Applied Sciences 2.1 (2014): 1-8.
Ladson Gaddy-Dubac, M. D., et al. "Spot Urine Protein: Creatinine Ratio versus 24-hour Urine Total Protein to Screen for Preeclampsia."
Kumari A, Singh A, Singh R. Evaluation of rapid diagnostic methods of urinary protein estimation in patients of preeclampsia of advanced gestational age. J Obstet Gynaecol India. 2013 Oct;63(5):306-10. doi: 10.1007/s13224-012-0343-5.
Sinha, Rashmi, and Indu Bhushan. "Study of urinary Calcium/Creatinine Ratio (CCR) in a spot sample of urine for early prediction of preeclampsia." IOSR Journal of Dental and Medical Sciences 15.5 (2016): 101-104.
Prasad I, Kumari B, Roy AN, Prakash P: National Evaluation of urinary calcium creatinine ratio in pre – eclampsia. Journal of Laborartory Medicine. 2016 April ;5(2):1-5. doi:10.7860/NJLM/2016/17110:2102.
Rizk, D. E. E., et al. "Predicting proteinuria in hypertensive pregnancies with urinary protein-creatinine or calcium-creatinine ratio." Journal of perinatology 27.5 (2007): 272-277.
Ibrahimi L, Paçarada M, Latifi Hoxha S, Bimbashi A, Ademi Ibishi V. Role of Calcium/Creatinine Ratio in Urine Compared with Proteinuria and Uric Acid in Predicting Preeclampsia: A Study from Kosovo. Med Sci Monit Basic Res. 2021 Mar 1;27: e929845.
Lekha Tejaswi Y, Preethi BP: Estimation of serum uric acid, urinary calcium–creatinine ratio and microalbuminuria in prediction of pre- eclampsia. Int Journal of clinical biochemistry and research, Apr-Jun, 2018; 5(2): 277 – 283. https:// doi.org/10.18231/2394-6377.2018.0057.
Begum, H., Rahman, M. N., Ferdous, M., Basak, S. K., Yasmin, N., & Parveen, A. Evaluation of Spot Urinary Calcium to Creatinine Ratio in Preeclampsia: A Cross Sectional Comparative Study. Journal of National Institute of Neurosciences Bangladesh, 3.1 (2017):14-20.
Copyright (c) 2021 Author (s). Published by Siddharth Health Research and Social Welfare Society
This work is licensed under a Creative Commons Attribution 4.0 International License.
OAI - Open Archives Initiative
Therapoid
