| Interpreting abnormal proteinuria in pregnancy: the need for a more pathophysiological approach. | |
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MedLine Citation:
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PMID: 20093912 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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This review and opinion article focuses on the definitions and meanings of abnormal protein excretion in pregnancy, asking the following questions: Are our tests to determine abnormal proteinuria adequately performed? Are current guidelines for diagnosis of excessive proteinuria, especially when used to identify preeclampsia, supported by adequate data? Can the magnitude of proteinuria be used as a reliable clinical biomarker of the gravity of preeclampsia? Should timed urine collections, primarily 24-hour excretions, be supplanted by the urine protein/creatinine ratio in clinical practice? The answers to most of these questions are: We are not sure, or some guidelines are poorly supported by data and may prove erroneous. We suggest a more physiologic approach to assessment of proteinuria and believe that if clinicians and investigators looked at proteinuria in terms of how the kidney handles protein in health and disease it would lead to a more rational and evidence-based approach to proteinuria in pregnancy. Finally, we recommend that current cutoff for abnormal proteinuria be used to diagnose preeclampsia, but the level of proteinuria should not guide management. Other variables, such as status of blood pressure control, evidence of increasing organ damage in the liver and hematological systems, evidence of falling glomerular filtration rate, and signs of neurological involvement, are more reliable indicators of severity of preeclampsia. |
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Authors:
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Marshall D Lindheimer; David Kanter |
Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Obstetrics and gynecology Volume: 115 ISSN: 1873-233X ISO Abbreviation: Obstet Gynecol Publication Date: 2010 Feb |
Date Detail:
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Created Date: 2010-01-22 Completed Date: 2010-02-16 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0401101 Medline TA: Obstet Gynecol Country: United States |
Other Details:
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Languages: eng Pagination: 365-75 Citation Subset: AIM; IM |
Affiliation:
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Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA. mlindhei@medicine.bsd.uchicago.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Animals Creatinine / urine Female Humans Kidney Glomerulus / physiopathology Kidney Tubules / physiopathology Pre-Eclampsia / diagnosis*, urine Pregnancy Pregnancy Complications / physiopathology, urine Proteinuria / diagnosis*, etiology, physiopathology Specimen Handling / standards Urinary Tract Physiological Phenomena |
| Chemical | |
Reg. No./Substance:
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60-27-5/Creatinine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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