Diagnosis of proteinuria using a random urine protein-creatinine ratio and its correlation with adverse outcomes in pregnancy with preeclampsia characterized by renal damage

Abstract

Based on a limited number of studies, a random urine protein-creatinine ratio (uPCR) value of ≥ 0.3 indicates abnormal proteinuria in preeclampsia with renal damage. However, current guidelines do not recommend a reasonable diagnostic threshold of uPCR for severe preeclampsia with renal damage. Furthermore, the correlation between the uPCR value and clinical adverse outcomes remains poorly understood. The aim of the present study was to evaluate the value of uPCR in the diagnosis of significant proteinuria and to assess its correlation with adverse pregnancy outcomes in preeclampsia characterized by renal damage. In all, 1837 women were enrolled in this retrospective cohort study. Eventually, 961 women were enrolled under the exclusion criteria. First, the authors found that uPCR and 24-hour proteinuria showed a significant association (r = 0.901). The optimal threshold of uPCR for diagnosing preeclampsia was 0.295, and for diagnosing severe preeclampsia the cut-off was 0.625. Meanwhile, the adjusted odds ratio per 1 unit increase in ln (uPCR) was 1.679 (95% confidence interval [CI]:1.142-2.469) for severe adverse perinatal outcomes; 1.456 (95% CI: 1.242-1.705) for small for gestational age; 1.380 (95% CI: 1.051-1.811) for severe small for gestational age; 1.672 (95% CI: 1.210-2.310) for very early preterm birth; 1.989 (95% CI 1.726-2.293) for severe hypertension; and 2.279 (95% CI 1.906-2.724) for preterm birth. This study indicated that there was a significant and positive correlation between uPCR and 24-hour urine protein. For neonatal and maternal adverse outcomes, uPCR is an independent predictor of prognosis.

Keywords: perinatal outcome; preeclampsia; urine protein-creatinine ratio.