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ASSESSMENT OF PROTEINURIA IN PATIENTS WITH PREECLAMPSIA AT THE IRRUA SPECIALIST TEACHING HOSPITAL, IRRUA, EDO STATE
Abstract
Accurate assessment of proteinuria in patients with pre-eclampsia will ensure prompt and timely intervention to reduce or prevent the maternal and perinatal morbidity and mortality associated with preeclampsia. The presence of protein in hypertensive disorders of pregnancy is a sign of worsening condition and thus requires intervention to prevent adverse consequences.
This study compared the more rapid diagnostic tests such as the dipstick, protein/creatinine ratio, 2hour protein estimation and 12hour protein estimation with the 24 hour protein estimation. The measure of test validity was done using the sensitivity, specificity, positive predictive value, negative predictive value, false positive rate, false negative rate and accuracy.
When compared with the gold standard, the most sensitive test was the protein/creatinine ratio (92%) and the least sensitive was the dipstick test (81%). The most specific was the 12hour protein estimation (88%) and the least specific was the dipstick test (47%).
The 12 hour protein estimation test had the highest positive predictive value (84%), while the protein/creatinine ratio had the highest negative predictive value (93%). The 12hour protein test (12%) and the protein/creatinine ratio (8%) had the lowest false positive and false negative rates respectively.
The most accurate tests were protein/creatinine ratio (88%) and 12hour protein estimation (88%). The dipstick tests were however much cheaper and results were faster. The protein/creatinine ratio, the 2hour and 12hour protein estimation correlated very significantly with the 24hour protein estimation.
It is recommended that in centres with appropriate laboratory personnel, laboratories and where patients can afford it, the protein/creatinine ratio, 12hour protein or 2 hour protein should be used for routine assessment or quantitation of proteinuria in patients with pre-eclampsia.
However, in poorer settings, selective use of the above tests is recommended only for patients with positive dipstick result. Its routine use for quantitation of proteinuria in selected clinical situations is also advocated.
