Evidence review for assessment of proteinuria: Hypertension in pregnancy: diagnosis and management

Excerpt

The reliable detection of significant proteinuria is important in women with new-onset hypertension during pregnancy because it helps distinguish between those pregnancies with pre-eclampsia and those with gestational hypertension and this determines the pathways for future monitoring and management.

Traditionally proteinuria has been assessed initially by urine dipstick (which can be read visually or by an automated device) and confirmed by various methods of laboratory quantification either using spot samples of urine, or 24 hour urine collection. A 24 hour urine collection is a time-consuming procedure for the woman, and in recent years spot urinary protein:creatinine ratio (PCR) and spot urinary albumin:creatinine ratio (ACR) (which are widely used outside maternity services) have been increasingly used in pregnant women. International definitions have recommended certain thresholds of PCR and ACR for diagnosis of ‘significant proteinuria’, and which are included in definitions of pre-eclampsia.

The aim of this review is to determine the best method for assessing proteinuria and to determine if currently used thresholds of PCR and ACR are correct to diagnose significant proteinuria.