Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 11 , ISSUE 4 ( July-August, 2019 ) > List of Articles

Original Article

Correlation of the Protein to Creatinine Ratio with the 24-hour Urine Protein Level in Pregnancy Complicated by Hypertension

Hanumant V Nipanal, Dilip Kumar Maurry, Susmitha S Reddy, Ravindra P Nagendra

Keywords : Hypertension in pregnancy, Protein to creatinine ratio, Proteinuria in pregnancy

Citation Information : Nipanal HV, Maurry DK, Reddy SS, Nagendra RP. Correlation of the Protein to Creatinine Ratio with the 24-hour Urine Protein Level in Pregnancy Complicated by Hypertension. J South Asian Feder Obs Gynae 2019; 11 (4):235-238.

DOI: 10.5005/jp-journals-10006-1695

License: CC BY-NC 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Objectives: This study was undertaken to compare the urine protein to creatinine ratio with 24-hour urine protein estimation in pregnancy complicated by hypertension and to establish the cutoff value of the urine protein to creatinine ratio for predicting significant 24-hour proteinuria. Design: This is a comparative study and consists of a single group of 240 subjects. Setting: This study was conducted in the Department of Obstetrics and Gynecology in collaboration with the Department of Biochemistry, JIPMER, Puducherry, India, from February 2011 to January 2013. Population: The subjects included 240 pregnant women admitted after 20 weeks of gestation to the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Hospital with hypertension (≥140/90 mm Hg). Patients with known cases of renal diseases, diabetes, and urinary tract infection were excluded. Materials and methods: A first voided morning sample was obtained for urine protein and creatinine estimation, and urine culture. Subsequent urine samples were collected for the 24-hour urine protein estimation. Main outcome measures: The spot urine protein to creatinine ratio and 24-hour urine protein were significantly correlated (r = 0.98; p < 0.0001). The cutoff value for the protein to creatinine ratio as an indicator of protein excretion ≥300 mg/day was 0.285. The sensitivity and specificity were 100% and 99.02%, respectively. The positive and negative predictive values were 100% and 99%, respectively. Results: The cutoff value for the protein to creatinine ratio as an indicator of protein excretion ≥300 mg/day was 0.285 with significant correlation. Conclusion: The spot urine protein to creatinine ratio is valuable for clinical purposes.

  1. Gifford RW, Cunningham G, Green LA, et al. Report of the national high blood pressure education program working group on high blood pressure in pregnancy. Am J Obstet Gynecol 2000;183(1):S1–S22. DOI: 10.1067/mob.2000.107928.
  2. Saudan P, Brown MA, Buddle ML, et al. Does gestational hypertension become pre-eclampsia? Br J Obstet Gynaecol 1998;105(11):1177–1184. DOI: 10.1111/j.1471-0528.1998.tb09971.x.
  3. Saudan PJ, Brown MA, Farrell T, et al. Improved methods of assessing proteinuria in hypertensive pregnancy. Br J Obstet Gynaecol 1997;104(10):1159–1164. DOI: 10.1111/j.1471-0528.1997. tb10940.x.
  4. Waugh JJ, Bell SC, Kilby MD, et al. Optimal bedside urinalysis for the detection of proteinuria in hypertensive pregnancy: a study of diagnostic accuracy. BJOG 2005;112(4):412–417. DOI: 10.1111/j.1471-0528.2004.00455.x.
  5. Kyle PM, Fielder JN, Pullar B, et al. Comparison of methods to identify significant proteinuria in pregnancy in the outpatient setting. BJOG 2008;115(4):523–527. DOI: 10.1111/j.1471-0528.2007.01621.x.
  6. Ginsberg JM, Chang BS, Matarese RA, et al. Use of single voided urine samples to estimate quantitative proteinuria. N Engl J Med 1983;309(25):1543–1546. DOI: 10.1056/NEJM198312223092503.
  7. Neithardt AB, Dooley SL, Borensztajn J. Prediction of 24-hour protein excretion in pregnancy with a single voided urine protein-to-creatinine ratio. Am J Obstet Gynecol 2002;186(5):883–886. DOI: 10.1067/mob.2002.123055.
  8. Robert M, Sepandj F, Liston RM, et al. Random protein-creatinine ratio for the quantitation of proteinuria in pregnancy. Obstet Gynecol 1997;90(6):893–895. DOI: 10.1016/S0029-7844(97)00536-X.
  9. Boler L, Zbella EA, Gleicher N. Quantitation of proteinuria in pregnancy by the use of single voided urine samples. Obstet Gynecol 1987;70(1):99–100.
  10. Young RA, Buchanan RJ, Kinch RA. Use of the protein/creatinine ratio of a single voided urine specimen in the evaluation of suspected pregnancy-induced hypertension. J Fam Pract 1996;42(4): 385–389.
  11. Jaschevatzky OE, Rosenberg RP, Shalit A, et al. Protein/creatinine ratio in random urine specimens for quantitation of proteinuria in preeclampsia. Obstet Gynecol 1990;75(4):604–606.
  12. Leanos-Miranda A, Marquez-Acosta J, Romero-Arauz F, et al. Protein:creatinine ratio in random urine samples is a reliable marker of increased 24-hour protein excretion in hospitalized women with hypertensive disorders of pregnancy. Clin Chem 2007;53(9): 1623–1628. DOI: 10.1373/clinchem.2007.089334.
  13. Ramos JG, Martins-Costa SH, Mathias MM, et al. Urinary protein/creatinine ratio in hypertensive pregnant women. Hypertens Pregnancy 1999;18(3):209–218. DOI: 10.3109/10641959909016194.
  14. James PR, Nelson-Piercy C. Management of hypertension before, during, and after pregnancy. Heart 2004;90(12):1499–1504. DOI: 10.1136/hrt.2004.035444.
  15. Rodriguez-Thompson D, Lieberman ES. Use of a random urinary protein-to-creatinine ratio for the diagnosis of significant proteinuria during pregnancy. Am J Obstet Gynecol 2001;185(4):808–811. DOI: 10.1067/mob.2001.117349.
  16. Yamasmit W, Chaithongwongwatthana S, Charoenvidhya D, et al. Random urinary protein-to-creatinine ratio for prediction of significant proteinuria in women with preeclampsia. J Matern Fetal Neonatal Med 2004;16(5):275–279. DOI: 10.1080/jmf.16.5. 275.279.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.