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Proteinuria is defined as urine dipstick reading greater than trace. This is the excretion of 0.3 gm or greater in a 24-hour specimen. This will usually correlate with 30 mg/dl ("1+ dipstick") or greater in a random urine determination. Read labels and instructions with your specific brand of urine dipsticks to determine protein concentration in the urine. Different brands may give different readings and may not be relied upon as an accurate assessment of proteinuria, but only as an initial screening for proteinuria with possible follow-up testing, if needed.
PROTEINURIA IN PREGNANCY MEDICAL DEFINITIONA. One 24 hour urine collection with a total protein excretion equal to or greater than 0.3 gm (300 mg) per 24-hours.
OR
B. Two "clean-catch-midstream" or catheter specimens of urine collected equal to or greater than 4 hours apart with:
- 1 gm albumin per liter or 2+ or more on reagent strip or sulfosalicylic "cold" test.
OR
- 0.3 gm albumin per liter or 1+ on reagent strip if specific gravity is less than 1.030 and pH is less than 8.
MIDWIFE MANAGEMENT OF PROTEINURIA
The midwife should repeat the test with midstream urine specimen.
If still positive, the midwife should screen the client for pre-eclampsia, UTI, and vaginitis.
The midwife should review the client's diet for adequate protein intake and provide counseling as needed.
If signs of pre-eclampsia or unexplained proteinuria persist, the midwife may have the client consult with her health care provider.
Proteinuria usually is a late sign in the course of pre-eclampsia; although it is non-specific, its appearance greatly bolsters the diagnosis of pre-eclampsia when combined with hypertension, edema and sudden weight gain. See the link below about pre-eclampsia / eclampsia for more information about this pregnancy-related disease.
MoonDragon's ObGyn Information: Preeclampsia/Eclampsia (Toxemia)
American Family Physician
Feb 15, 1993
Proteinuria is an important feature in the diagnosis of preeclampsia and "superimposed" preeclampsia in women with chronic hypertension. Most clinicians use urine dipsticks to screen for proteinuria during pregnancy. If this test is positive, 24-hour urine samples are collected to measure protein excretion. However, few data exist regarding the excretion rate of urinary protein in normal pregnancies, including the definition of normal values. To determine 24-hour urinary excretion rates in normal pregnancies and assess the reliability of proteinuria assessment by dipstick measurement, Kuo and colleagues prospectively followed and measured urinary protein excretion in 196 normotensive pregnant volunteers.
Of the normotensive volunteers, 22 subsequently developed pregnancy-induced hypertension in the third trimester. The 95th percentile confidence limit (the upper limit of normal) for the normotensive group was less than 200 mg of protein per 24 hours (0.20 g per day). The 24-hour urinary protein excretion rate did not differ significantly between the normal group and the hypertensive group. Neither the women with chronic essential hypertension nor the women who developed hypertension during pregnancy had 24-hour protein excretion values outside the range of the normal population.
The normotensive pregnant control subjects were also compared with 68 pregnant women admitted consecutively to a hospital because of new onset of hypertension (diastolic blood pressure 90 mm Hg or greater) and positive dipstick urine tests for proteinuria (1+ or greater).
Although the urine dipstick and 24-hour urine protein measurements were significantly correlated, a significant percentage of false-positive and false-negative dipstick results were obtained when the manufacturer's instructions were used (i.e., + = 30 mg per dL, ++ = 100 mg per dL and +++ = 500 mg per dL). Furthermore, there was a significant amount of interobserver variability in reading the dipsticks. For example, almost 20 percent recorded urine protein concentrations below dipstick detection levels as 1+. Dipstick protein values of 1+ were also associated with an extremely wide scatter of values for 24-hour protein excretion, from zero to 2,400 mg (zero to 2.4 g per day).
The authors conclude that the 95th percentile values for urinary protein excretion in normal pregnant women is less than 200 mg per 24 hours (0.20 g per day). They also suggest that dipstick urinalysis should not be relied on to detect or exclude the presence of proteinuria in pregnant women. (American Journal of Obstetrics and Gynecology, September 1992, vol. 167, p. 723.)
"Assessment of proteinuria during pregnancy".
American Family Physician.
FindArticles.com. 09 Dec. 2008
A NEW METHOD FOR DIAGNOSING PROTEINURIA IN PREGNANCY?
The gold standard for diagnosing proteinuria in pregnancy is the presence of 300 mg or more of protein in a 24-hour urine collection. This method is slow, unpleasant, and burdensome. To find a quicker, simpler method, these researchers examined the effectiveness of using a urinary protein-to-creatinine ratio to screen pregnant women for proteinuria. They also hoped to define a cutoff value for predicting proteinuria. A total of 138 pregnant women undergoing evaluation for preeclampsia were screened using both a urinary protein-to-creatinine ratio and a 24-hour urine collection.
The authors found a strong correlation between these 2 methods (P less than 0.001). A protein-to-creatinine cutoff value of 0.14 had a sensitivity of 1.00 and a specificity of 0.51 for the presence of proteinuria; a cutoff value of 0.19 had a sensitivity of 0.90 and a specificity of 0.70. With the cutoff value of 0.19, there were 7 false-negative test results and 21 false-positive test results; however, most of these results were within 50 mg of the 300-mg standard cutoff used in the 24-hour urine test.
Comment: Further research should help to determine whether the burdensome and slow 24-hour urine collection for the diagnosis of proteinuria in pregnant women can be replaced with the urinary protein-to-creatinine ratio. At this time, use of this ratio may be helpful for clinicians who are pressured to make decisions regarding delivery and seizure prophylaxis. Protein-to-creatinine ratios below 0.14 appear to exclude clinically important proteinuria.
By Ann J. Davis, MD
Published in Journal Watch Women's Health
December 17, 2001
Citation(s):
Rodriguez-Thompson D and Lieberman ES. Use of a random urinary protein-to-creatinine ratio for the diagnosis of significant proteinuria during pregnancy. Am J Obstet Gynecol 2001 Oct 185 808-811.
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