DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20201915

Accuracy of automated urine dipstick test as a screening tool for proteinuria in hypertensive disorders of pregnancy

Sankar Sundaram, Ann Mili Kuriakose, Vijayan C. P.

Abstract


Background: Progressive proteinuria implies worsening of the condition in hypertensive disorders of pregnancy and hence its quantification guides clinician in making decision and planning treatment. The gold standard is 24 hour urine protein estimation. Urine sediment cytology, also known as ‘liquid renal biopsy’ identifies and analyses the extent of renal damage.

Methods: Objectives of the study were to compare the efficacy of urine dipstick test to 24 hour urine protein estimation in detecting proteinuria in pre-eclampsic patients and to describe the findings in urine sediment examination in assessing proteinuria in above patients. Urine dipstick test and sediment cytology were performed on the urinary samples of 242 pregnant women with high BP recordings (BP>140/90 mm Hg) which were collected and tested in Department of Pathology, Government Medical College, Kottayam during the study period of 18 months. This was compared with 24 hour urine protein values (gold standard).

Results: About 154 patients (63.63%) had significant proteinuria of more than 300mg/24hr. Dipstick method showed 78.57% sensitivity and 81.82% specificity for prediction of significant proteinuria. Positive predictive value and negative predictive value of urine dipstick test were 88.32% and 68.57% respectively. Urine sediment examination revealed the presence of casts only in 11.98% of study population. 

Conclusions: Diagnostic accuracy of automated urine dipstick test in assessing proteinuria was 79.75%. For grade 1 proteinuria, diagnostic accuracy was 79.81%, for Grade 2 it increased to 93.14% and for grade 3 & 4, accuracy was 98.68%. Urine sediment examination didn’t correlate with proteinuria and hence the extent of renal damage in pre-eclampsia.


Keywords


Automated dipstick test, Diagnostic accuracy, 24 hour urine estimation, Hypertension, Pre-eclampsia, urine, Pregnant women

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References


Government of India. National Health Portal, 2016. Available at: https://www.nhp.gov.in/disease/gynaecology-and-obstetrics/preeclampsia. Accessed 23 October 2019.

Amin SV, Illipilla S, Hebbar S, Rai L, Kumar P, Pai MV. Quantifying proteinuria in hypertensive disorders of pregnancy. Int J Hypert. 2014;8:1-14.

Saudan PJ, Brown MA, Farrell T, Shaw L. Improved methods of assessing proteinuria in hypertensive pregnancy. BJOG: An Int J Obstetr Gynaecol. 1997 Oct;104(10):1159-64.

Mol BW, Roberts CT, Thangaratinam S, Magee LA, De Groot CJ, Hofmeyr GJ. Pre-eclampsia. Lancet. 2016 Mar 5;387(10022):999-1011.

Myatt L. Role of placenta in preeclampsia. Endocrine. 2002 Oct 1;19(1):103-11.

Maynard SE, Karumanchi SA. Angiogenic factors and preeclampsia. Semin Nephrol. 2011;31(1):33-46.

Carman RH. Examination of urine - Urinalysis. In: Carman RH eds. Handbook of Medical Laboratory Technology. 2nd ed. Vellore: Christian Medical Association of India; 1987: 223-248.

Larson TS. Evaluation of Proteinuria. Mayo Clin Proc. 1994;69(12):1154-8.

Bhagyalakshmi A, Sirisha O, Uma P, Urmila Devi P, Vijayababu PVSS, Kasibabu A. Role of urine sediment cytology in the diagnosis of renal disorders in comparison with biochemical and histopathological findings. Int J Res Med Sci. 2014;2(2):560-8.

Waugh JJ, Bell SC, Kilby MD, Blackwell CN, Seed P, Shennan AH, et al. Optimal bedside urinalysis for the detection of proteinuria in hypertensive pregnancy: a study of diagnostic accuracy. BJOG. 2005;112(4):412-7.

Dwyer BK, Gorman M, Carroll IR, Druzin M. Urinalysis vs urine protein-creatinine ratio to predict significant proteinuria in pregnancy. J Perinatol. 2008;28(7):461-7.