What is the role of urinalysis in the evaluation of hypertensive disorders during pregnancy?

Updated: Jun 12, 2018
  • Author: Michael P Carson, MD; Chief Editor: Edward H Springel, MD, FACOG  more...
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Answer

Answer

Urinalysis may be used as a screen for proteinuria. Trace levels to +1 proteinuria are acceptable, but levels of +2 or greater are abnormal and should be quantified with a 24-hour urine collection or spot urine protein-creatinine ratio.

In a 24-hour urine collection, the reference range for protein excretion in pregnancy is up to 300 mg/d. Higher levels are abnormal and may reflect renal involvement in preeclampsia. Creatinine clearance increases approximately 50% during pregnancy, and levels less than 100 mL/min suggest renal dysfunction that is either chronic or due to preeclampsia.

Serum creatinine is usually less than 0.8 mg/dL during pregnancy; higher levels suggest intravascular volume contraction or renal involvement in preeclampsia. A serum uric acid level greater than 5 mg/dL is abnormal; this is a sensitive but nonspecific marker of tubular dysfunction in preeclampsia.


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