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Protein/Creatinine ratio versus 24-Hour urine protein in preeclampsia Ibrahim A. Abdelazim1,2*, Svetlana Shikanova3, Bakyt Karimova3, Kanshaiym Sakiyeva3, Mukhit Sarsembayev3, Gulmira Mukhambetalyeva3, Tatyana Starchenko3, Mariya Bekzhanova3 1Department of Obstetrics and Gynecology, Ahmadi hospital, KOC, Kuwait.2Department of Obstetrics and Gynecology, Sin Shams University, Egypt.3Department of Obstetrics and Gynecology №1, Marat Ospanov, West Kazakhstan State Medical University (WKSMU), Aktobe, Kazakhstan*Corresponding Author:Ibrahim A. Abdelazim Professor of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt, and Ahmadi Kuwait Oil (KOC) Company Hospital, Kuwait.Phone: +965-66551300E-mail: dr.ibrahimanwar@Researcher ID: F-7566-2013. ORCID: : Ahmadi Hospital, Kuwait Oil Company (KOC), Kuwait, P.O. Box: 9758, 61008 Ahmadi, Kuwait.Co-authors[1]. Svetlana Shikanova Mail; shik.sv@mail.ru[2]. Bakyt KarimovaMail; bakyt7@mail.ru[3]. Kanshaiym SakiyevaMail; sakieva_k@mail.ru[4]. Mukhit SarsembayevMail; muhit130372@mail.ru[5]. Gulmira MukhambetalyevaMail; guli-76-02@mail.ru[6]. Tatyana StarchenkoMail; tatyanastar18@mail.ru[7]. Mariya Bekzhanova Mail; bekzhanova.1956@mail.ruRunning Head: Protein/Creatinine ratio in preeclampsia Study Design: Prospective comparative study.Place of the study: Multicenter study (Ahmadi hospital and West Kazakhstan State Medical University (WKSMU), Aktobe, Kazakhstan.BACKGROUNDProteinuria is a main component of preeclampsia and one of the diagnostic criteria of its severity. Protein measurement in the 24-hour urine sample is the traditional standard method for the detection of proteinuria and the Twenty-four-hour urine collection is time-consuming and inconvenient. Objectives: This prospective study designed to evaluate the accuracy of protein to creatinine ratio (P/C) versus 24-hour urine collection in detection of remarkable proteinuria in preeclampsia. Study Design: Prospective study.Place of the study: Ahmadi, Kuwait Oil Company, hospital, Kuwait and West Kazakhstan State Medical University (WKSMU), Aktobe, Kazakhstan.INTRODUCTION Preeclampsia defined as hypertensive disease with pregnancy occurs after 20 weeks` gestation [1]. Preeclampsia associated with major fetal and maternal morbidity [2]. Preeclampsia occurs in 2-10% of all pregnancies and the incidence of preeclampsia is greater in developing countries compared to developed countries [3,4]. Proteinuria is a main component of preeclampsia and one of the diagnostic criteria of its severity [5]. Protein measurement in the 24-hour urine sample is the traditional standard method for the detection of proteinuria [5].?Twenty-four-hour urine collection is time-consuming and inconvenient and results may be inaccurate when the collection of urine is missed. The management of preeclampsia may be delayed during the urine collection. A more rapid test that enables the accurate prediction of 24-hour urine results would be valuable [6-7]Although the results of studies about the urine protein/creatinine (P/C) ratio as a substitute for 24-hour urine protein excretion for detecting significant proteinuria in patients with preeclampsia are discordant [8]Demirci at al, concluded that the P/C ratio can be used as a good predictor for remarkable proteinuria and they also concluded that the P/C ratio seems to be highly predictive for diagnosis of proteinuria over one gram [5].So, this study designed to evaluate the accuracy of P/C ratio versus 24-hour urine collection for the detection of remarkable proteinuria in preeclampsia.PATIENT AND METHODSThe study will include women between 20-40 years old, diagnosed as preeclampsia and admitted for control of blood pressure and investigations after 20 weeks` gestation during the period from December 2018 till December 2019 after informed consent and approval of the study by the local ethical committee of both hospitals.Preeclampsia defined as the presence of hypertension and urinary proteins after 20 weeks` gestation. Hypertension defined as blood pressure ≥ 140/90 mmHg. Urinary protein defined as the presence of ≥ 300 mg protein in the 24-hour collected urine and/or a positive urine dipstick test. Exclusion criteria includes; women > 40 years, women with chronic hypertension, gestational hypertension (without proteinuria), diabetes, pre-existing chronic renal disease or urinary tract infections, refused to participate and/or refused to give consent.In addition; women with bacteria on urine microscopy or premature rupture of membranes and women with more than 24 hours’ bed rest (due to the effect of postural proteinuria on spot urine-protein excretion) will be excluded from the study.A complete obstetrical history, clinical examination and laboratory investigations will be done to the studied women to exclude the conditions affecting urinary protein/creatinine ratio (as chronic renal disease). The studied women will be admitted for moderate 24 hours bed rest, control of blood pressure and for the 24-hour urine collection for assessment of proteinuria, which started on the morning following the hospitalization. Spot mid-stream urine specimens (first morning urine sample) for measuring P/C ratio will be obtained shortly before the 24-hour urine collection. Urinary protein will be determined by the Biuret method [9]. Urine creatinine level will be measured by a modified Jaffe test (Hitachi 7170 Autoanalyzer, Hitachi, Tokyo, Japan) [5]. SAMPLE SIZE AND STATISTICAL ANALYSISThe required sample size will be calculated using G Power software version 3.17 for sample size calculation (Heinrich Heine Universit?t; Düsseldorf; Germany), setting QUOTE α -error probability at 0.05, power (1- β error probability) at 0.95%, and effective sample size (w) at 0.3. The effective sample ≥110 women will be needed to produce a statistically acceptable figure. Collected data at the end of the study will statistically analyzed to evaluate the accuracy of protein to creatinine ratio (P/C) versus 24-hour urine collection in detection of remarkable proteinuria in preeclampsia.REFERENCES [1]. Osungbade KO, Ige OK. Public Health Perspectives of Preeclampsia in Developing Countries: Implication for Health System Strengthening. Journal of Pregnancy. 2011; 1-6. . [Google Scholar] ?[2]. Wallis AB, Saftlas AF, Hsia J, Atrash HK. Secular Trends in the Rates of Preeclampsia, Eclampsia, and Gestational Hypertension, United States, 1987-2004. Am J Hypertens. 2008; 21(5):521-6. Doi: 10.1038/ajh.2008.20. [PubMed][3]. Ananth CV,?Basso O. Impact of pregnancy-induced hypertension on stillbirth and neonatal mortality. Epidemiology.?2010;21(1):118-23. Doi: 10.1097/EDE.0b013e3181c297af. [PubMed][4]. Kooffreh ME, Ekott M, Ekpoudom DO. The prevalence of pre-eclampsia among pregnant women in the University of Calabar Teaching Hospital, Calabar.?Saudi J Health Sci.?2014;3 (3):133–6. Doi:? 10.4103/2141-9248.180269. [PubMed][5]. Demirci O,? HYPERLINK "" Kumru P,? HYPERLINK "" Ar?nkan A,? HYPERLINK "" Ard?? C,? HYPERLINK "" Ar?soy R,? HYPERLINK "" Tozk?r E,?et al. Spot protein/creatinine ratio in preeclampsia as an alternative for 24-hour urine protein. Balkan Med J.?2015;32(1):51-5. Doi: 10.5152/balkanmedj.2015.15447. [PubMed][6]. Keane WF, Eknoyan G. Proteinuria, albuminuria, risk, assessment, detection, elimination (PARADE): a position paper of the National Kidney Foundation.?Am J Kidney Dis.?1999;33:1004–10.?[PubMed][7].?Boyd J, Newall R, Price C. Use of protein:creatinine ratio measurements on random urine samples for prediction of significant proteinuria: a systematic review.?Clin Chem.?2005;51:1577–1586.?Doi: HYPERLINK "" \t "_blank" 10.1373/clinchem.2005.049742. [PubMed][8]. Durnwald C, Mercer B. A prospective comparison of total protein/creatinine ratio versus24-hour urine protein in women with suspected preeclampsia.?Am J Obstet Gynecol.?2003;189:848-52.?[PubMed][9].?Shahbazian N, Hosseini-Asl F. A comparison of spot urine protein-creatinine ratio with 24-hour urine protein excretion in women with preeclampsia.?Iran J Kidney Dis.?2008;2:127-31. [PubMed] ................
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