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Query: UMLS:C0033687 (proteinuria)
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Data on the outcome of pregnancy are based upon a prospective study of 14,833 single births to women whose blood pressures during the fifth and sixth months of gestation were recorded. With each 5 mm, Hg rise in the mean arterial pressure (MAP) there is a progressive increase in the perinatal mortality rate. At each MAP level, the stillbirth rates and neonatal mortality rates are higher in blacks than in whites. When middle-trimester MAP is 90 mm. Hg or more, there is a significant increase in (1) the stillbirth rate, (2) the frequency of proteinuria, hypertension, and diagnosed pre-eclampsia in the third trimester, and (3) the frequency of intrauterine fetal growth retardation. We believe that all of these events are due to an impaired uteroplacental circulation, with which elevated blood pressures are associated. Women who have an average MAP of 90 or more during the fifth and sixth months should be considered in a high-risk category.
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PMID:The impact of mean arterial pressure in the middle trimester upon the outcome of pregnancy. 93 99

Mild preeclampsia, as defined by a rise in blood pressure to 140/90 mm Hg or more in the third trimester of pregnancy, does not affect the baby either in terms of increased perinatal mortality or a reduction in birth weight. Higher maternal weight gains are associated with greater birth weight of the babies in primigravidae, provided that proteinuria does not occur. Reduction of water retention by diuretic treatment does not lower the incidence of preeclampsia, does reduce the weight of the baby.
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PMID:Is mild preeclampsia (EPH gestosis) harmful to the baby? 95 64

No differences were found at the 30th week of pregnancy in total body water, serum sodium, potassium, chloride and osmolality, plasma volume, total protein concentration, intravascular protein mass, serum albumin concentration, intravascular albumin mass, and urinary estriol and pregnanediol in 94 primigravidae who remained normotensive, 35 who developed mild preeclampsia, and 23 who developed severe preeclampsia (i.e. hypertension and significant proteinuria in the third trimester). In twin pregnancies no differences were found between 13 primigravidae who remained normotensive and nine who subsequently developed proteinuria and hypertension.
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PMID:Changes preceding the development of preeclamptic toxemia. 95 65

A total of 99 patients with pre-eclampsia and proteinuria were managed conservatively between 30 and 37 weeks of gestation, based on serial urinary estriol, liquor amnii, and renal function studies. The over-all perinatal wastage was 14 per cent, but was 35 per cent in association with subnormal estriol excretion and oligohydramnios (less than 250 ml.). In severe pre-eclampsia (blood pressure greater than 170/110 mm. Hg with proteinuria greater than 5 Gm. per liter) the incidence of subnormal estriol was 73 per cent and, becuase of this and the associated maternal hazards, conservative treatment had little place. However, in less severe pre-eclampsia with proteinuria early in the third trimester, this prospective study, based on serial placental and renal function tests, showed that frequently the pregnancy could be prolonged and fetal losses due to prematurity avoided. It should be stressed that such conservative treatment should not be continued when there are strong clinical contraindications. Irrespective of the severity of the prior pre-eclampsia, it was unusual for patients to show residual hypertension, proteinuria, or abnormal pyelography at their postnatal examination. Postpartum renal biopsy showed either normal histology or regression of the classical glomerular lesion in 77 per cent of cases.
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PMID:Placental function and renal tract studies in pre-eclampsia with proteinuria and long-term maternal consequences. 98 68

Several methods were used in an attempt to produce preeclampsia in the pregnant rat. Desoxycorticosterone acetate plus increased NaCl intake produced hypertension, proteinuria, rapid weight gain, convulsions, decreased litter size, decreased offspring weight, increased fetal and maternal mortality, and renal lesions similar to those seen in human preeclampsia. Injection of placenta in Freund's adjuvant produced mild blood pressure elevation and proteinuria in the pregnant rat. Rabbit antirat placenta serum produced hypertension in the pregnant rat but not in the nonpregnant rat. Liver congestion and renal glomerular congestion were observed in both pregnant and non-pregnant rats. Pregnancy in the rat reduced hypertension produced by applying a Goldblatt clamp prior to breeding. Uterine ischemia produced by wrapping the uterus in cellophane produced mild blood pressure elevation and proteinuria. A vitamin-E-deficient diet that contained substantial amounts of partially perioxidized, polyunsaturated fatty acids produced morphological lesions in the pregnant rat similar to those seen in human preeclampsia, but hypertension, edema, and proteinuria were absent. None of the maneuvers was effective in producing a complete model of human preeclampsia, but they do provide material for study that could answer somebasic questions about preeclampsia.
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PMID:The rat as a model for preeclampsia. 100 52

The defect in glomerular permeability that leads to proteinuria can be assessed by determining the relative clearance of macromolecules of known but different dimensions, that is, glomerular selectivity. Such estimates can be made using naturally occurring plasma proteins and dextran or polyvinylpyrrolidone injected into the circulation. In preeclampsia, protein and dextran selectivities show good concordance. The proteinuria is intermediate in its selectivity. These findings confirm that proteinuria is glomerular in origin and that the glomerular abnormality is uniform throughout the majority of functioning glomeruli. In abruptio, protein selectivity is very low and dextran selectivity is high. This pattern is seen also in acute ischemic renal failure and suggests that the true glomerular functional defect is actually less severe than in preeclampsia and that much of the protein in the urine in abruptio is postglomerular in origin. The structural lesion in preeclampsia is "characteristic" only in the sense that a number of individual components of glomerular injury, which are themselves commonly seen in other glomerular disorders, occur in a particular balance, and not because of any single unique or specific feature. The important components--that is, endothelial swelling, mesangial cytoplasmic activity, subendothelial deposits, and occational thrombosis of the afferent arterioles--all occur, albeit to a lesser degree, in abruptio placentae, as well as in other glomerular disorders in which intravascular coagulation is a primary cause or plays a major role.
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PMID:Proteinuria and the renal lesion in preeclampsia and abruptio placentae. 100 54

Relative protein clearance measurements have gone a long way toward characterizing the nature of pregnancy proteinuria but have failed to distinguish between preeclampsia and primary renal disease. The prognostic significance of different degrees of selectivity has been a source of disagreement in past studies. The polymer clearance studies reported here, using tracer doses of labeled PVP, have demonstrated two forms of proteinuria: a benign form due to a vasoconstrictor effect where fetal outlook is good ("vasoactive"), and a form associated with intravascular coagulation which indicates worse fetal prognosis ("membranous"). Underlying chronic renal damage of minor degree is identifiable with PVP clearance. Concurrent measurements of protein clearance, using smaller-sized proteins than is customary, gave hope for future development of meaningful clinical tests.
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PMID:Selectivity of proteinuria during pregnancy assessed by different methods. 100 55

1. The blood pressures of pregnant patients with proteinuria seem to be no higher than the levels of blood pressure in patients with no proteinuria. The presence of proteinuria and pregnancy in the absence of blood pressure elevation increases perinatal mortality above the values where blood pressure elevation occurs alone. This relationship is most prominent among nulliparous median-age pregnant patients. Even though the number of patients is small, the highest rates occur in the young white nullipara from the sixteenth to twenty-third week of pregnancy. Attempts to compare black and white median-aged nulliparas are meaningless because of the tremendous variability of data. 2. The findings in all cohorts with proteinuria were essentially the same as those in Cohorts I, II and III. Proteinuria of 2+ or greater occurs more frequently in black than in white gravidas. 3. Our observations indicate that perinatal mortality rates in patients with proteinuria are, for the most part, at least twice the rates of patients without proteinuria. 4. The volume of data available is insufficient to determine whether proteinuria influences prematurity rates or mean birth weights. However, our data suggest that some vascular or renal lesion must be affecting perinatal mortality. 5. The small number of patients in the proteinuria study group does not permit meaningful comparisons with the patient group presenting no edema or proteinuria. 6. Adherence to suitable criteria for discovering and measuring proteinuria is necessary to make the diagnosis of preeclampsia. These criteria include careful collection of urine in the clinic or hospital, utilization of acceptable standard testing methods, and the application of uniform principles of medical practice to the overall care of obstetric patients. 7. The data are presented, not interpreted. However, we cannot discount the value of the present data in suggesting the urgent need to restudy more of the current data available. It also seems desirable to initiate another program to investigate a smaller group of patients made up of the same sequential cohorts where it may be possible and more practical to apply strict supervision of statistical design, patient care, personnel, laboratory testing, data recording, data processing and reporting and statistical analysis.
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PMID:Blood pressure, edema and proteinuria in pregnancy. 6. Proteinuria relationships. 103 Jul 91

The frequency distributions of blood pressures in large populations fail to show two groups, one normotensive and the other hypertensive. In the spectrum of pressures, some people merely have higher levels than others and division of abnormal from normal is artificial and arbitrary, although it is useful for prognosis. The blood pressure of 140/90 as the conventional dividing line does not seem to be appropriate in pregnant women. From the standpoint of fetal prognosis, a level of 125/75 before the thirty-second week and 125/85 thereafter seems more reasonable. Moreover, those levels are close to the 120/80 that Robinson and Brucer specified as the upper limit of normal for all adults and are close to the 130/70 and 120/80 that the eminent British authority, F.J. Browne, used successively in the diagnosis of hypertensive disorders in pregnancy. If the standard of 125/75 were adopted, however, a quarter of all pregnant women would be hypertensive in the second trimester and half in the last month, which are disturbingly high proportions. For the diagnosis of preeclampsia, a rise in blood pressure probably is more significant than an arbitrary level. The usual blood pressure in midpregnancy merely defines the patient's place in the spectrum. Figure 9-1 indicates that in white nulliparas the diastolic pressure rises an average of 10 mm. Hg in the middle of the third trimester. If the mean and median are close together, greater increases would occur in half of the women. The classification of the American Committee on Maternal Welfare and of the Committee on Terminology of the American College of Obstetricians and Gynecologists specify increases of 30 mm. Hg or more in the systolic or 15 mm. Hg or more in the diastolic pressures as criteria of preeclamptic hypertension. pperhaps the rise in diastolic pressure should be set at some greater value. Our analysis of data made thus far cannot decide that issue. The next phase of the study will include analyses in individual women of the times, magnitudes, persistence or transience, and the like of changes in blood pressure, edema, and proteinuria. Such data will afford much more information than can be derived from the preliminary studies reported here. Although edema of the hands and face may be more common in preeclamptic than in normal women, such edema is so common in normal pregnancy as to suggest that it usually is normal. In our data, edema seems to bear no relation to hypertension or proteinuria. The triad of signs -- hypertension, proteinuria, and edema -- is generally accepted as characteristic, though far from specific for preeclampsia. Our data support Hytten's conclusion that edema should by dropped from the triad. There is some indication, however, that some edema is abnormal and that it is associated with an adverse effect when it coincides with proteinuria late in pregnancy.
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PMID:Blood pressure, edema and proteinuria in pregnancy. 9. Proposal for classification. 103 Jul 94

Between 1969 and 1971 4,749 antenatal patients were observed. Compared to the tables for ideal weights of the Metropolitan Life Insurance Company Statistical Bureau, 26.76 percent of the patients were above ideal weight and 11.35 percent of the patients were obese. It was found that complications and illnesses during the pregnancy increased progressively with weight groups above the ideal weight. Hypertension was five times as frequent in obese women than normal, edema and proteinuria were common. Pre-eclampsia was more common in the obese. Varicosities occurred much more often in the maternity cases above normal weight and with obesity.
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PMID:[Pregnancy in obese women (A'uthor's transl)]. 114 May 48


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