Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0033687 (proteinuria)
 24,015 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In view of the association between pre-eclampsia and disseminated intravascular coagulation, three patients presenting with severe pre-eclampsia before the 28th week of pregnancy were treated with heparin. In all three patients, there was deterioration of hypertension and proteinuria that necessitated the withdrawal of treatment after five to six days. During treatment, serum and urinary fibrinolytic degradation products (FDPs) continued to rise or remained unaltered, plasminogen levels showed a steady fall, and the platelet count remained at a reduced level. These data suggest that heparin was an ineffective form of treatment and did not prevent the intravascular fibrin deposition associated with severe pre-eclampsia.
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PMID:Failure of heparin therapy to affect the clinical course of severe pre-eclampsia. 118 91

The human placenta contains a significant amount of histamine, a potent vasoconstrictor of the placental vasculature, shown by the author to be stored within the tissues' mast cells. The proposed hypothesis suggests that placental mast cells may have an important role in normal and, or pathological processes during pregnancy. This suggestion will be applied to the confounding problem of pre-eclampsia, a complication of pregnancy characterised by hypertension, oedema and proteinuria, which is associated with increased morbidity and mortality of mother and baby. It is postulated that pre-eclampsia reflects an inflammatory-type reaction, in which mast cell-mediated events play a significant role. The mediators released upon mast cell activation, such as histamine and prostaglandins, may be involved in the vasospasm that characterises pre-eclampsia; while processes such as uptake and clearance of vasoactive mediators by mast cells may be important in normotensive pregnancies and upset in those women who develop pre-eclampsia.
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PMID:Human placental mast cells: a role in pre-eclampsia? 128

HELLP syndrome continues to be a clinical entity of difficult diagnosis. Weinstein first defined it in 1982 giving the practicing obstetrician a sequence of useful initials (H = hemolysis; EL = elevated liver enzymes; LP = low platelets). Since then a lot has been written and it has become clear that the syndrome is a form of severe preeclampsia. The American College of Obstetrics and Gynecology does not include HELLP in the description of severe pre-eclampsia as such but does accept each of its components as being part of severe pre-eclampsia. The case presented deals with a 33 year old white female, admitted at 27 weeks gestation with nausea, epigastric pain resembling acute abdomen, nose bleeding and mild hypertension. The analysis revealed an abnormal liver profile with elevated GOT, GPT and LDH, heavy proteinuria (14.4 g/day), decreased platelet count (92000/mm3) and elevated total bilirubin. Pregnancy was terminated by cesarean section 24 hours after admission because the patient's condition was deteriorating. Obviously in pre-eclampsia/eclampsia there is a systematic injury to all tissues. Proof of this is the hypertension as a consequence of vascular spasm and proteinuria due to glomerular injury. In HELLP the sequence of events is probably altered; hepatic injury precedes vascular and renal injury of conventional preeclampsia. The syndrome results from many clinical and pathological symptoms derived from endothelial microvascular injury which determine a rapid platelet activation causing vascular spasm, platelet aggregation and further endothelial injury through a feedback mechanism.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Massive proteinuria and HELLP syndrome]. 130 8

In order to investigate the renal change in preeclampsia, molecular weight and specific protein analyses in unconcentrated urine were performed by the immunoblot method. Urine samples were taken from 34 preeclamptic cases (pure type), including 20 severe cases. Polypeptide profiles of urine consisted of four patterns: low MW (L) pattern (tubular damage), high MW (H) pattern (glomerular damage), high and low MW (HL) pattern, and middle MW (M) pattern. The incidences of the HL, H, L, and M patterns were 26.5%, 14.7%, 11.8%, and 47.1%, respectively. The HL pattern was found more frequently in severe proteinuria than in mild proteinuria. High incidences of the HL and H patterns were found in the hypertensive group. Larger amounts of IgM, fibronectin, IgG, and beta 2 microglobulin in urine were confirmed using specific antibodies. Our results suggest that the immunoblot method makes it possible to differentiate glomerular and tubular damages and to evaluate the severity of renal damage in preeclampsia using unconcentrated urine.
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PMID:Analysis of urinary protein by immunoblot method using unconcentrated urine in preeclampsia. 138 Feb 35

Researchers analyzed data on 47 black, pregnant women of more than 33 weeks gestation who had preeclampsia with diastolic blood pressure of at least 110 mm Hg and 1+ of proteinuria and were in the delivery department of King Edward VIII Hospital in Durban, South Africa to compare antihypertensive effects of dihydralazine infusion with that of epoprostenol sodium infusion. Overall, both treatments reduced the patient's systolic and diastolic blood pressures. No significant differences in the hypertensive effects existed between the 2 groups. Yet the reduction in blood pressures occurred much more quickly in the epoprostenol group than in the dihydralazine group (51.1 minutes vs. 86.8 minutes;p=.0072). Epoprostenol reduced high blood pressure in all 22 patients while dihydralazine did not adequately control blood pressure in 2 of 25 patients. Physicians had to perform a cesarean section in these 2 cases due to considerable deceleration of the fetal heart rate. They had to 1st administer the rapidly acting ganglion blocking agent, trimetaphan, before placing the women under general anesthesia. Their blood pressures returned to normal after delivery. Even though both groups experienced tachycardia after treatment, the pulse rate of dihydralazine patients was significantly higher than that of epoprostenol patients (102.68/minute vs. 88.36/minute; p=.0024). Only 2 women suffered from side effects. The epoprostenol patient experienced nausea and vomiting. The other patient received dihydralazine and experienced a severe headache. The researchers concluded that physicians should use epoprostenol in patients with severe hypertension and tachycardia and those who need acute control of severe hypertension on the operating table before endotracheal intubation (which tends to cause considerable increases in blood pressure) and administration of general anesthesia.
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PMID:A comparative study of the use of epoprostenol and dihydralazine in severe hypertension in pregnancy. 142 10

In a prospective, randomized, double-blind study for the prevention of pregnancy-induced hypertension and preeclampsia, 41 primigravidae with positive roll-over test (28th-32nd week of pregnancy) received 80 mg aspirin/day or placebo until the end of the 37th week. In the patients treated with acetylsalicylic acid (n = 22), 3 cases of proteinuria occurred, but no hypertensive pregnancy complication. In the placebo group (n = 19), 10 patients developed pregnancy-induced hypertension (6 of them preeclampsia). Group-specific differences concerning the occurrence of hypertension were statistically highly significant (p = 0.0004). No relevant differences were observed with regard to pregnancy duration, birth weight and umbilical artery pH value. The placebo group included 1 intrauterine death. No increased tendency to maternal or fetal bleeding was noticed.
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PMID:Low-dose aspirin in primigravidae with positive roll-over test. 142 14

The literature dealing with screening for hypertension in pregnancy was reviewed. No level of blood pressure or any other factor provides a guarantee of no risk for the development of preeclampsia. However, higher blood pressure in early pregnancy and a failure to decrease blood pressure in mid-pregnancy are both associated with the development of preeclampsia. The development of proteinuria, rather than the level of blood pressure, is the best predictor of poor pregnancy outcome. Multiparas, especially those with severe chronic hypertension who develop preeclampsia, are at greatest risk of poor pregnancy outcome.
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PMID:Screening for hypertension in pregnancy. 142 47

Doppler studies of the arcuate and umbilical arteries were performed longitudinally commencing at 24 weeks or less, in 29 pregnant women with chronic hypertension. The hypothesis was that pregnant women with chronic hypertension who develop superimposed gestational proteinuric hypertension and/or deliver small for gestational age babies are those who have abnormal arcuate and/or umbilical flow velocity waveforms. Abnormal arcuate waveforms occurred in 7 women and abnormal umbilical waveforms in 12. Nine babies were small for gestational age, and 6 of them had abnormal arcuate waveforms. Abnormal arcuate waveforms were significantly associated with the delivery of a small for gestational age baby (p = .001) and identified those babies where early delivery was necessary for fetal reasons. All small for gestational age babies had abnormal umbilical waveforms. Superadded gestational proteinuria (or preeclampsia) occurred in 8 pregnancies, however, only 3 had abnormal arcuate waveforms. An abnormal arcuate waveform did not predict the later development of gestational proteinuria. An abnormal umbilical waveform however, was associated with the subsequent development of gestational proteinuria. We consider that these findings need to be confirmed in a larger study.
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PMID:Doppler ultrasound in pregnancies with hypertension. 144 32

The course of eight pregnancies in seven renal transplant patients was analyzed. Immunosuppression consisted of Azathioprine and Prednisone. Pregnancy lasted from 32 to 39 weeks and the fetal development corresponded to the gestational age in every case. There were three cases which had complications during the pregnancy. One case had severe arterial hypertension, proteinuria and pedal edema, which was thought to be due to pre-eclampsia. Another patient had cholestatic jaundice and premature fissure of membranes and the third patient also had this last complication. Four patients had vaginal deliveries and in four cesarean section was performed. Renal function did not deteriorate during any of the pregnancies nor during the follow-up period, but the expected increase in creatinine clearance was not found. Clinical evaluation of the children, 4 months to 8 years of age, did not disclose any abnormalities.
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PMID:[Pregnancy in renal transplant recipients. Long-term evaluation of their children]. 145 32

Preeclampsia has traditionally been viewed as one of several forms of hypertension complicating pregnancy. More recently, the multisystem nature of this unique gestational disorder has been emphasized. Pathophysiologic events, including abnormal placentation and heightened vascular reactivity, may occur weeks or months prior to clinical recognition of the disease. Although most frequently presenting as hypertension and proteinuria, hepatic (abdominal pain and elevation of transaminases) and hematologic (intravascular hemolysis and thrombocytopenia) involvement may be important features of the disease. Current theories suggest that multiorgan dysfunction may be caused by widespread vascular endothelial dysfunction, vasospasm, and variable activation of coagulation mechanisms. Pending delivery, which is the only definitive therapy for preeclampsia, maternal complications of intracerebral hemorrhage and eclampsia may be prevented with judicious use of antihypertensive medication (e.g., hydralazine) and magnesium sulfate, respectively. Finally, data from a number of small trials suggest that low-dose aspirin (60-100 mg/d) may reduce the incidence of preeclampsia in patients at high risk without adversely affecting the fetus or newborn; however, it is recommended that aspirin not be used as a routine prophylactic intervention until publication of results of several ongoing large multicenter trials, which will help to more fully clarify the benefits and risks of this approach.
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PMID:The syndrome of preeclampsia. 147 40


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