Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0033687 (proteinuria)
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During a 12-year period, 254 cases of eclampsia were managed at this center. Eighty patients (32%) did not have edema, 58 (23%) had "relative hypertension," and 49 (19%) did not have proteinuria at the time of convulsions. Eclampsia developed at less than or equal to 20 weeks in 6 patients and beyond 48 hours post partum in 40 (16%). Convulsions developed in 33 while they were receiving standard doses of magnesium sulfate for preeclampsia during or after birth, and subsequent seizures developed in 36 (14%) after magnesium sulfate therapy was started. There was one maternal death (0.4%) and morbidity was frequent (acute renal failure, 4.7%; pulmonary edema, 4.3%; cardiorespiratory arrest, 3.1%; and aspiration, 2%. The use of multiple drug therapy was associated with significant maternal and neonatal complications. The total perinatal mortality was 11.8%, with the majority of them related to either abruptio placentae or extreme prematurity. These findings emphasize the need for intensive monitoring of women with preeclampsia throughout hospitalization and underscore the importance of maternal stabilization before and during transfer.
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PMID:Eclampsia. VI. Maternal-perinatal outcome in 254 consecutive cases. 240 30

Flow velocity waveforms of the uteroplacental arteries were analyzed at 20 and 24 weeks of gestation, by means of duplex pulsed Doppler ultrasonography, in 93 women at risk for preeclampsia or intrauterine growth retardation. The ability of an elevated resistance index to predict these conditions was tested. At 20 and 24 weeks an abnormal resistance index was significantly associated with intrauterine growth retardation but not with preeclampsia, with or without proteinuria. A low fetal abdominal circumference at 20 or 24 weeks or an increasing maternal plasma uric acid concentration at 24 weeks was as predictive as an elevated resistance index. In a second group of 43 women, screened in the same way, the only association was of an elevated resistance index at 20 weeks with intrauterine growth retardation. Although elevated resistance indices occur more commonly in women who develop intrauterine growth retardation and/or preeclampsia, the correlation is not close enough to be clinically useful as a screening test.
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PMID:The value of Doppler assessment of the uteroplacental circulation in predicting preeclampsia or intrauterine growth retardation. 240 72

Plasma concentrations of thyroxine (T4) and thyroxine-binding globulin (TBG) as well as triiodothyronine uptake (T3U) were measured in 32 proteinuric pre-eclamptic patients and 24 normotensive pregnant women at similar gestations in the third trimester. The pre-eclamptic patients had slightly lower TBG, and significantly lower T4, concentrations, which were significantly correlated. They also had significantly lower infant birth weight which was correlated to the TBG and T3U values. There was no correlation between T4 and TBG or between birth weight and TBG or T3U in the normotensive women. It is likely that the correlation between TBG and birth weight in the pre-eclamptic patients reflects the severity of proteinuria in pre-eclampsia.
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PMID:Birth weight and thyroxine-binding globulin in pre-eclampsia. 247 68

Dextran 40 was used in the management of hypovolemia and hemoconcentration in patients with hypertensive disease induced by pregnancy; 50 cases were randomly selected from a total of 150 patients from the Intensive Care Unit for Adults. The obstetrical profile, and perinatal profile, were determined. Hemodynamic and laboratory parameter, were statistically analyzed, before administration of Dextran 40 and at 2, 4, 6 and 8 hours after, and were compared. Eighty eight per cent of the selected cases corresponded to severe pre-eclampsia, and 12% to eclampsia; the age of the patients was 24 years; the number of gestations was 2.1 and they were at 32.6 weeks of gestation, average; eighty four percent were pregnant, and 16% were in puerperium at the moment of starting infusion; ninety per cent of the patients underwent cesarean section, and 10% were attended of a delivery. The products weighed 2,696 g; Apgar of 7.1 and 8.4 at fetal one and five minutes respectively, in average; there was one fetal death (2.4%), and one mortinate (2.4%); morbidity was 12%, and 85% of the products evolutionated satisfactorily. There were no maternal deaths. There was an statistically significant decrease is of BP after two hours, and a decrease of heart beat after four hours from starting infusion; as well as an increase in central venous pressure and diuresis, both after two hours from starting infusion of Dextran 40. There was a quantitative diminution of edema and proteinuria; as well as a quantitative diminution of hemoglobin, hematocrit, and fibrinogen after eight hours from starting infusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Dextran 40 for hypovolemia caused by hypertensive disease in pregnancy]. 248 12

We have obtained some new findings from the observation and management of 15 pregnancies and deliveries, all complicated with IgA nephropathy, which was diagnosed by open renal biopsy before each pregnancy. The classification of IgA nephropathy was from Grade I to Grade IV according to Nomoto et al. Clinical and pathological changes during each pregnancy were observed in the appearance and degree of edema, proteinuria and hypertension. The criteria were based on the classification of toxemia of pregnancy of the Committee for Toxemia of Pregnancy. Japan Society of Obstetrics and Gynecology. We referred to laboratory data such as complete blood counts, coagulation tests, blood chemistry tests, urinalysis and renal function tests. We also referred to Amagasaki's criteria which indicate whether the pregnancy and delivery will be normal or not. Three cases with Grade I IgA nephropathy all had normal courses. Nine cases with Grade II satisfied the criteria of Amagasaki for normal delivery, but during the third trimester, proteinuria was recognized in seven cases, edema in one case and hypertension in two cases. Three cases with Grade III were all met the criteria for abnormal pregnancy and delivery. Only one case showed proteinuria from the first trimester, but she had no obstetrical complications or deterioration of renal function during her course. There were 12 vaginal deliveries and three Cesarian sections. All infants were in good condition except for one intrauterine fetal death. In view of the above results, we concluded that patients with Grade II IgA nephropathy could not continue their pregnancies safety. However, some of the patients with Grade III had successful deliveries.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical studies of IgA nephropathy during pregnancy]. 258 6

A retrospective study was made to determine the incidence of pregnancy-induced hypertension (PIH, pre-eclampsia) in Iceland. One-fourth of all births in Iceland in 1985 were selected from the national birth registry files by random number allocation, a total of 904 women. Maternity records were found in 97.9% of the cases. The criteria used to define PIH were met in 17.4% of the women. There were 146 (16.5%) with mild PIH (blood pressure of greater than or equal to 140/90 mmHg with or without proteinuria after the 20th gestational week). Eight (0.9%) had severe PIH (blood pressure of greater than or equal to 160/110 mmHg with or without proteinuria after the 20th gestational week). Primigravid women formed one-third of the group and of these 20.9% had PIH compared with 15.4% of the parous women. The incidence in parous women was higher than usually reported.
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PMID:Incidence and relation to parity of pregnancy-induced hypertension in Iceland. 263 27

To evaluate risk for exacerbation of systemic lupus erythematosus (SLE) during pregnancy, we prospectively evaluated 80 pregnant women with SLE for manifestations of disease activity. Fifty-three of these women were not taking prednisone at the time of conception. Disease activity was scored in 4 ways: global assessment, prednisone therapy, cumulative number of organ systems with abnormalities, and display of abnormalities of each organ system. No patient received prophylactic therapy to prevent disease exacerbation. Thrombocytopenia, proteinuria, and hypocomplementemia were the most common abnormalities and were usually attributable to the pregnancy complications of preeclampsia and anticardiolipin antibody syndrome rather than to SLE. If all possible abnormalities were attributed to SLE, disease exacerbation occurred in less than 25% of all patients; if only SLE-specific abnormalities were counted, disease exacerbation occurred in less than 13%. Worsening of SLE is uncommon in pregnancy, and prophylactic prednisone therapy is unnecessary.
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PMID:Pregnancy does not cause systemic lupus erythematosus to worsen. 232 40

EPH-gestosis (pre-eclampsia-eclampsia) characterized by edema, proteinuria and hypertension occurs primarily in the nullipara, usually after the 20th gestational week. As in normal pregnancy there is striking change in both renal blood flow and glomerular filtration rate a slight increase in urinary protein secretion is not considered abnormal until it exceeds 300 mg/day. Abnormal proteinuria commonly accompanies pre-eclampsia and may be minimal, moderate or severe (even exceeding greater than 25 g/l). Proteinuria was typed mainly of nonselective glomerular origin by using the SDS-disc-electrophoresis. Additionally the clearance ratio of IgG to transferrin in all patients with abnormal proteinuria was evaluated. In none of the patients studied the ratio was less than 0.1 (highly selective). As severe proteinuria is associated with fetal growth retardation, preterm deliveries and prenatal mortality the quantitation and typing of early proteinuria is essential for considering patients who are at risk for developing EPH-gestosis.
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PMID:[Proteinuria in normal pregnancy and in EPH gestosis]. 265 75

Preeclampsia, a major cause of fetal and maternal morbidity and mortality, may be difficult to distinguish clinically from other hypertensive disorders of pregnancy. Signs helpful in its diagnosis include presentation during late gestation in a nullipara with edema and proteinuria, and one or more of the following: hemoconcentration, hypoalbuminemia, liver function and/or coagulation abnormalities, and increased urate levels. Measures that may prove useful in differentiating preeclampsia from less dangerous forms of hypertension are decreased antithrombin III levels, increments in serum iron and carboxyhemoglobin, and decreases in urinary calcium. Major pathophysiological features of preeclampsia are decreased cardiac output, pulmonary capillary wedge pressure, and plasma volume; and marked increases in peripheral vascular resistance, as well as exaggerated pressor responses to endogenous angiotensin II and catecholamines. Renal hemodynamics decrease, in part as a result of a characteristic morphological lesion in glomeruli ("endotheliosis"), and there may be increased vascular permeability leading to albumin loss from the intravascular space. When gestation is advanced, termination is the treatment of choice; when temporization is required, several antihypertensive medications whose safety and efficacy have been tested in pregnant women are available. Magnesium sulfate remains the drug of choice for impending convulsions (the eclamptic phase of the disease). Finally, the etiology of preeclampsia remains unknown, but a popular theory suggests that alterations in prostaglandin metabolism may be responsible for the hypertension and coagulopathy in this disorder. In this respect, prophylactic treatment with low doses of aspirin, which decrease platelet thromboxane production but spare endothelial prostacyclin release, may decrease the incidence of preeclampsia in "high-risk" populations.
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PMID:Preeclampsia: pathophysiology, diagnosis, and management. 265 50

A prospective ultrasound study was undertaken to investigate the prevalence of pleural effusion in patients with moderate or severe pre-eclampsia. The costophrenic angles of 34 consecutive patients were scanned postpartum with a real-time sector scanner. Six patients had pleural effusions. These patients did not have a greater degree of hypertension or proteinuria than the group without pleural effusion but had early severe disease requiring early delivery. The prematurity of these infants resulted in tenfold increase in perinatal death.
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PMID:The prevalence of pleural effusions in pre-eclampsia: an ultrasound study. 266 1


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