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)

Three hundred and ninety-five pregnancies undertaken by 238 women with primary glomerulonephritis between 1962 and 1987 were analysed to record fetal and maternal outcome and identify risk factors for a poor outcome. Of 398 fetuses, 26 per cent were lost (including therapeutic abortions), 24 per cent surviving infants were premature (less than or equal to 36 weeks gestation) and 51 per cent were term. Excluding therapeutic abortions, 20 per cent of fetuses were lost, 15 per cent after 20 weeks gestation. Fifteen per cent of 237 fetuses whose birth weight was recorded were small for gestational age: Deterioration in maternal renal function was seen in 15 per cent of pregnancies and in 5 per cent of women failed to resolve post partum. Only four women had impaired renal function recorded in the first-trimester and two of these were known to have renal impairment before pregnancy. Hypertension was recorded in 52 per cent of pregnancies, developed early (less than or equal to 32 weeks gestation) in 26 per cent and was severe in 18 per cent. Treated hypertension pre-dated 12 per cent of pregnancies and in 7 per cent (included in the overall incidence of hypertension) exacerbation occurred during pregnancy despite continued antihypertensive medication. Forty-four women (18 per cent) who developed de novo hypertension in pregnancy had permanent hypertension postpartum. Increased proteinuria was recorded in 59 per cent of pregnancies and was irreversible in 15 per cent of women. Comparison of pregnancies which occurred before or after renal biopsy revealed a significantly higher fetal loss rate after 20 weeks gestation in those pregnancies undertaken before the diagnosis of renal disease, and a significantly higher incidence of hypertension and increased proteinuria. Impaired renal function, early or severe hypertension or nephrotic range proteinuria was significantly associated with increased fetal loss, prematurity and fewer full-term infants. There was no significant difference in fetal outcome or maternal complications in pregnancy in patients with treated hypertension before pregnancy and those who were normotensive in the first-trimester. The highest incidence of fetal and maternal complications occurred in patients with primary focal and segmental hyalinosis and sclerosis and the lowest in non-IgA diffuse mesangial proliferative glomerulonephritis. The presence of severe vessel lesions on renal biopsy was associated with a significantly higher total fetal loss and fetal loss after 20 weeks gestation.
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PMID:Primary glomerulonephritis and pregnancy. 260 50

A questionnaire about the management of hypertension in pregnancy was sent to the 150 members of the Royal New Zealand College of Obstetricians and Gynaecologists. Sixty five out of a total of 77 replies were suitable for analysis. There was a wide variation in the criteria for diagnosis and the outpatient and inpatient investigation and treatment. The commonest drugs prescribed in imminent eclampsia were hydralazine as an anti-hypertensive, and diazepam or phenytoin as anticonvulsants. All clinicians practised aggressive management with induction of delivery if significant proteinuria complicated hypertension in pregnancy. Glucocorticoid therapy for the premature induction of fetal lung maturity in mothers and severe hypertension was considered beneficial by some, yet contraindicated by others.
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PMID:New Zealand obstetricians' management of hypertension in pregnancy. A questionnaire survey. 275 77

Two hundred primiparae underwent continuous-wave Doppler investigation of the uteroplacental circulation at 18-20 weeks gestation as a possible screening test for hypertension in pregnancy. Seventy-five women with abnormal waveforms suggestive of high uteroplacental resistance were tested again at 24 weeks when 21 demonstrated a persistent abnormality. Only nine (43%) of these went on to have an uncomplicated pregnancy, as compared with 150 (84%) of the remainder. Seventeen (8.5%) of the women in the study developed a hypertensive disorder of pregnancy, five of whom had abnormal waveforms at 18-20 weeks and at 24 weeks. These five women had a more severe degree of hypertension with proteinuria or intra-uterine growth retardation, and two required clinical intervention before term. The remaining 12 women were delivered at term of average, or heavier than average babies. Doppler investigation of the uteroplacental circulation at 24 weeks may prove to be a sensitive screening test for later severe pre-eclampsia with intra-uterine growth retardation.
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PMID:Doppler ultrasound of the uteroplacental circulation as a screening test for severe pre-eclampsia with intra-uterine growth retardation. 304 76

In 51 patients with pregnancy hypertension (H) and 51 normotensive gravid women (N), matched for age of gestation, plasma prolactin was measured at 8.30 am (PRL1) and 9.30 am (PRL2) in basal conditions and after 10 minutes of upright posture (PRL3). While in N there was a fall from PRL1 to PRL2 which was nonsignificant, in H there was a significant fall from PRL1 to PRL2. With upright posture there was a further decrease in prolactin in N and a significant increase in H. With multiple regression analysis, systolic and diastolic blood pressure did not show any independent relations with PRL1, PRL2 and PRL3, while serum proteins and proteinuria showed a significant relation with PRL1, as did serum proteins, serum potassium and serum urate with PRL2 and serum urate with PRL3. As has been suggested in primary hypertension, a certain increase in peripheral sympathetic tone, dependent on a decreased central dopaminergic activity, may be present in patients who develop pregnancy hypertension compared to normotensive pregnant controls and may be involved in the pathogenesis of pregnancy hypertension.
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PMID:Role of prolactin in pregnancy hypertension. 330 30

1. Elucidation of some of the mechanisms responsible for blood pressure elevation in pregnancy has permitted therapy to be based on more rational principles. The decreased arterial reactivity encountered in normotensive pregnancy is most likely mediated by prostaglandins; preventive therapy using low dose aspirin is an option to prevent development of proteinuria in pre-existing hypertension and provide prophylaxis against pregnancy-induced hypertension. 2. Antihypertensive therapy utilizing sympathetic inhibition with either methyldopa or alpha- and beta-adrenoceptor blockade yields the most promising results. Vasodilation with hydralazine, calcium entry blockers (nifedipine), intravenous labetalol or diazoxide is primarily used in severely hypertensive patients. The use of orally administered nifedipine in severely hypertensive women is associated with encouraging results. 3. It is clear that women with blood pressure levels greater than 170/110 mm Hg need antihypertensive therapy for maternal safety; it remains to be proven to what extent foetal growth and welfare can be improved in women with diastolic pressure levels 85-110 mm Hg when adrenoceptor blocking agents are used for blood pressure control. Initial studies are suggestive of improved foetal growth, prevention of proteinuria and the respiratory distress syndrome but more long-term controlled studies are required. 4. In a recent study, at our institution, of foetal growth during long term antihypertensive therapy, treatment with pindolol yielded better foetal growth than therapy with atenolol. It is as yet unclear whether the ISA or beta 2-mediated vasodilation associated with pindolol was responsible for the improved foetal growth. Further controlled studies are indicated in hypertension in pregnancy to confirm the suggested benefits of beta-adrenoceptor blocker therapy.
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PMID:Hypertension in pregnancy: whom and how to treat. 332 31

Perinatal outcome and various indicators of perinatal risk were analyzed in a prospective study of 268 pregnant women with hypertension. Poor perinatal outcome was defined by stillbirth (n = 13), neonatal death (n = 2), and in surviving babies, by birth before 32 weeks or a birthweight below 1500 g (n = 13). In multivariate analysis, proteinuria and onset of hypertension between the 27th and 36th weeks of amenorrhea were the only two independent indicators of poor outcome (relative risks of 4.0 and 3.7, p less than 0.001 and p less than 0.01 respectively). Both these indicators were more frequent in mothers with no history of pre-pregnancy hypertension.
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PMID:Factors predictive of perinatal outcome in pregnancies complicated by hypertension. 380 86

From January 1978 to July 1983 22 patients have recovered from eclampsia in the Obstetrics and Gynecology Department - Vitt. Emanuele II Hospital - Catania University. 64% of the patients had hypertension in pregnancy combined with edema in 92.85% of the cases (13 cases) and with proteinuria in 18% of the cases (4 cases). Eclampsia manifested itself before labour in 28.57% (6 cases), during labour in 19.05% (4 cases), in postpartum in 19.05% (4 cases) and in the successive three days after delivery in 33.33% (7 cases). Perinatal death rate was 11.28% and in all the cases it was due to intrauterine fetal death. In 22 patients treated there was a case of acute pulmonary edema and a case of maternal death.
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PMID:A clinical and epidemiological study on eclampsia in the obstetrics and gynecology department of Catania in the years 1978-1983. 384 Jul 26

Hypertension in pregnancy has implications for both maternal and fetal welfare. Extrapolation from concepts of mechanisms operating in hypertension in general to pregnancy-related hypertension is not justified. In the latter, the major features are a hyper-adrenergic state, plasma volume reduction and an increased systemic resistance. A reduction in uteroplacental perfusion may result from or may activate the mechanisms that elevate blood pressure. Humoral factors (e.g. hormonal attenuation of vascular reactivity) and prostacyclin deficiency may be central to the disordered physiology. Treatment of hypertension in pregnancy should aim at avoiding the vascular damage due to blood pressure elevation but not cause a reduction in uteroplacental perfusion. Unlike earlier antihypertensive regimens using centrally acting sympatholytics, adrenergic neuron blockers or diuretics, regimens using beta-blockers or combinations of beta-blockers with alpha-blockers or vasodilating agents such as hydralazine permit effective blood pressure control, even in severe hypertension, and pregnancy can often proceed until term or until fetal maturity is secured. Adverse effects on the fetus (growth retardation, cardiorespiratory depression, hypoglycaemia, hyperbilirubinaemia) formerly attributed to beta-blockers are more likely related to poorly controlled hypertension. Specific benefits of maternal beta-adrenoceptor blockade are suggested by evidence for prevention of proteinuric deterioration and a decrease in the incidence and severity of respiratory distress in premature infants. Hypertension in pregnancy still presents a formidable therapeutic challenge and requires comprehensive management with close monitoring of fetal welfare. The presence or development of proteinuria in a hypertensive pregnant woman implies a major increase in risk to the fetus and warrants immediate admission to hospital for specialist management.
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PMID:Hypertension in pregnancy. Pathophysiology and management. 614 40

During the period 1969-73, 0.3% of 17 000 unselected non-diabetic pregnancies in our hospital were complicated by severe pre-eclampsia, 0.6% by mild pre-eclampsia and 0.6% by hypertension in pregnancy. Records from affiliated maternity centres and the hospital regarding these 261 women were studied and pertinent data assembled for comparison with 260 matched normotensive pregnancies. Instrumental deliveries were more common in all types of hypertensive pregnancy, with a 35% frequency of caesarean section in severe pre-eclampsia compared with fewer than 5% for controls. Significantly longer hospitalization and increased perinatal mortality were observed in hypertensive pregnancies, most pronounced in severe pre-eclampsia. The combination of high blood pressure and proteinuria was associated with the greatest risk for premature birth, low infant weight and perinatal mortality. The overall incidence of hypertensive disorders in pregnancy was relatively low, 1.5%, but these women counted for a significant proportion of obstetric complications requiring hospitalization and instrumental delivery.
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PMID:Characteristics of hypertension in pregnancy. A retrospective study of 261 consecutive cases. 658 26

The aim of the present study was to identify factors predicting later hypertension following a hypertensive pregnancy. In the years 1969-1973, 261 out of a total of 17 000 pregnancies were complicated by pre-eclampsia or hypertension in pregnancy. In a follow-up study seven to 12 years later, 238 (91.2%) of these women were investigated. It was discovered that 26.4% of the women had hypertension and 10.1% had borderline hypertension compared with 2 and 6.5% respectively in a group of matched control subjects. A stepwise regression analysis was performed in order to evaluate the association between nine different variables and blood pressure at follow-up. We found that systolic blood pressure in early pregnancy was the single most important factor predicting systolic blood pressure at follow-up (r2 = 0.28). When highest recorded blood pressure before delivery and age were entered into the statistical model, r2 was increased to 0.35 (P less than 0.0001). Unlike previous studies, parity and proteinuria did not add to the predictive power of the analysis. Late hypertension was found in more than 25% of women seven to 12 years after a hypertensive pregnancy. The most important factor associated with later hypertension was blood pressure before pregnancy.
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PMID:Prediction of later hypertension following a hypertensive pregnancy. 659 6


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