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)

Antithrombin III (AT III) is the main physiological inhibitor of blood coagulation. In a prospective study, plasma AT III was determined in 653 women during pregnancy, using an automated amidolytic technique. A control value 8 weeks after delivery was obtained in 192 of the women. In women with pregnancy-induced or aggravated hypertension a significant decrease in AT III levels was observed compared with normotensive controls of the same period of gestation and compared with the patients' own control values 6-8 weeks after delivery. No AT III depression occurred in patients with chronic hypertension during pregnancy. Patients with pregnancy hypertension and proteinuria had lower AT III levels than those without proteinuria, whose AT III levels were also depressed. Lowest AT III levels were seen in 2 eclamptic patients and in patients with severe preeclampsia, whose pregnancies were terminated for fetal distress while the infants were still preterm. Monitoring At III levels is of value in preeclampsia.
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PMID:Antithrombin III levels in normotensive and hypertensive pregnancy. 662 44

To evaluate the effects of gestational hypertension on fetal growth, we studied the standardized records of 2996 single live-birth pregnancies. Mothers all had documented diastolic blood pressure of less than 85 mmHg before the 16th wk of amenorrhea and no history of pre-pregnancy hypertension or kidney disease. Diastolic blood pressure readings exceeding 84 mmHg were found later in pregnancy in 38.4% of the mothers, and were associated with an increased number of small-for gestational-age infants: 3.2% in mothers whose diastolic blood pressure had never reached 85 mmHg, 6.3% when peak diastolic blood pressure had been in the 85-94 mmHg range, and 8.5% when it had exceeded 94 mmHg (p less than 0.01). In mothers who had had one or more diastolic readings of more than 84 mmHg, and for all peak diastolic pressures, the rate of small-for-gestational-age infants was higher when hypertension had begun early in third trimester (between the 27th and 36th wk), than in the second trimester or later than the 35th wk (10.2% compared to 5.6 and 6.1% respectively, p = 0.02). This temporal reinforcement of the adverse fetal effects of hypertension when it began in the early third trimester was not explained by differences in the incidence of proteinuria or in maternal age, parity, obstetric history or smoking habits.
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PMID:Fetal growth retardation in gestational hypertension: relationships with blood pressure levels and the time of onset of hypertension. 667 7

A rise in arterial pressure above 140 mmHg systolic or 85 mmHg diastolic is pathological in pregnant women. Such changes may either reveal chronic hypertension or constitute a purely gestational complication. The persistence or regression of abnormally high BP values 3 months after delivery retrospectively indicates whether the hypertension was chronic or pregnancy-related. When BP values are very high (diastolic above 110 mmHg) the mother is exposed to vascular accidents and the most effective anti-hypertensive drugs are required. In the more common moderate hypertension, both the mother (eclampsia) and the foetus (intra-uterine or neonatal death, low birth-weight) are at risk. The risk is better predicted by proteinuria and hyperuricaemia than by the BP values themselves, and whether anti-hypertensive drugs are warranted is uncertain. Studied comparing patients with treated and untreated moderate hypertension have yielded two valuable results: (1) methyldopa administered to the mother is harmless to the foetus, and (2) abortion during the second trimester of pregnancy is probably prevented when methyldopa is prescribed against chronic hypertension. No study has yet afforded evidence that the use of anti-hypertensive drugs in gestational hypertension benefits the foetus. Further therapeutic trials and a better knowledge of the natural history and mechanisms of hypertension in pregnancy are required before adequate management of this condition can be determined.
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PMID:[Kidneys, hypertension and pregnancy. II. Hypertension in pregnancy: significance, prognosis, and treatment (author's transl)]. 709 40

During a survey of all pregnant patients seen during 1 month at the King Edward VIII Hospital, Durban, the prevalence of hypertension in pregnancy proved to be 11,4%. The incidence in primigravidas was 17,8%, twice the figure in multigravid patients. The perinatal mortality rate for both groups of patients was increased, especially when proteinuria was also present. The infants born to the multigravid patient with hypertension and proteinuria not only have a higher risk of perinatal mortality (5 - 6-fold increase) but a significantly lower birth weight than the infant born to the primiparous patient.
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PMID:A survey of hypertension in pregnancy at the King Edward VIII Hospital, Durban. 742 93

This is the first report of the largest study of blood pressure measurement in pregnancy in a New Zealand population using standardized definitions and methodology. Over 3,800 women who delivered in an 8-month period in the Wellington region were included in the study. Blood pressure measurement and the presence of oedema and proteinuria were recorded from booking until delivery and in the puerperium. Only 2.7% of women were unable to be contacted after delivery for details on outcomes. The results established normal ranges for blood pressure throughout pregnancy. The data show that blood pressure greater than 140/90 until 35 weeks' gestation is outside 2 standard deviations at all gestations and justifies using these measurements as the definition of hypertension in pregnancy. The fall in blood pressure in the 2nd trimester was less than 1 mm Hg per week in both the systolic and diastolic pressures. This fall was smaller than previously recorded in other studies. Gestational hypertension was the commonest blood pressure abnormality occurring in 15.2% of the population. This represented 69% of the pregnant women with a hypertensive disorder. The overall incidence of both gestational hypertension and preeclampsia was 18.5% which is higher than reported in other parts of the world. In this study obesity was significantly associated with hypertensive disorders in pregnancy. An arm circumference of > 33 cm, one of the measurements of obesity, was found in 6.8% of the study population. Even after the effect of arm circumference was taken into account, hypertensive disorders were also more common in Pacific Island women.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Measurements of blood pressure, oedema and proteinuria in a pregnant population of New Zealand. 777 96

To evaluate the Laser-Doppler flowmeter (LD) as a diagnostic tool in microcirculatory alterations of gestosis, cutaneous circulation was measured in the forearm under basal conditions and during reactive hyperaemia by means of an MBF3D (Moor Instrument Ltd., Oxford) in 11 hypertonic and in 14 normotonic pregnant women (+/- proteinuria, +/- pathologic increase in body mass, 16-36 years old, 26-40th week of gestation) with the exception of systolic and diastolic blood pressure, all statistical and clinical criteria were identical in the two groups. There were, however, in the hypertonic patients significant reductions in most of the LD criteria (basal and maximal speed and concentration of erythrocytes, duration of reactive hyperaemia). Regardless of group assignment, there were negative correlations between erythrocytes speed on the one side (basal, maximal), and blood pressure an the other, in some instances also to the increase in body mass and to the APGAR score of newborns. These preliminary findings are considered on an expression of cutaneous vasoconstriction accompanying hypertension in pregnancy. Extensive validation of LD under these conditions seems promising.
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PMID:[Laser Doppler: new diagnostic possibilities in gestosis]. 804 90

Despite a large body of literature or hypertension in pregnancy, there still is no recognized prognosis factor for this frequent and severe disease. Management still relies on clinical features (occasional blood pressure measurements, weight curve) and appropriate tests including fetal and maternal echodoppler, urinary uric acid, 24 h proteinuria and fetal heart rate monitoring. Recent developments including self measurement and ambulatory monitoring of blood pressure have helped improve follow-up and therapeutic management in high risk pregnancies. By repeating the measurements, these techniques require more intensive medical follow-up and an adapted therapy near the term of pregnancy. They do not however provide a means of predicting outcome or recurrence of preeclampsia. These techniques have effectively been shown to reduce the number and duration of hospitalizations.
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PMID:[Evaluation and surveillance of blood pressure during pregnancy]. 805 53

From the clinical point of view proteinuric hypertension or preeclampsia is the most important form of hypertension in pregnancy and carries the greatest risks for mother and foetus. The syndrome 'preeclampsia' differs from other types of hypertension and its effects on mother and foetus are not clearly benefited by lowering the blood pressure with drugs. The characteristic morphological changes and altered vascular reactivity which develop in preeclampsia commence at about 14 weeks gestation, long before hypertension or proteinuria appear. Many abnormalities in coagulation mechanisms appear in preeclampsia and some may play an important part in pathogenesis. Increased plasminogen activator inhibitor may play a key role. Antihypertensive drugs used during pregnancy may reduce foetal mortality and the incidence of preeclampsia. Calcium supplementation and aspirin may reduce the incidence of preeclampsia in high risk subjects. Heparin and dipyridamole may reduce the risk of preeclampsia in high risk patients with renal disease.
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PMID:Hypertension in pregnancy. 819 15

This review on hypertension in pregnancy focuses mainly on the pathophysiology and prevention of pregnancy induced hypertension which, when associated with proteinuria, is usually called preeclampsia. Rather than a genuine hypertensive disease, preeclampsia is mainly a systemic endothelial disease causing activation of platelets and diffuse ischemic disorders whose most obvious clinical manifestations involve the kidney (hence the proteinuria, edema and hyperuricemia), the liver (hence the hemolytic elevated liver enzymes and low platelets, or HELLP syndrome), and the brain (hence eclamptic convulsions). Hypertension is explained by increased vascular reactivity rather than by an imbalance between vasoconstrictive and vasodilating circulating hormones. This increased reactivity is due to endothelial dysfunction with imbalance between prostacyclin and thromboxane A2 and possibly dysfunction of NO and endothelin synthesis. The aggressive substances for endothelium are thought to be of placentar origin and the cause of their release is explained by placentar ischemia related to a defect of trophoblastic invasion of the spiral arteries. The etiology of this latter defect is unknown but involves immunologic mechanisms with genetic predisposition. The only effective treatment for PIH is extraction of the baby with the whole placenta. The decision for extraction is often a very delicate obstetric problem. Antihypertensive drugs are mainly indicated in severe hypertension (> 160-100 mm Hg), with the aim of preventing cerebral hemorrhage in the mother, but have not been shown to improve fetal morbidity or mortality. Eclamptic seizures can be prevented and treated more effectively with magnesium sulfate than with diazepam or phenytoin. Prevention of preeclampsia remains the main challenge. Whereas antihypertensive drugs are ineffective, calcium supplementation and low dose aspirin have proven effective but mainly in selected populations with a relatively high incidence of preeclampsia (> 8-10%). In multiparas the selection of such a high risk population is relatively easy when at least 2 (or 1?) previous pregnancies were complicated with early preeclampsia and/or intrauterine growth retardation. In nulliparas the selection of the high-risk population is still a subject of research. The 2 most promising criteria are abnormal Doppler velocimetry of the uterine arteries at around 20 weeks of amenorrhea, and abnormally high plasma levels of beta HCG at 17 weeks of amenorrhea.
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PMID:[Hypertension and pregnancy. Diagnosis, physiopathology and treatment]. 853 76

Over the last 16 years the evolution of 24 pregnancies in 17 women with biopsy-proven glomerular disease was analyzed. The underlying renal histology was IgA nephropathy in 8 cases, lupus nephritis in 7, mesangiocapillary glomerulonephritis type I in 1, and focal segmental glomerulosclerosis in 1. All but 2 had normal renal function before conception and 3 were hypertensive. Fetal survival rate was 75%. There were 6 preterm deliveries (33.3%), 3 newborns small for gestational age (17%), 1 stillbirth, and 5 therapeutic abortions. The perinatal mortality was 5.5%. De novo hypertension occurred in 8 pregnancies (33.3%). In 11 pregnancies (46%) increased proteinuria was diagnosed and in 6 (25%) a decline in maternal renal function was recorded. Permanent impairment of renal function was seen in 2 women with renal insufficiency before conception. Maternal hypertension and renal function impairment were associated more frequently with obstetric complications. In conclusion, pregnancy is safe for normotensive mothers with glomerular diseases and normal renal function. Hypertension and impaired renal function at conception seem to carry increased risk for mothers and fetuses. Low-dose immunosuppressive treatment during pregnancy is not harmful for the fetus.
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PMID:Outcome of pregnancy in women with glomerular diseases. 882 May 9


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