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Query: UMLS:C0033687 (proteinuria)
 24,015 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Preeclampsia is a disorder of pregnancy characterized clinically by hypertension, proteinuria, and edema and characterized pathologically in its late stages by widespread microvascular thrombi. There is evidence from a number of studies that production of prostacyclin (prostaglandin I2, PGI2), a potent vasodilator and inhibitor of platelet aggregation, is deficient in preeclamptic compared to normal pregnancy. Traditional therapy utilizes infusions of large amounts of MgSO4, but the physiologic basis for this is not clear. We studied the effect of MgSO4 on PGI2 release by cultured human umbilical vein endothelial cells (HUVEC) by several methods. By platelet aggregometry, the known antiaggregatory effect of intact HUVEC was enhanced by MgSO4. By radioimmunoassay for 6-keto-PGF1 alpha, the stable metabolite of PGI2, it was shown that MgSO4 amplifies release of PGI2 by HUVEC in a dose-dependent manner, with a peak occurring between 2 and 3 mM. In separate experiments, MgSO4 overcame the enhanced adherence of platelets to HUVEC exhausted by repeated exposure to thrombin. Finally, PGI2 production was 2- to 5-fold greater by HUVEC incubated with plasma obtained from preeclamptic patients undergoing MgSO4 therapy than by HUVEC incubated with pretherapy plasma. We conclude that MgSO4 mediates enhanced production of PGI2 by vascular endothelium, thereby potentially enhancing its thromboresistant properties.
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PMID:Magnesium sulfate: rationale for its use in preeclampsia. 351 61

The study was retrospective, encompassing 2 years period of time (2000-2001), as it was carried out at the First and the Second Clinics of Obstetrics at the Higher Institute of Medicine-Pleven. Fifty pregnant women and women in-child-birth having Praeeclampsia-Eclampsia (PE-E) were treated during this period, as 26 of them were administered Cormagnesin (first group) and 24 (second group) were not treated with magnesium preparations. In the first group 6 pregnant women had severe PE and 4-E, total 10 (38.4%). All E pregnant women and the PE cases with RR > or = 180/120 were treated with Cormagnesin. In the second group there were 4 pregnant women with severe PE (16.67%) but proteinuria was predominant (> or = 5 g/l) as RR was not higher than 160/110, so we did not have the reason to administer them Cormagnesin. The highest total dose MgS was 100 g and it was applied only in 1 E case (20g /daily for the duration of 5 days). In the remaining E cases the total dose was 60, 48, 2 g, respectively, as the number of applications was from 1 to 4 times daily, and the duration from 1 to 4 days. Cormagnesin gave excellent results in 80% of the cases with severe PE-E. The frequency rate of s.c. in the first group was 57.69%, in the second group--25%. The authors made the conclusion that the severity of PE-E and mainly the high values of RR and the other accompanying symptoms determined treatment with MgSO4. Cormagnesin application scheme was strictly individual. MgSO4 application allowed the possibility for conducting the delivery under more favourable conditions when convulsions were under control and RR was stabilised.
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PMID:[Current position on the treatment and prevention of pre-eclampsia-eclampsia with magnesium sulfate]. 1214 70

Nitric oxide inhibitor L-NAME when given alone caused a significant rise in both systolic and diastolic pressure, an increase in 24 hr urinary protein excretion and reduction in weight of the litter as compared to control group. Supplementation of MgSO4 at lower dose (250 mg/kg) did not inhibit this pre-eclamptic effect of L-NAME; but in higher doses (500 and 750 mg/kg), it inhibited the pre-eclamptic action of L-NAME. The results suggest that administration of MgSO4 improves the foetal outcome and significantly prevents the development of symptoms of pre-eclampsia like hypertension and proteinuria.
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PMID:Effect of oral magnesium supplementation on experimental pre-eclampsia induced by prolonged blockade of nitric oxide synthesis in pregnant rats. 1263 9

Pre-eclampsia is a multisystem disorder, of unknown aetiology, usually associated with raised blood pressure and proteinuria. Although outcome for most women and their babies is good, it remains a major cause of morbidity and mortality. A wide range of interventions for prevention and treatment of pre-eclampsia have been evaluated in randomized trials. This evidence provides the basis for a rational approach to care. Overall, there is insufficient evidence for any firm conclusion about the effects of any aspect of diet or lifestyle during pregnancy. Antiplatelet agents are associated with a 19% reduction in the risk of pre-eclampsia (relative risk 0.81; 95% CI 0.75, 0.88), a 7% reduction in the risk of preterm birth (RR 0.93; 95% CI 0.89, 0.98), a 16% reduction in the risk of stillbirth or neonatal death (RR 0.84; 95% CI 0.74, 0.96) and an 8% reduction in the risk of a small for gestational age baby (RR 0.92; 95% CI 0.85, 1.00). For mild to moderate hypertension, trials evaluating bed rest are too small for reliable conclusions about the potential benefits and hazards. Antihypertensive agents halve the risk of progression to severe hypertension (RR 0.52; 95% CI 0.41, 0.64), but with no clear effect on pre-eclampsia (RR 0.99; 95% CI 0.84, 1.18), or any other substantive outcome. For severe hypertension, there is no good evidence that one drug is any better than another. Plasma volume expansion for severe pre-eclampsia seems unlikely to be beneficial, although the trials are small. The optimum timing of delivery for pre-eclampsia before 34 weeks is unclear. Magnesium sulphate more than halves the risk of eclampsia (RR 0.41; 95% CI 0.29, 0.58) and probably reduces the risk of maternal death (RR 0.54; 95% CI 0.26, 1.10). It is also the drug of choice for treatment of eclampsia.
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PMID:Pre-eclampsia and the hypertensive disorders of pregnancy. 1471 62

A disturbed balance between angiogenic and antiangiogenic growth factors is a highly accepted mechanism in the pathogenesis of pregnancy-induced hypertension and proteinuria, which is clinically known as preeclampsia (PE). We investigated the effect of magnesium sulfate (MgSO4) therapy on vascular endothelial growth factor (VEGF), placental growth factor (PlGF), nitric oxide (NO) metabolites, soluble fm-like tyrosine kinase-1 (sFlt-1) and endoglin levels in PE rats and the effect of this treatment on the feto-maternal outcome. The PE group showed hypertension, proteinuria and decreased number and weight of live pups relative to the control group. This result was associated with increased sFlt-1, VEGF receptor-2 (VEGFR-2), VEGFR-3 and endoglin levels but decreased NO metabolites. MgSO4 therapy ameliorated systolic hypertension and proteinuria and decreased sFlt-1, VEGFR-2, VEGFR-3 and endoglin levels but increased NO metabolites in the treated group. Physiological and biochemical changes and improved pup weight and viability were observed in the treated group. The vasodilator action of MgSO4 and increased NO production are expected to increase placental blood flow and help fetal nutrition and development. Relief of placental ischemia decreases the production of antiangiogenic growth factors and restores the bioavailability of angiogenic factors (PlGF and VEGF). These changes resulted in better fetal outcome and an improved clinical picture of PE. These findings are promising and encourage further study of the mechanism of action of MgSO(4) to support its widespread use in the prevention and management of the etiopathological changes underlying the vast majority of the manifestations and complications of PE.
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PMID:Magnesium sulfate therapy of preeclampsia: an old tool with new mechanism of action and prospect in management and prophylaxis. 2276 74

Nausea and vomiting are symptoms frequently seen in normal pregnancy. We report a patient with gastric carcinoma who presented with severe hyperemesis gravidarum that led to extreme volume depletion, hypertension, proteinuria, and acute renal failure. A 35-year-old woman (para 2-1-0-1) with a prenatal course significant for persistent nausea, vomiting, and poor weight gain presented at 36 weeks' gestation with elevated blood pressure (157/114 mm Hg), proteinuria (4+), hypochloremic metabolic alkalosis, and severe intravascular volume contraction. A presumptive diagnosis of severe preeclampsia was made, the patient was given intravenous MgSO4, and cesarean delivery was accomplished uneventfully. When significant emesis persisted in the postoperative period, esophagogastroduodenoscopy revealed an antral/prepyloric mass with a biopsy-proven poorly differentiated adenocarcinoma. To our knowledge, this is the first report of a case of hyperemesis gravidarum with gastric cancer masquerading as preeclampsia.
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PMID:A Case of Hyperemesis Gravidarum due to Gastric Cancer Masquerading as Preeclampsia. 2370 89

Preeclampsia continues to be a leading cause of maternal and foetal mortality and morbidity worldwide. It is defined as hypertension and proteinuria after 20 weeks' gestation, which resolves after delivery. It is complicated by intracerebral haemorrhage, pulmonary oedema and respiratory and hepatic failure, which form the commonest causes of death. There is a genetic and immunological element to the pathophysiology of the disease, which is still not completely understood, but the underlying cause is an abnormality of placentation and placental hypoxia. This is thought to result in an imbalance of angiogenic and antiangiogenic proteins that leads to systemic endothelial disruption and multiorgan involvement. Successful treatment requires delivery of the placenta and management should be undertaken by a multidisciplinary team, aiming primarily to stabilise the condition of the mother before delivery is contemplated. Guidelines and protocols all have common management goals which are to treat hypertension, prevent seizures, control fluid intake and optimise the timing of delivery. Hypertension can be treated with a range of antihypertensive drugs, but labetalol is regarded as first-line therapy. Magnesium sulphate is the treatment of choice for eclampsia because it reduces the risk of seizures by more than 50%. A fluid restriction policy should be used to prevent iatrogenic pulmonary oedema. Effective anaesthetic management relies on neuraxial techniques. Epidural, combined spinal-epidural and single-shot spinal anaesthetic techniques are all perfectly acceptable and should be actively promoted to the mother unless contraindications such as thrombocytopaenia exist.
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PMID:Preeclampsia: pathophysiology, old and new strategies for management. 2438 82