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Urinary Calcium Creatinine Ratio and Association with Pre-Eclampsia

Article Information

Lizwana Nusrat Lia1*, Rezwan Sultana2, Jasmin Ara Zaman3, Fathima Sultana4, Afreen Kabir Kheya5

1Medical Officer, Green Road Urban Dispensary, New market, Dhaka, Bangladesh.

2Medical Officer, Department of Hand & Microsurgery, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh.

3Medical Officer, Green Road Urban Dispensary, New market, Dhaka, Bangladesh

4Microbiologist, National Institute of Cardiovascular Disease (NICVD), Dhaka, Bangladesh.

5Medical Officer, Department of Pediatric Orthopedics, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh.

*Corresponding Author: Lizwana Nusrat Lia, Green Road Urban Dispensary, New market, Dhaka, Bangladesh.

Received: 01 June 2024; Accepted: 11 June 2024; Published: 12 July 2024

Citation: Lizwana Nusrat Lia, Rezwan Sultana, Jasmin Ara Zaman, Fathima Sultana, Afreen Kabir Kheya. Urinary Calcium Creatinine Ratio and Association with Pre-Eclampsia. Anesthesia and Critical care 6 (2024): 31-39.

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Abstract

Background: Preeclampsia is a significant threat to the mother as well as the fetus. It forms deadly tried along with haemorrhage and infection and contributes significantly to maternal morbidity. Ra's complex pathophysiology remains unclear. An early prediction of preeclampsia with enabled accuracy is one of the essential prerequisites for its prevention. Aim of the study: This study aimed to diagnose the urinary calcium creatinine ratio and its association with preeclampsia. Methods: A case-control comparative study was conducted at the Department of Obstetrics & Gynecology in Mymensingh Medical College Hospital from October 2020 to September 2021. Pregnant women with preeclampsia were selected as cases, and women with normal pregnancies were selected as controls in their third trimester for the study. Singleton pregnancies with the same gestational age were matched in case and control. Urinary calcium, creatinine levels and calcium creatinine ratio were measured in a urine sample for all 140 subjects. Data were collected using a structured questionnaire and analyzed using the Statistical Package for Social Sciences (SPSS) version 26.0. Result: 140 pregnant women in their third trimester were involved, whereas 70 with preeclampsia and 70 with normal pregnancy were selected for the study. A significant difference between preeclampsia and the norm group was observed in the case of urinary calcium concentration (p<0.001), but urinary creatinine concentration did not show any significant difference. Similarly, the urinary calcium to creatinine ratio was significantly lower in preeclampsia than in the standard group (p<0.001). Regarding assessment, decreased urinary calcium level (OR: 22.37, 95% CI: 3.96-24.7, p-value 0.001) and decreased urinary calcium creatinine ratio level (OR: 25.13, 95% CI: 4.58-27.9, p-value <0.0 were found as independent risk factors for preeclampsia. Conclusion: The study revealed a decreased urinary calcium creatinine ratio in preeclampsia. So, the urinary calc creatinine ratio can be regarded as a predictor for preeclampsia

Keywords

Preeclampsia; Urinary Calcium Creatinine Ratio.

Preeclampsia articles; Urinary Calcium Creatinine Ratio articles.

Article Details

1. Introduction

Pre-eclampsia is an idiopathic multisystem disorder that causes maternal and fetal morbidity and mortality. It is one of the most common medical disorders obstetricians diagnose in clinical practice [1]. Pregnancy is a normal physiological condition, but its complications are the cause of maternal death of about 600000 every year worldwide [2]. Pre-eclampsia affects approximately 2-8% of pregnancies [3]; predisposing factors are nulliparity, black race, maternal age below 20 or over 35 years, low socioeconomic status, multiple gestation, hydatidiform mole, polyhydramnios, twins, obesity and underlying renal disease [4]. All over the world, pre-eclampsia is the third and seventh leading cause of maternal and perinatal mortality and morbidity, respectively [5]. In developing countries, the reason for maternal mortality for pre-eclampsia is 15-20% [6]. About 16% of maternal deaths are associated with pre-eclampsia in Bangladesh [7]. It is said that pre-eclampsia and eclampsia contribute to the death of a woman every 3 minutes worldwide [8]. Pre-eclampsia (PE) is a pregnancy-specific condition characterized by hypertension and proteinuria occurring after 20 weeks of gestation [5]. It is a serious complication of the second half of pregnancy [9]. Pre-eclampsia may cause maternal mortality and serious morbidity like stroke, convulsion, cerebral and pulmonary oedema, renal failure, hepatic failure, abruption of the placenta and disseminated intravascular coagulation. It also causes fetal complications such as intrauterine growth restriction, stillbirth and iatrogenic prematurity [10]. In severe disease, there is widespread organ dysfunction, especially kidneys, liver and brain. However, the chief target organ is the kidney, and proteinuria and hypertension are the predominant clinical features [11]. In healthy pregnant women, marked glomerular hyperfiltration is seen above normal non-gravid levels by 40 to 60%, primarily due to reduced plasma oncotic pressure (RPF) in glomerular capillaries and elevated renal plasma flow rate (RPF). However, there is a variable degree of renal insufficiency in pre-eclampsia, and GFR and RPF are significantly reduced [12]. One of the most important clinical problems is that complications appear suddenly in pregnant women, and unfortunately, as yet, no definite predictive factor is available [13]. Several potential predictive associated factors have been proposed for pre-eclampsia, ischides markers for liver and renal function, coagulation and fibrinolytic factor, colour Doppler USG, and Doppler velocimetry in the uterine artery. Angiotensin sensitivity test, calcium and calcium creatinine ratio [14]. As the pathogenesis is undefined, none of these methods has been proven ideal for predicting pre-eclampsia because of their complexity, high incidence of false positive results or subjective nature of results in interpretation [15]. Calcium metabolism in pregnancy is a complex process that changes during pregnancy [16]. It increases in all pregnant women, possibly because of increased intestinal absorption of calcium, increased renal filtered load of calcium and increased GFR of pregnancy [17]. Several abnormalities of calcium metabolism have been described in pre-eclampsia, the most important being hypocalciuria, i.e. reduced renal calcium excretion [18]. It is possibly due to reduced dietary intake of calcium, decreased absorption, increased uptake by fetus and placenta, reduced GFR, and increased glomerular calcium reabsorption [19]; women with established pre-eclampsia have been reported to have lower urinary calcium excretion, lower 1, 25 dihydroxycholecalciferol levels, ionized calcium levels, and higher PTH levels than normotensive controls [20]. The placenta contributes approximately 50% of circulating 1, 25 dihydroxycholecalciferol levels in pregnancy. it was postulated that in pre-eclampsia, the defective placenta is unable to produce sufficient levels of 1, 25 dihydroxycholecalciferols, resulting in inadequate gastrointestinal calcium absorption, low ionized calcium levels, and a secondary rise in PTH, which leads to increased intracellular calcium concentration in vascular smooth muscle cells and causes vasoconstriction and hypertension [21]. Low calcium levels may also contribute to hypertension by stimulating renin release from the kidney [22]. Creatinine is a product of muscle metabolism. It is produced nearly constantly and excreted in the urine [23]. Because of its constant production rate, the creatinine in the urine indirectly measures kidney function [24]. The physiologic increase in GFR and blood volume during pregnancy normally results in increased creatinine filtered out of blood and passed into the urine. If the kidneys are affected by pre-eclampsia, the creatinine clearance value decreases in urine because the kidneys filter less creatinine out of the blood [25]. The kidney damage can be estimated by the decrease in the creatinine clearance value [26]. Proteinuria is seen as a sign of many complications. It is used as a diagnostic parameter for several conditions, such as urinary tract infection, chronic kidney disease and pregnancy-related complications like pre-eclampsia [27]. However, the gold standard method for diagnosis of pre-eclampsia is 24-hour proteinuria detection. Measuring 24 hours' urine is time-consuming and has a chance of getting contaminated, causing errors in final estimation and diagnosis, which produces the need for a method which can provide a faster screening method with better accuracy and validity [28]. There is hypercalciuria during a normal pregnancy, while pre-eclampsia is associated with hypocalciuria and a low urinary calcium-creatinine ratio. This phenomenon occurs early enough and persists throughout gestation, so it is useful for the early identification of patients at risk [29]. Since pre-eclampsia represents a state of profound pathophysiological changes and one of the important alterations is a change in urinary calcium creatinine ratio, this test has emerged significantly as the early predictor for the development of pre-eclampsia in pregnant women who are free of symptoms [30]. Several studies implemented in different parts of the world revealed that spot urinary calcium creatinine ratio is a good indicator to detect pre-eclampsia [31]. So, the calcium creatinine ratio of a single voided urine specimen may have an important diagnostic role in managing pre-eclamptic women. Estimating urinary calcium creatinine ratio could be a simpler, quicker, more convenient and less expensive test to assess and predict pre-eclampsia. This study should evaluate the association between urinary calcium creatinine ratio and pre-eclampsia as it requires a specific, low-cost, easy, and quicker test to predict pre-eclampsia.

2. Methodology & Materials

This case-control comparative study was conducted at the Department of Obstetrics & Gynecology in Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Singleton pregnant women with pre-eclampsia in their third trimesters (29 weeks to 40 weeks) were selected as the case, whereas singleton normotensive pregnant women in their third trimesters (29 weeks to 40 weeks) with no medical or obstetrical disorders were the control group. The study duration was one year, from October 2020 to September 2021. There was no physical, psychological, social or legal risk during the patient history, physical examination and investigations. Proper safety measures were taken at every step of the study. Only the researcher was allowed to access the collected data. Ethical clearance was obtained from the Institutional Review Board (IRB) of MMCH to undertake the current study.

  • Inclusion criteria:
  • Gestational age 29 to 40 weeks.
  • Normal pregnant women as a case.
  • Pregnancy with pre-eclampsia as control.
  • Exclusion criteria:
  • Medical history includes previous history of pre-eclampsia, chronic hypertension, diabetes mellitus, renal diseases, chronic liver disease, and recurrent urinary tract infections.
  • Subject who did not give consent.
2.1 Operational Definition

Pre-eclampsia: Pre-eclampsia is a hypertensive disorder in pregnancy which is characterized by the occurrence of a new set of persistent hypertensions with a new onset of proteinuria or, in the absence of proteinuria, the presence of new-onset end-organ damage, usually after 20 weeks of gestation [32]. Pre-eclampsia without severe feature: Raised blood pressure 2140/90 mm Hg plus 24-hour urine protein greater than or equal to 300mg/24 hour or urine dipstick +1 after 20 weeks of gestation in previously normotensive women. (ISSHP, 2018).

Pre-eclampsia with severe feature: Systolic blood pressure of 160 mm Hg or more, or diastolic blood pressure of 110 mm Hg or more on two occasions at least 4 hours apart (unless antihypertensive therapy is initiated before this time).

2.2 Data collection and analysis:

Data were collected using a structured questionnaire containing all the variables of interest. The questionnaire was finalized following pretesting. All data collection sheets were checked very carefully to identify any errors in collecting data. Data processing consisted of registering schedules, editing, coding, computerizing, preparing dummy tables, and analyzing and matching data. The researcher's matters included the technical matters of editing, code writing, and computerization. After collection, data were entered into a personal computer and then analyzed, plotted, and presented in graphs and tables. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 26.0. P-values less than 0.05 (95% CI) were considered statistically significant.

3. Results

Distribution of maternal age was observed in the study. Maximum participants from both groups belonged to the age group of ≤30 years: 57(81.4%) from the pre-eclampsia group and 51(72.8%) from the normal pregnancy group (Figure 1). The distribution of sociodemographic characteristics among pre-eclampsia and normal pregnancy is shown in Table 1. Women live in urban and rural areas in pre-eclamptic groups 43(61.4%) and 27(38.6%), in regular pregnant groups 37(52.8%) and 33(47.2%). Most women completed secondary school education, 57(81.4%) from the pre-eclamptic group and 41 (58.6%) from the normal pregnant group. More than two-thirds were housewives in both groups, 57(81.4%) in the pre-eclamptic group and 56 (80.0%) in the normal pregnant group. Also, most belonged to low- and medium-income families, 36(51.4%) in the pre-eclamptic group and 31(44.3%) in the normal pregnancy group. Figure 2 represents the distribution of obstetric variables between pre-eclampsia and normal pregnancy. The maximum number of women from both groups were primigravida, which was 56(80.0%) in the pre-eclamptic group and 48(68.7%) in the normal pregnant group. Most women are multipara, 41(58.6%) from the pre-eclamptic group and 45(64.3%) from a normal pregnancy. Table 2, distribution of clinical variables between pre-eclampsia and normal pregnancy, shows that blood pressure was higher in pre-eclampsia without severe feature group 57(81.43%) than in normal pregnancy. Oedema was observed more in pre-eclamptic group 58(82.85%) than in normal pregnancy, and it showed statistically significant. No significant difference was observed concerning proteinuria. The study of urinary biochemical markers in Table 3 shows that a decreased level of urinary calcium was observed more in a pre-eclamptic group than in the normal pregnancy group, 59(84.3%) and 13(18.6%), respectively, which was statistically significant. An average urinary creatinine level was observed among most participants between the two groups. The study of urinary calcium creatinine ratio markers in Table 4 shows that decreased level of urinary calcium creatinine ratio was more found in pre-eclamptic group 57(81.4%) than in normal pregnancy group 10(14.3%), which was statistically significant. Table 5 shows urinary calcium (OR: 23.5, 95% CI: 9.74-56.7) and urinary calcium creatinine ratio (OR: 26.3, 95% CI: 10.6-64.7) are associated with the risk of occurring pre-eclampsia. Multivariate binary logistic regression of significant variables is presented in Table 4.6, which shows decreased urinary calcium level (OR: 22.37, 95% CI: 3.96-24.7, p-value 0.001). Decreased urinary calcium creatinine ratio levels (OR: 25.13, 95% CI: 4.58-27.9, p-value <0.001) are independent risk factors for pre-eclampsia (Table 6).

fortune-biomass-feedstock

Figure 1: Distribution of maternal age among cases & control.

Table 1: Demographical characteristics based on pre-eclampsia & normal pregnancy.

Variables

Pre-eclampsia (n=70)

Normal Pregnancy (n=70) 

P Value

 n

%

 n

%

Residence

Urban

43

61.4

37

52.8

0.305

Rural

27

38.6

33

47.2

Educational status

No formal Education

2

2.8

3

4.3

0.03

Primary

7

10

17

24.3

Secondary

57

81.4

41

58.6

Graduate and above

4

5.8

9

12.8

Occupation

Housewife

57

81.4

56

80

0.397

Service Holder

5

7.2

9

12.9

Student

8

11.4

5

7.1

Economic status

Below medium

25

35.7

23

32.8

0.292

Low medium

36

51.4

31

44.3

Upper medium

4

5.8

11

15.8

Upper status

5

7.1

5

7.1

fortune-biomass-feedstock

Figure 2: Distribution of obstetric variables between pre-eclampsia and normal pregnancy.

Table 2: Distribution of clinical variables among pre-eclampsia & normal pregnancy.

Pre-eclampsia (n=70)

Normal Pregnancy (n=70) 

P Value

 n

%

 n

%

Blood pressure

Normotensive

0

70

100

0.061

Pre-eclampsia without severe feature

57

81.43

0

0

Pre-eclampsia with severe feature

13

18.57

0

0

Oedema

Present

58

82.85

6

8.58

0.0001

Absent

12

17.15

64

91.42

Proteinuria

Negative

0

0

67

95.72

0.082

Trace

22

31.43

3

4.28

 +

20

28.58

0

0

 ++

19

27.14

0

0

 +++

9

12.85

0

0

Table 3: Distribution of urinary biomarkers between pre-eclampsia (n=70) and normal pregnancy (n-70).

Variables

Pre-eclampsia (n=70)

Normal Pregnancy (n=70) 

P Value

 n

%

 n

%

Urinary Calcium

Normal

11

15.7

57

81.4

<0.001

Decreased

59

84.3

13

18.6

Urinary Creatinine

Normal

47

67.2

58

82.8

0.154

Decreased

23

32.8

12

17.2

Table 4: Distribution of urinary calcium creatinine ratio between both groups.

Variables

Pre-eclampsia (n=70)

Normal Pregnancy (n=70) 

P Value

 n

%

 n

%

Normal

13

18.6

60

85.7

<0.001

Decreased

57

81.4

10

14.3

Table 5: Association of clinical and biochemical variables with pre-eclampsia.

Variables

Category

OR*

95% CI**

Urinary Calcium

Decreased Normal

23.5

9.74-56.7

Urinary Ca/Cr

Decreased Normal

26.3

10.6-64.7

Oedema

Present Absent

0.02

0.01-0.05

Table 6: Binary logistic regression of risk factors associated with occurrence of pre-eclampsia.

Variables

Category

OR*

95% CI**

P value***

Urinary Calcium

Decreased Normal

22.37

3.96-24.7

0.001

Urinary Ca/Cr

Decreased Normal

25.13

4.58-27.9

0.001

Discussion

This case-control con-positive study was done in the Obstetrics & Gynecology department of Mymensingh Medical College Hospital. A total of 140 patients, all pregnant women (70 normal pregnant and 70 with pre-eclampsia), were taken by purposive non-random sampling; patients attending the OPD in the third trimester of gestation and admitted into the indoor of Mymensingh Medical College Hospital were the study population. The cases were selected according to inclusion and exclusion criteria. Different aspects of the study population were assessed. Regarding demographic variables, the maximum number of participants from both groups belonged to the age group of ≤ 30 years, 81.4% from the pre-eclampsia group and 72.8% from the normal pregnancy group, respectively. There was no statistically significant difference (p=0.05). The result was similar to Leppälahti et al.'s (2013) [33]. It has been found that the maximum number of pre-eclampsia women were ≤ 30 years. However, Lamminpää et al. (2012) had a different opinion [34]. They found that women of advanced maternal age (AMA) exhibited more pre-eclampsia (9.4%) than younger women (6.4%). In this study, women of the two groups did not show any significant difference regarding demographic variables like residence, educational status, occupation, or income. These results were similar to the study by Ramesh et al. (2014) [35]. However, according to demographic variables, Tereza et al. (2020) found a significant difference (p=0.002) between pre-eclampsia and the normal pregnant group [36]. Silva et al. (2008) reveal that women with low educational levels were more likely to develop pre-eclampsia (odds ratio 5.12; 95% confidence interval: 2.20, 11.93) than women with high educational levels [37]. Gravity and parity were also found statistically insignificant between pre-eclampsia and the normal pregnant group. Primigravida was noted in 80% of cases of pre-eclampsia and 68.7% of cases of normal pregnant patients. These results correlate well with the study outcome by Marvielet et al. (2008) and Hernandez et al. (2009) [38,39]. These results also correlate well with Qublan et al. (2008) and Duley L et al. (2009), where primigravida was noted in 30 (40%) cases of pre-eclampsia and 25 (33.33%) cases of normal pregnant patients [40,41]. Regarding parity, 58.6% of patients with pre-eclampsia and 64.3% of normal pregnant were multiparas. These results were similar to Kumar et al. (2010) [42]. Significant risk factors were identified in univariate analysis, where multipara women (OR=573) are the significant risk factor of pre-eclampsia. However, Manoj et al. (2017) did not agree with the result [43]. This study found primi parity to be an independent risk factor for the development of pre- (OR 4.51:2.76-736). Regarding clinical variables, no significant difference was observed concerning blood pressure (p>0.05). These results correlate well with the study outcome by Laura et al. (2012) [44]. The distribution of cinema revealed significant differences between the two groups. Oedema was the highest 58 (82.85%) in pre-eclampsia patients than in normal pregnancy. The result was similar to Emily et al. (2020) [45]. Regarding proteinuria, no significant difference was observed between pre-eclampsia and normal pregnancy (p>0.05). The result agreed with Pierre et al. (2019) [46]; regarding the study, proteinuria was more observed in a pre-eclamptic group than in a normal pregnancy. Analysis of urinary biochemical reveals that women with pre-eclampsia did not differ significantly from normal pregnant women regarding urinary creatinine concentration (p> 0.05). The study was comparable to Ingec et al. (2006) [17], which revealed that urinary creatinine concentration did not differ significantly between the two groups. Satya et al. (2009) did not agree with the result [47]. In this study, the mean creatinine clearance in the normal non-pregnant and pre-eclamptic groups was 102.63 ml/min and 71.98 ml/min, respectively, and the difference is significant (p<0.005). In the case of urinary calcium concentra, women showed reduced calcium excretion compared to normal pregnant women (p <0.001), and the results were significant. These results correlate well with the study outcome by Kristen et al. (2017) [38], indicating urinary calcium excretion was lower among women with pre-eclampsia than those with normotensive pregnancies (WMD -158.43, 95% CI -187.95 to 128.92). Another study by Valerie et al. (2005) revealed that Women with pre-eclampsia had significantly lower calciuria than normotensive patients (1.5 mmol/24h+/-1.0 versus 6.0 mmol/24h+/-4.2. p=0.0001) [49]. Vural et al. (2000) conducted a case-control study with 59 patients, concluding that hypocalciuria might be an important feature of pre-eclampsia [50]. Malas et al. (2001) and Bilgin et al. (2000) concluded from their studies that hypocalciuria is an important feature of pre-eclampsia [51-52]. Szmidt et al. (2006) conducted a case-control study that included 47 pre-eclamptic women [18]. A logistic regression analysis investigated the relationship between hypocalciuria and pre-eclampsia. Women with pre-eclampsia had significantly lower akiliria than normotensive patients (15 mmol/24h+/-10 versus 6.0 mmol/24h+/-42, -0.0001), and hypocalciuria was significantly associated with pre-eclampsia (82417442-00001)60.71 in this study calcium-creatinine ratio in a urine sample is evaluated as a predictor of pre-eclampsia. Here, the urinary calcium-creatinine ratio in women with pre-eclampsia is compared with normal pregnant women, and the result is highly significant (p<0.001). The ratio comes in pre-eclampsia patients in comparison to normal pregnant. These results correlate very well with several previous studies. Anjali et al. (2016) revealed that urinary CCR had a sensitivity of 63.63% and a specificity of 94.87%, and urinary CCR will be an effective screening method for pre-eclampsia [53]. Anita et al. (2017) showed that a study was conducted over seven months, and a total of 100 patients were included in the study, out of which 50 were pre-eclamptic patients and (group 1) another 50 belonged to the normotensive group (group 2) [54]. The urinary calcium to creatinine ratio was significantly reduced (t-value=3.57, p=0.0005) in pre-eclampsia patients compared to the normotensive group. Another study by Sinha et al. (2016) found that CCR had a sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of 81.2%, 96.4%, 86.6%, and 94.7%, respectively, with a statistical accuracy of 93.1% and p-value of <0.001 (strongly significant) [55]. It was found to be a good test for the prediction of pre-eclampsia. Similarly, Nagalakshmi et al. (2016) revealed that among the cases, 84% of the patients had CCR ≤0.04, in contrast to 6% of controls with CCR ≤0.04 [56]. The Chi-square (x) value was 58.34, showing that the ratio is highly significant (p<0.0001). Kazerooni et al. (2003) conducted a similar with 102 patients, and the result favoured a significantly lowered calcium-creatinine ratio in pre-eclampsia [9]. Likewise, the outcome of research worked by Szmidt et al. (2006) has also revealed the same results in favour of the present proposition in a case-control study of 47 pre-eclampsia women and 50 controls [18]. Similar findings by Rizk et al. (2007) demonstrated a predictive nature of spot urine calcium/ creatinine ratio in pre-eclampsia [57]. However, Lindita et al. (2021) had the opposite opinion [58]. The study found that the sensitivity of proteinuria as a predictor of pre-eclampsia was 96.6% (P=0.000) and specificity was 21.3%, whereas, for the urine calcium/creatinine ratio, the sensitivity was 87.9% (P=0.000) and the specificity 40.7%, which corresponds to a value of 0.105 (cutoff). So, the role of the calcium/creatinine ratio in urine is inferior to proteinuria in predicting pre-eclampsia Another study outcome by David et al. (2016) reported that on statistical analysis, it was found that when CCR alone is taken as high-risk factor for prediction of pre-eclampsia, p < 0.001 was statistically significant, sensitivity was 80 %, specificity 98.04 % PPV 80 %, NPV 98.04 %, and diagnostic accuracy So this test was satisfactory as an early predictor for development pre-eclampsia.

Limitations of the study: This study is a single-centre, hospital-based investigation primarily focusing on individuals from a particular region. Consequently, the findings presented here may differ significantly from those of broader studies conducted over more extended periods. The sample size was restricted, and the study duration was brief. The research does not compare the urinary calcium-creatinine ratio with other pre-eclampsia screening tools. Furthermore, budgetary constraints may have impacted the scope of the study.

5. Conclusion and Recommendations

This study showed a close relationship between urinary calcium creatinine ratios in e-eclampsia patients. The level of urinary calcium creatinine was significantly decreased in pre-tempting patients compared to normotensive women. This test can be used as a screening tool to predict the development of pre-eclampsia in symptom-free patients. So, measurement of urinary calcium creatinine ratio is a non-invasive, inexpensive and easy-to-carry method for predicting pre-eclampsia and thereby helps initiate prompt education of the patients and timely prophylactic interventions, thus minimizing the severity of pre-eclampsia.

Funding

No funding sources

Conflict of interest

None declared

Ethical approval

The study was approved by the Institutional Ethics Committee

References

  1. Samadi AR, Mayberry RM, Zaidi AA, Pleasant JC, McGhee Jr N, et al., Maternal hypertension and associated pregnancy complications among African-American and other women in the United States. Obstetrics & Gynecology 87 (1996): 557-563.
  2. Memon AR, Memon FW, Akram M, Memon PJ, Rahman I. Association of serum zinc level with pre eclampsia. Liaquat Univ. Med. Heal. Sci 16 (2017): 58-61.
  3. American College of Obstetricians and Gynecologists. Gestational hypertension and preeclampsia: ACOG practice bulletin, number 222 135 (2020): 237-260.
  4. Osman R, Modawe G, AbdElkarim A. Assessment of Iron Status in Pregnant Ladies with Pre-eclampsia. International Journal of Research in Pharmacy and Biosciences 2 (2015).
  5. Nahar K, Islam F, Khan NA. Relationship between severity of hypertension and renal impairment in preeclampsia. Bangabandhu Sheikh Mujib Med Univ J 11 (2018): 213-217.
  6. Shaheen G, Sajid S, Jahan S. Evaluation of coagulation factors and serum ferritin in preeclamptic Pakistani women. J Pak Med Assoc 70 (2020): 2048-2050.
  7. Yesmin F, Islam MS, Ferdoushi S, Faisal FM, Rehena Z, et al. Evaluation of Serum Ferritin Concentration in Mild and Severe Pre-Eclamptic Women. Mymensingh medical journal: MMJ 25 (2016): 119-125.
  8. Lin YS, Tang CH, Yang CY, Wu LS, Hung ST, et al., Effect of pre-eclampsia–eclampsia on major cardiovascular events among peripartum women in Taiwan. The American journal of cardiology 107 (2011): 325-330.
  9. Kazerooni T, Hamze-Nejadi S. Calcium to creatinine ratio in a spot sample of urine for early prediction of pre-eclampsia. International Journal of Gynecology & Obstetrics 80 (2003): 279-283.
  10. Musa J, Mohammed C, Ocheke A, Kahansim M, Pam V, et al., Incidence and risk factors for pre-eclampsia in Jos Nigeria. African health sciences 18 (2018): 584-595.
  11. Solomon CG, Seely EW. Preeclampsia—searching for the cause. New England Journal of Medicine 350 (2004): 641-642.
  12. Moran P, Baylis PH, Lindheimer MD, Davison JM. Glomerular ultrafiltration in normal and preeclamptic pregnancy. Journal of the American Society of Nephrology 14 (2003): 648-652.
  13. Qublan HS, Ammarin V, Bataineh O, Al-Shraideh Z, Tahat Y, et al., Lactic dehydrogenase as a biochemical marker of adverse pregnancy outcome in severe pre-eclampsia. Medical science monitor: international medical journal of experimental and clinical research 11 (2005): CR393-397.
  14. Magann EF, James Jr N. The laboratory evaluation of hypertensive gravidas. Obstetrical & gynecological survey 50 (1995):138-145.
  15. Meads CA, Cnossen JS, Meher S, Juarez-Garcia A, Ter Riet G, et al., Methods of prediction and prevention of pre-eclampsia: systematic reviews of accuracy and effectiveness literature with economic modelling.
  16. Power ML, Heaney RP, Kalkwarf HJ, Pitkin RM, Repke JT, et al,. The role of calcium in health and disease. American journal of obstetrics and gynecology. 1999 Dec 1;181(6):1560-9.
  17. Ingec M, Nazik H, Kadanali S. Urinary calcium excretion in severe preeclampsia and eclampsia. Clinical Chemistry and Laboratory Medicine (CCLM) 44 (2006): 51-53.
  18. Szmidt-Adjidé V, Vendittelli F, David S, Brédent-Bangou J, Janky E. Calciuria and preeclampsia: a case-control study. European Journal of Obstetrics & Gynecology and Reproductive Biology 125 (2006):193-198.
  19. Ramos JG, Costa SH, Kessler JB, Costa CA, Barros EJ. Calciuria and preeclampsia. Brazilian journal of medical and biological research. Ribeirão Preto, SP 31 (1998):  519-522.
  20. McGrowder DA, Williams A, Gordon L, Crawford T, Alexander-Lindo RL, et al., Hypocalciuria in pre-eclampsia and gestational hypertension due to decreased fractional excretion of calcium. Archives of medical science 5 (2009): 80-85.
  21. Sanchez-Ramos L, Gillen G, Zamora J, Stenyakina A, Kaunitz AM. The protein-to-creatinine ratio for the prediction of significant proteinuria in patients at risk for preeclampsia: a meta-analysis. Annals of Clinical & Laboratory Science 43 (2013): 211-220.
  22. Seely EW. Calciotropic hormones in preeclampsia: a renewal of interest. The Journal of Clinical Endocrinology & Metabolism 92 (2007): 3402-3403.
  23. Myers GL, Miller WG, Coresh J, Fleming J, Greenberg N, et al., Recommendations for improving serum creatinine measurement: a report from the Laboratory Working Group of the National Kidney Disease Education Program. Clinical chemistry 52 (2006): 5-18.
  24. Moran P, Baylis PH, Lindheimer MD, Davison JM. Glomerular ultrafiltration in normal and preeclamptic pregnancy. Journal of the American Society of Nephrology 14 (3): 648-652.
  25. Hladunewich M, Karumanchi SA, Lafayette R. Pathophysiology of the clinical manifestations of preeclampsia. Clinical Journal of the American Society of Nephrology 2 (3): 543-549.
  26. Magann EF, James Jr N. The laboratory evaluation of hypertensive gravidas. Obstetrical & gynecological survey 50 (1995): 138-145.
  27. Dong X, Gou W, Li C, Wu M, Han Z, et al., Proteinuria in preeclampsia: Not essential to diagnosis but related to disease severity and fetal outcomes. Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health 8 (2017): 60-64.
  28. Steinhäuslin F, Wauters JP. Quantitation of proteinuria in kidney transplant patients: accuracy of the urinary protein/creatinine ratio. Clinical nephrology 43 (1995): 110-115.
  29. Anai T, Hirota Y, Yoshimatsu J, Oga M, Miyakawa I. Hypocalciuria in women with preeclampsia. Nihon Sanka Fujinka Gakkai Zasshi 44 (1992): 28-32.
  30. Aggarwal N, Suri V, Soni S, Chopra V, Kohli HS. A prospective comparison of random urine protein-creatinine ratio vs 24-hour urine protein in women with preeclampsia. The Medscape Journal of Medicine 10 (2008): 98.
  31. Huikeshoven FJ, Zuijderhoudt FM. Hypocalciuria in hypertensive disorder in pregnancy and how to measure it. European Journal of Obstetrics & Gynecology and Reproductive Biology 36 (1990): 81-85.
  32. Mateus J, Newman R, Sibai BM, Li Q, Barton JR, et al., Massive urinary protein excretion associated with greater neonatal risk in preeclampsia. American Journal of Perinatology Reports 7 (2007): e49-58.
  33. Leppälahti S, Gissler M, Mentula M, Heikinheimo O. Is teenage pregnancy an obstetric risk in a welfare society? A population-based study in Finland, from 2006 to 2011. BMJ open 3 (2013): e003225.
  34. Lamminpää R, Vehviläinen-Julkunen K, Gissler M, Heinonen S. Preeclampsia complicated by advanced maternal age: a registry-based study on primiparous women in Finland 1997–2008. BMC pregnancy and childbirth 12 (2012): 1-5.
  35. Ramesh K, Gandhi S, Rao V. Socio-demographic and other risk factors of pre eclampsia at a tertiary care hospital, karnataka: case control study. Journal of clinical and diagnostic research: JCDR 8 (2014): JC01.
  36. Macedo TC, Montagna E, Trevisan CM, Zaia V, de Oliveira R, et al., Prevalence of preeclampsia and eclampsia in adolescent pregnancy: A systematic review and meta-analysis of 291,247 adolescents worldwide since 1969. European Journal of Obstetrics & Gynecology and Reproductive Biology 248 (2020):177-186.
  37. Silva LM, Coolman M, Steegers EA, Jaddoe VW, Moll HA, et al., Low socioeconomic status is a risk factor for preeclampsia: the Generation R Study. Journal of hypertension 26 (2008):1200-1208.
  38. Merviel P, Touzart L, Deslandes V, Delmas M, Coicaud M, et al., Risk factors of preeclampsia in single pregnancy. Journal de gynecologie, obstetrique et biologie de la reproduction 37 (2008): 477-482.
  39. Hernández-Díaz S, Toh S, Cnattingius S. Risk of preeclampsia in first and subsequent pregnancies: prospective cohort study. Obstetric Anesthesia Digest 30 (2010): 98-99.
  40. Qublan H, Amarin Z, Dabbas M, Farraj AE, Beni-Merei Z, et al., Low-molecular-weight heparin in the treatment of recurrent IVF–ET failure and thrombophilia: a prospective randomized placebo-controlled trial. Human fertility 11(2008): 246-53.
  41. Duley L. The global impact of pre-eclampsia and eclampsia. InSeminars in perinatology \ 33 (2009): 130-137.
  42. Ganesh KS, Unnikrishnan B, Nagaraj K, Jayaram S. Determinants of pre-eclampsia: a case–control study in a district hospital in South India. Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine 35 (2010): 502.
  43. Verma MK, Kapoor P, Yadav R, Manohar RK. Risk factor assessment for pre-eclampsia: a case control study. International Journal of Medicine and Public Health 7 (2017): 172-177.
  44. Reyes LM, García RG, Ruiz SL, Camacho PA, Ospina MB, et al., Risk factors for preeclampsia in women from Colombia: a case-control study. PloS one 7 (2012): e41622.
  45. Dessources K, Aviki E, Leitao Jr MM. Lower extremity lymphedema in patients with gynecologic malignancies. International Journal of Gynecologic Cancer 30 (2020).
  46. Robillard PY, Dekker G, Scioscia M, Bonsante F, Iacobelli S, et al., Increased BMI has a linear association with late-onset preeclampsia: A population-based study. PloS one 14 (2019): e0223888.
  47. Prakash S, Sharma N. Creatinine clearance as a marker for diagnosing the severity of preeclempsia. International Journal of Pharmaceutical Sciences and Research 4 (2013):1488.
  48. McMaster KM, Kaunitz AM, Burbano de Lara P, Sanchez-Ramos L. A systematic review and meta-analysis of hypocalciuria in pre-eclampsia. International Journal of Gynecology & Obstetrics 138 (2017): 3-11.
  49. Szmidt-Adjidé V, Vendittelli F, David S, Brédent-Bangou J, Janky E. Calciuria and preeclampsia: a case-control study. European Journal of Obstetrics & Gynecology and Reproductive Biology 125 (2006):193-198.
  50. VURAL P, AKGÜL C, CANBAZ M. Calcium and phosphate excretion in preeclampsia. Turkish Journal of Medical Sciences 30 (2000): 39-42.
  51. Malas NO, Shurideh ZM. Does serum calcium in pre-eclampsia and normal pregnancy differ?. Saudi medical journal. 2001 Oct 1;22 (10): 868-871.
  52. Bilgin T, KUTLU Ö, KIMYA Y, KÜÇÜKKÖMÜRCÜ S, UNCU G. Urine calcium excretion in preeclampsia. Türkiye Klinikleri Jinekoloji Obstetrik Dergisi 10 (2001): 29-32.
  53. Munge AM, Satia MN. Urinary calcium to creatinine ratio to predict preeclampsia and use of calcium supplementation to prevent preeclampsia. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 5 (2016):1380-1386.
  54. Anita V, Adma HS. Urinary calcium to creatinine ratio in preeclampsia-a comparative study. J Med Sci Clin Res. 2017;5 (2017): 23582-23586.
  55. Sinha R, Bhushan I. Study of urinary calcium/creatinine ratio (ccr) in a spot sample of urine for early prediction of preeclampsia. J Dent Med Sci 15 (2016): 101-104.
  56. Divya Lakshmi A. Lactic acid dehydrogenase and uric acid-biochemical markers for pre eclampsia-eclampsia (Doctoral dissertation, Stanley Medical College, Chennai).
  57. Rizk DE, Agarwal MM, Pathan JY, Obineche EN. Predicting proteinuria in hypertensive pregnancies with urinary protein-creatinine or calcium-creatinine ratio. Journal of perinatology 27 (2007): 272-277.
  58. Ibrahimi L, Paçarada M, Hoxha SL, Bimbashi A, Ibishi VA. Role of calcium/creatinine ratio in urine compared with proteinuria and uric acid in predicting preeclampsia: a study from Kosovo. Medical Science Monitor Basic Research 27 (2021): 929845-929851.

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