Nephrotic and Non-nephrotic range Proteinuria in Preeclampsia and Obstetric outcomes

Shrayasi Ghosh, T Parvathi, Haritha Sagili, Zachariah Bobby

Objective:  To compare the pregnancy outcome among preeclamptic women with nephrotic and non-nephrotic range proteinuria  

Design: A Prospective Cohort Study

Method: The study was conducted at a tertiary care hospital in India from January 2021 to December 2022. After taking informed written consent, 278 women diagnosed with preeclampsia as per ACOG 2020 guidelines were included. Participants with Chronic hypertension, Pre-existing renal disease, lupus nephritis, urinary tract infections, and pre-existing proteinuria before 20 weeks of gestation were excluded. Recruited women into two groups in 1: 4 ratios, i.e., 56 women in group A with nephrotic range proteinuria (≥3.5g in 24 hours urine or urine protein creatinine ratio ≥3.5) and 222 women in group B with non-nephrotic range proteinuria (300mg-<3.5 g protein in 24-hour urine or urine protein creatinine ratio <3.5). Following delivery, all women were followed till discharge from the hospital. Maternal and Perinatal outcomes were recorded. Data were analysed using SPSS software version 19.0. A p-value <0.05 was taken as statistically significant.

Results: Among 278 women in the study, the baseline characteristics (age, gravidity, gestational weight gain, plurality) were comparable in both groups. The women with nephrotic range proteinuria had a higher risk of eclampsia (RR 4.29, 95% CI 2.07-8.89, p<0.01), HELLP syndrome (RR 6.79, 95% CI 2.8-16.46, p<0.01), Abruption (RR 4.95   95% CI 2.05-11.97, p<0.01), Pulmonary oedema (RR 5.94 95% CI 2.55-13.84, p<0.01), Acute Kidney Injury (RR 4.75 95% CI 1.5-15.02, p 0.003) and Retinal detachment (RR 23.78 95% CI 2.92-193.5, p <0.01). There was a significantly increased risk of stillbirth, Small for gestational age, and NICU admission in nephrotic range proteinuria than in non-nephrotic range proteinuria.

Conclusions: The study results show that preeclamptic women with nephrotic range proteinuria were associated with poor maternal and perinatal outcomes compared to non-nephrotic range proteinuria.