title: Urinary dipstick protein: a poor predictor of absent or severe proteinuria.
abstract: OBJECTIVE
  Our purpose was to compare urinary protein dipstick values with standard 24-hour urinary protein excretion in women with hypertension in pregnancy.
  
  
  METHODS
  Urinary protein dipstick determinations and concurrent 24-hour urinary protein excretion measurements were compared by review of 300 urine samples obtained from women with hypertension in pregnancy.
  
  
  RESULTS
  One hundred twenty-three samples had negative to trace protein on dipstick on two occasions at least 6 hours apart. Eight-one (66%) of these patients had significant proteinuria (> or = 300 mg per 24 hours). Seventy-six samples revealed 3+ to 4+ protein on dipstick in at least two samples. Of these, 27 (36%) had heavy proteinuria (> or = 5 gm per 24 hours), and 42 (55%) had nephrotic range proteinuria of > or = 3.5 gm per 24 hours. One hundred one patients had urine dipstick values of 1+ to 2+, of whom 89 (88%) had significant proteinuria.
  
  
  CONCLUSIONS
  Urinary protein dipstick values > or = 1+ have a positive predictive value of 92% (162/177) for predicting > or = 300 mg per 24 hours. In contrast, a dipstick of negative to trace should not be used to rule out significant proteinuria because its negative predictive value is only 34% (42/123) in hypertensive patients. Moreover, urine dipstick values of 3+ to 4+ should not be used to diagnose severe preeclampsia because their positive predictive value is only 36% (27/76).
authors.affiliation: Department of Obstetrics and Gynecology, University of Tennessee, Memphis 38103.
authors.forename: N L
authors.initials: NL
authors.lastname: Meyer
authors.forename: B M
authors.initials: BM
authors.lastname: Mercer
authors.forename: S A
authors.initials: SA
authors.lastname: Friedman
authors.forename: B M
authors.initials: BM
authors.lastname: Sibai
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000652:urine*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011507:Proteinuria / Q000175:diagnosis* / Q000209:etiology / Q000652:urine; D012189:Retrospective Studies; D016482:Urinalysis / Q000379:methods*