A comparison of the inactive urinary kallikrein:creatinine ratio and the angiotensin sensitivity test for the prediction of pre-eclampsia.
OBJECTIVE
To determine the relation between the inactive urinary kallikrein: creatinine ratio (IUK:Cr) and the angiotensin sensitivity test (AST) at 28 weeks of gestation and to assess each as a screening test for pre-eclampsia.


METHODS
Prospective interventional study.


METHODS
Four hundred and fifty-nine normotensive nulliparous women recruited from hospital antenatal clinics.


METHODS
John Radcliffe Maternity Hospital, Oxford, and Queen Charlotte's and Chelsea Hospital, London.


METHODS
A urine sample for IUK:Cr measurement was provided before performing the AST at 28 weeks of gestation. Those women who demonstrated increased sensitivity to angiotensin II were entered into a randomised placebo controlled trial of low dose aspirin for the prevention of pre-eclampsia (CLASP).


METHODS
The development of pre-eclampsia.


RESULTS
The IUK:Cr ratio was significantly lower in those women who showed increased sensitivity to angiotensin II (P < 0.0001 Student's t test). The sensitivity and specificity for detecting pre-eclampsia were, respectively, 22% and 85% for the AST and 67% and 75% for the IUK:Cr. Low-dose aspirin (60 mg) had no effect on the pregnancy outcome.


CONCLUSIONS
There appears to be some relation between the IUK:Cr and AST tests in pregnancy. However, in this population, the IUK:Cr ratio was a better screening test for pre-eclampsia than the AST, but overall neither test was a powerful predictor for the syndrome.
Kyle
P M
PM
Institute of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, London, UK.
Campbell
S
S
Buckley
D
D
Kissane
J
J
de Swiet
M
M
Albano
J
J
Millar
J G
JG
Redman
C W
CW
D000804:Angiotensin II / Q000378:metabolism*; D003404:Creatinine / Q000652:urine*; D005260:Female; D006801:Humans; D007610:Kallikreins / Q000652:urine*; D011225:Pre-Eclampsia / Q000175:diagnosis* / Q000652:urine; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D000804:Angiotensin II; D003404:Creatinine; D007610:Kallikreins