Optimal bedside urinalysis for the detection of proteinuria in hypertensive pregnancy: a study of diagnostic accuracy.
OBJECTIVE
To compare semi-quantitative visual and automated methods of urine testing with fully quantitative point of care urinalysis for the detection of significant proteinuria (0.3 g/24 hours) in pregnancy complicated by hypertension.


METHODS
A prospective comparative study.


METHODS
A large teaching maternity hospital.


METHODS
One hundred and seventy-one pregnant women referred to the obstetric day-care unit for assessment of newly arisen hypertension.


METHODS
Early morning urine specimens were tested with four dipstick techniques (Multistix 8SG visual and automated and microalbumin/creatinine ratio visual and automated; Bayer, Elkhart, USA) as well as a fully quantitative measure of the microalbumin creatinine ratio with the DCA 2000 (a point of care assay for albumin; Bayer). These results were compared to a 24-hour urine protein measurement and measures of diagnostic accuracy/prediction are reported.


METHODS
Significant proteinuria (> or =0.3 g/24 hours) measured by laboratory assay.


RESULTS
Automated dipstick urinalysis using the Clinitek 50 has significantly better predictive values for significant proteinuria (LR(+) 4.27, 95% CI 2.78 to 6.56; LR(-) 0.225, 95% CI 0.14 to 0.37) than conventional visual dipstick urinalysis (LR(+) 2.27, 95% CI 1.47 to 3.51; LR(-) 0.635, 95% CI 0.49 to 0.82). Dipstick microalbumin/creatinine ratio testing did not improve overall detection rates with automated or visual testing. Fully quantitative point of care measurement of albumin/creatinine ratio (ACR) was significantly better than any dipstick technique (LR(+) 14.6, 95% CI 6.74 to 31.8; LR(-) 0.069, 95% CI 0.030 to 0.16).


CONCLUSIONS
This study confirms that in pregnancy automated dipstick urinalysis is a more accurate screening test for the detection of proteinuria than visual testing. ACR testing can offer a significant improvement over conventional urinalysis if a fully quantitative method of detection is employed that uses pregnancy-specific thresholds. Dipstick assessment of ACR does not improve the detection rate of significant proteinuria.
Waugh
Jason J S
JJ
Reproductive Science Section, Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester Royal infirmary, Infirmary Square, Leicester LEI SWW, UK.
Bell
Stephen C
SC
Kilby
Mark D
MD
Blackwell
Claire N
CN
Seed
Paul
P
Shennan
Andrew H
AH
Halligan
Aidan W F
AW
D000328:Adult; D003631:Day Care, Medical; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000652:urine*; D019095:Point-of-Care Systems / Q000592:standards*; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000592:standards*; D011446:Prospective Studies; D011507:Proteinuria / Q000175:diagnosis*; D012372:ROC Curve; D011934:Reagent Strips / Q000592:standards; D012680:Sensitivity and Specificity; D016482:Urinalysis / Q000592:standards*
D011934:Reagent Strips