title: A comparison of podocyturia, albuminuria and nephrinuria in predicting the development of preeclampsia: a prospective study.
abstract: Preeclampsia, a hypertensive multisystem disease that complicates 5-8% of all pregnancy, is a major cause for maternal and fetal mortality and morbidity. The disease is associated with increased spontaneous and evoked preterm birth and remote cardio-renal disorders in the mother and offspring. Thus the ability to predict the disease should lead to earlier care and decreased morbidity. This has led to fervent attempts to identify early predictive biomarkers and research endeavors that have expanded as we learn more regarding possible causes of the disease. As preeclampsia is associated with specific renal pathology including podocyte injury, early urinary podocyte (podocyturia), or the podocyte specific proteinuria nephrin in the urine (nephrinuria), as well as the more easily measured urinary albumin (albuminuria), have all been suggested as predictive markers. We performed a prospective study recruiting 91 pregnant women (78 of whom were high risk) and studied the predictive ability of these three urinary biomarkers. The subjects were recruited between 15-38 weeks of gestation. Fourteen patients, all in the high-risk obstetric group, developed preeclampsia. The levels of podocyturia, nephrinuria, and albuminuria were variably higher in the high-risk pregnant patients who developed preeclampsia. The sensitivities and specificities for podocyturia were 70% and 43%, for albuminuria were 36% and 96%, and for nephrinuria were 57% and 58%, respectively. Also, abnormal nephrinuria (69%) and podocyturia (38%) were detected in low risk women who had uncomplicated gestations; none of these women exhibited albuminuria. In our study, none of the three urinary markers achieved the minimum predictive values required for clinical testing. The lack of excessive albuminuria, however, may indicate a preeclampsia-free gestation. Given a discrepant literature, further studies with larger sample size should be considered.
authors.affiliation: Jacobi Medical Center, Albert Einstein College of Medicine, Department of Nephrology/Medicine, Bronx, New York, United States of America.
authors.forename: Belinda
authors.initials: B
authors.lastname: Jim
authors.affiliation: James J. Peters VA Medical Center, Department of Nephrology/Medicine, Bronx, New York, United States of America.
authors.forename: Swati
authors.initials: S
authors.lastname: Mehta
authors.affiliation: Jacobi Medical Center, Albert Einstein College of Medicine, Department of Nephrology/Medicine, Bronx, New York, United States of America.
authors.forename: Andi
authors.initials: A
authors.lastname: Qipo
authors.affiliation: Providence Alaska Medical Center, Anchorage, Alaska, United States of America.
authors.forename: Kwanghee
authors.initials: K
authors.lastname: Kim
authors.affiliation: Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York, United States of America.
authors.forename: Hillel W
authors.initials: HW
authors.lastname: Cohen
authors.affiliation: Jacobi Medical Center, Albert Einstein College of Medicine, Department of Obstetrics and Gynecology, Bronx, New York, United States of America.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Moore
authors.affiliation: James J. Peters VA Medical Center, Department of Nephrology/Medicine, Bronx, New York, United States of America; Mount Sinai School of Medicine, Department of Nephrology/Medicine, New York, New York, United States of America.
authors.forename: John C
authors.initials: JC
authors.lastname: He
authors.affiliation: Mount Sinai School of Medicine, Department of Nephrology/Medicine, New York, New York, United States of America.
authors.forename: Shuchita
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000150:complications*; D015415:Biomarkers / Q000652:urine; D003404:Creatinine / Q000652:urine; D005260:Female; D006801:Humans; D008565:Membrane Proteins / Q000652:urine*; D050199:Podocytes / Q000473:pathology*; D011225:Pre-Eclampsia / Q000652:urine*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second / Q000652:urine; D011263:Pregnancy Trimester, Third / Q000652:urine; D011446:Prospective Studies; D012306:Risk
chemical_list: D015415:Biomarkers; D008565:Membrane Proteins; C113267:nephrin; D003404:Creatinine