How is proteinuria diagnosed in preeclampsia?

Updated: Nov 29, 2018
  • Author: Kee-Hak Lim, MD; Chief Editor: Ronald M Ramus, MD  more...
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To diagnose proteinuria, a 24-hour urine collection for protein and creatinine should be obtained whenever possible. Up to 30% of women with gestational hypertension who have trace protein noted on random urine samples may have 300 mg of protein in a 24-hour urine collection. [46] Thus, a 24-hour urine protein analysis remains the criterion standard for proteinuria diagnosis. Alternatively, greater than 1+ protein on a dipstick analysis on a random sample is sufficient to make the diagnosis of proteinuria.

Random urine samples can be used to calculate the protein-creatinine ratio. Thresholds of 0.14-0.3 have been proposed for diagnosing proteinuria. [47] However, there is no agreement yet as to the best threshold for identifying pregnant women with significant proteinuria. Moreover, up to 10% of patients with preeclampsia and 20% of patients with eclampsia may not have proteinuria. [48, 49] (HELLP syndrome has been known to occur without hypertension or proteinuria.)

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