Outcome of pregnancy in patients with isolated proteinuria.

PURPOSE OF REVIEW: The outcome of pregnancy in patients with isolated proteinuria is believed to be favorable. However, whether women with isolated proteinuria are at risk for progressing to preeclampsia has not been extensively studied.

RECENT FINDINGS: The amount of proteinuria is thought to increase in the early third trimester, irrespective of whether preeclampsia has been diagnosed. A dipstick urinalysis has a poor sensitivity (ranging from 22 to 86%) for the detection of significant proteinuria (> or = 0.3 g/day). Measurements of the levels of circulating angiogenic factors such as soluble fms-like tyrosine kinase 1, soluble endoglin, vascular endothelial growth factor, and placental growth factor suggest that gestational proteinuria is a mild variant of preeclampsia. In one study, women with isolated proteinuria (> or = 0.3 g/day) were found to be more likely to progress to preeclampsia than women with isolated hypertension. A considerable number of women with eclampsia exhibited proteinuria alone during their last antenatal visit performed within a week prior to their first convulsion.

SUMMARY: The outcome of women with a retrospective diagnosis of gestational proteinuria is generally favorable. However, a considerable number of women with isolated proteinuria develop hypertension and progress to preeclampsia. Therefore, the statement that the 'outcome of pregnancy in patients with isolated proteinuria is favorable' is misleading. Physicians should be aware of this type of preeclampsia when counseling patients. One possible explanation for the difficulty in diagnosing this form of preeclampsia might be the low sensitivity of the dipstick urinalysis technique for the detection of significant proteinuria.