2021-09-08 10:55:42
Pregnant women know it well: every month, without interruption, they must collect their urine and bring them back to the laboratory for analysis the presence or absence of proteins.
Proteinuria, what is it exactly?
“Proteinuria is the presence of proteins and in particular albumin, at the time of the analysis, in the urine of the future mother”, simply explains Dr. Cyril Huissoud, gynecologist-obstetrician at the CHU de la Croix-Rousse. In Lyon. ” If the presence of albumin is present in small quantities in a healthy individual, it tends to increase in pregnant women, which is normal. On the other hand, too high a proteinuria, beyond the threshold, indicates kidney and kidney filter dysfunction and maybe the first sign of pre-eclampsia. It is therefore necessary to ensure this regularly,” he continues.
What is the right proteinuria level during pregnancy? When to worry?
You should know that the proteinuria threshold in pregnant women is higher than in a healthy person in normal times. Thus, if the threshold to be monitored in a normal person is set at 150 mg per 24 hours, in pregnant women in contrast, a condition that induces a change in protein filtration, the concentration of protein in urine should not exceed 300 mg/ 24 hours. It is only beyond this threshold that we are concerned.
Pregnancy: how to measure proteinuria and albumin?
There are two complementary examinations to measure the urine protein level : a simple examination with a quick result, screening, carried out monthly; another, longer to refine the result when the concentration is too high.
A screening on the sample of a urine stream
This is the simplest and quickest examination to perform but is only a screening: it involves testing the urine stream each month to obtain, via a strip, or by a laboratory assay a fairly general assessment of the proteinuria level. The analysis is often coupled with glycosuria. If the proteinuria level exceeds the set threshold, the pregnant woman is then prescribe a 24-hour test.
A dosage made over 24 hours
In order to refine a screening result which may raise questions, we can then set up a 24-hour urine test, i.e. the collection of all patient urine over a 24-hour period, from one morning to the next. The 24-hour test results in a quantified rate in milligrams / 24 hours. It is this which gives a precise indication of whether or not there is a malfunction. If the rate is acceptable, routine monitoring continues monthly without further hassle. If the rate is too high, other complementary analyses, in particular on blood pressureshould be done quickly.
How to react in case of high proteinuria?
The first attitude to adopt is to quickly consult your obstetrician which will set up surveillance adapted to the situation and the quantity of proteins detected.
If the proteinuria proves to be too high, the pregnant woman may be hospitalized and a premature birth may be considered depending on the risks involved, explains Dr. Huissoud.
“If isolated proteinuria, called pregnancy nephropathyit can be set up biological monitoring in hospital or at home, associated with the visit of a midwife every day. But beware, isolated proteinuria can also progress to pre-eclampsia”. Hence the need for increased monitoring.
What are the risks of excessive proteinuria in pregnant women?
If the search for proteins and albumins is simple to carry out, it is on the other hand very important for the health of the mother as for that of the baby.
If the proteinuria is too high, the mother’s blood pressure should be checked quickly, specifies the obstetrician. Because if proteinuria can indicate an isolated kidney problem, it can also be a sign of preeclampsia, a risky situation.
Preeclampsia
The pre-eclampsia or toxaemia of pregnancyis a pathology of pregnancy characterized in particular by a kidney dysfunction associated with a increased blood pressure usually occurring following 20 weeks of pregnancy (although it can occur at any stage of pregnancy, even in the first trimester). According to Inserm (source 1), 40,000 women are affected each year in France, ie approximately 5% of pregnancies. Pathology is also responsible for second leading cause of maternal death in France. Under supervision, most women with preeclampsia deliver a healthy baby and recover well. On the other hand, a untreated preeclampsia that was not caught in time can lead to stunted growth of the baby, premature birth, or even death of the mother and/or child.
The evolution of physiological and clinical signs can also help detect pre-eclampsia. Throughout her pregnancy, the pregnant woman must be monitored, especially in the event of:
All these signs should lead you to consult quickly.
How to lower protein in urine when pregnant?
Unfortunately, there is no no means or treatment to lower the protein level in maternal blood and urine during pregnancy. In the case of pre-eclampsia, the way to stop this phenomenon, and to save the mother and the child, is toterminate the pregnancyin planning a birth sometimes premature. “Fortunately, in the majority of cases, pre-eclampsia is late, following 34 weeks of pregnancyi.e. in the 8th month, it is therefore possible to give birth to the child in complete safety”, reassures the doctor.
Proteinuria at the end of pregnancy: and following?
If proteinuria is detected before the 20th week of pregnancy, it may be a sign of a kidney problem, isolated or not. “In this case, it is advisable to set up special monitoring, even beyond birth, advises the doctor. Kidney function and blood pressure should normalize following pregnancy, it is important for the woman’s health to ensure this”.
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