MICROALBUMINURIA AS AN EARLY PREDICTOR OF PREECLAMPSIA IN THE PRE-GESTATIONAL DIABETIC POPULATION

M ZEN1,2, S PADMANABHAN1,  W CHEUNG1,2,  A KIRBY1, S JESUDASON 4, T  ALAHAKOON1,3, V LEE1,2
1Westmead Hospital, Westmead, Australia, 2University of Sydney, Sydney, Australia, 3Westmead Institute for Maternal & Fetal Medicine, Westmead, Australia, 4Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia

Background: Microalbuminuria is an established marker of endothelial cell dysfunction and micro-vascular disease, and a hallmark of diabetic nephropathy. Outside of pregnancy, uACR is a well-validated tool in the diagnosis and prognosis of renal disease. In contrast, little is known about the utility of uACR in predicting adverse pregnancy outcomes within the obstetric population.
Aim: To determine if microalbuminuria can be used as a predictive marker of preeclampsia (PE) and adverse pregnancy and neonatal outcomes in women with pre-existing diabetes and to compare the prognostic utility of urinary albumin to creatinine ratio (uACR) and urinary protein to creatinine ratio (uPCR) and their ability to predict PE.
Methods: This is a multicentre prospective cohort study of 158 women with pre-existing diabetes. A spot uPCR and uACR was performed in each trimester and pregnancy and fetal outcomes were investigated using linear and logistic regression models and receiver operating characteristic (ROC) curves.
Results: Increasing levels of both uPCR and uACR in trimester 3 were associated with the occurrence of PE (p = 0.007, 0.010 respectively). In the 113 patients with normal pregnancy uPCR (<30mg/mmol) in trimester 1, microalbuminuria was found to be predictive of PE (p = 0.01) and need for operative delivery (p = 0.03).
Conclusions: In women with pre-existing diabetes, uPCR and uACR have similar ability to diagnose PE, but microalbuminuria demonstrates prognostic ability at a much earlier gestation, prior to the onset of other signs or symptoms of PE. We therefore suggest that assessing microalbuminuria rather than overt proteinuria in trimester 1 provides prognostic information in women with pre-existing diabetes and that early diabetic nephropathy confers a worse prognosis compared to diabetes without nephropathy.


Biography:
Dr Zen is an obstetric fellow at Westmead Hospital. Her current research interest is in prediction, pathogenesis and outcomes of preeclampsia.

About ANZSN

The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

Conference Managers

Please contact the team at Conference Design with any questions regarding the Annual Scientific Meeting

© 2015 - 2016 Conference Design Pty Ltd