Natriuria and calciuria levels in preeclampsia

a cross-sectional study

Authors

  • Rose Gasnier Universidade Federal do Rio Grande do Sul and Hospital de Clínicas de Porto Alegre
  • Edimárlei Gonsales Valério Universidade Federal do Rio Grande do Sul and Hospital de Clínicas de Porto Alegre
  • Janete Vettorazzi Universidade Federal do Rio Grande do Sul and Hospital de Clínicas de Porto Alegre
  • Sérgio Hoffmeister Martins-Costa Universidade Federal do Rio Grande do Sul and Hospital de Clínicas de Porto Alegre
  • Elvino Guardão Barros Universidade Federal do Rio Grande do Sul and Hospital de Clínicas de Porto Alegre
  • José Geraldo Lopes Ramos Universidade Federal do Rio Grande do Sul and Hospital de Clínicas de Porto Alegre

Keywords:

Pregnancy, high-risk, Pre-eclampsia, Hypertension, pregnancy-induced, Natriuresis, Diagnosis, differential

Abstract

CONTEXT AND OBJECTIVE: Sodium excretion abnormalities in preeclampsia have been studied in relation to several factors. The objective of this study was to compare natriuria (mEq/24 h) and calciuria levels (mg/24 h) in preeclamptic patients. DESIGN AND SETTING: An analytical cross-sectional study with a control group was conducted in the obstetric center and the high-risk pregnancy outpatient clinic at a university hospital in southern Brazil, and in a primary healthcare unit in the same city, including pregnant women with mild preeclampsia, severe preeclampsia or chronic hypertension, and women with normal pregnancies (14 patients in each group). METHOD: Natriuria was measured using an ion-selective electrode in an automated clinical chemistry analyzer (Hitache 917, Roche). All the patients collected 24-hour urine, at home or at the hospital, for analysis of proteins, creatinine, calcium, sodium and uric acid. Quantitative variables with asymmetrical distribution were described using the median, minimum and maximum, and were compared using the Kruskal-Wallis test. The results were logarithmically transformed, with one-way analysis of variance (ANOVA) by ranks and then the post-hoc Tukey test, and were analyzed by means of the Spearman correlation and receiver operating characteristic (ROC) curve. The significance level used was 0.05. RESULTS: There were significant differences between the groups in comparing severe preeclampsia with chronic hypertension and severe preeclampsia with controls (P < 0.0001 for both measurements). CONCLUSION: Natriuria levels may be lower in preeclampsia when associated with calciuria. Natriuria assessment is an additional test for differential diagnosis of hypertensive diseases in pregnancy, but is a poor predictor when used alone.

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Author Biographies

Rose Gasnier, Universidade Federal do Rio Grande do Sul and Hospital de Clínicas de Porto Alegre

MD. Gynecologist and Obstetrician, Hospital de Clínicas de Porto Alegre (HCPA), Department of Obstetrics and Gynecology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.

Edimárlei Gonsales Valério, Universidade Federal do Rio Grande do Sul and Hospital de Clínicas de Porto Alegre

MD. Gynecologist and Obstetrician, Hospital de Clínicas de Porto Alegre (HCPA), Department of Obstetrics and Gynecology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.

Janete Vettorazzi, Universidade Federal do Rio Grande do Sul and Hospital de Clínicas de Porto Alegre

MD. Gynecologist and Obstetrician, Hospital de Clínicas de Porto Alegre (HCPA), Department of Obstetrics and Gynecology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.

Sérgio Hoffmeister Martins-Costa, Universidade Federal do Rio Grande do Sul and Hospital de Clínicas de Porto Alegre

MD. Gynecologist and Obstetrician and Professor, Hospital de Clínicas de Porto Alegre (HCPA), Department of Obstetrics and Gynecology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.

Elvino Guardão Barros, Universidade Federal do Rio Grande do Sul and Hospital de Clínicas de Porto Alegre

MD, PhD. Nephrologist and Professor, Hospital de Clínicas de Porto Alegre (HCPA), Department of Obstetrics and Gynecology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.

José Geraldo Lopes Ramos, Universidade Federal do Rio Grande do Sul and Hospital de Clínicas de Porto Alegre

MD. Gynecologist and Obstetrician and Professor, Hospital de Clínicas de Porto Alegre (HCPA), Department of Obstetrics and Gynecology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.

References

Lindheimer MD, Umans JG. Explaining and predicting preeclampsia. N Engl J Med. 2006;355(10):1056-8.

Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet. 2005;365(9461):785-99.

Brown MA, Wang J, Whitworth JA. The renin-angiotensin-aldosterone system in pre-eclampsia. Clin Exp Hypertens. 1997;19(5-6):713-26.

Tihtonen KM, Kööbi T, Vuolteenaho O, Huhtala HS, Uotila JT. Natriuretic peptides and hemodynamics in preeclampsia. Am J Obstet Gynecol. 2007;196(4):328.e1-7.

Graves SW. Sodium regulation, sodium pump function and sodium pump inhibitors in uncomplicated pregnancy and preeclampsia. Front Biosci. 2007;12:2438-46.

Reis ZSN, Cabral ACV, Barra JS, et al. Pressão arterial e concentração plasmática do peptídeo atrial natriurético e do peptídeo natriurético tipo B, em gestações complicadas pela pré-eclâmpsia [Influence of atrial natriuretic peptide and type B natriuretic peptide plasma levels on arterial pressure in pregnancies complicated by preeclampsia]. Rev Bras Gynecol Obstet. 2003;25(6):413-8.

Cunningham FG, Gant NF, Leveno KJ, et al. Hypertensive disorders in pregnancy. In: Cunningham FG, Gant NF, Leveno KJ, et al (eds.). Williams Obstetrics. 21st ed. United States of America: McGraw-Hill Companies; 2001. p. 567-618.

McGrowder DA, Williams A, Gordon L, et al. Hypocalciuria in pre- eclampsia and gestational hypertension due to decreased fractional excretion of calcium. Archives of Medical Science. 2009;5(1):80-5. Available from: http://www.termedia.pl/Hypocalciuria-in-pre-eclampsia-and-gestational-hypertension-due-to-decreased-fractional-excretion-of-calcium,19,12290,0,1.html. Accessed in 2012 (Aug 7).

Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee. Diabetes Care. 1998;21 Suppl 2:B161-7.

Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol. 2000;183(1):S1-S22.

Kaisiske BL, Keane WF. Laboratory assessment of renal disease: clearance, urinalysis, and renal biopsy. In: Brenner B, Rector M, editors. The kidney. Philadelphia: WB Saunders: 1996. p. 1137-74.

Ramos JG, Martins-Costa SH, Kessler JB, Costa CA, Barros E. Calciuria and preeclampsia. Braz J Med Biol Res. 1998;31(4):519-22.

Cavalli RC, Sandrim VC, Santos JET, Duarte G. Predição de pré-eclâmpsia [Preeclampsia prediction}. Rev Bras Ginecol Obstet. 2009;31(1):1-4.

Szmidt-Adjidé V, Vendittelli F, David S, Brédent-Bangou J, Janky E. Calciuria and preeclampsia: a case-control study. Eur J Obstet Gynecol Reprod Biol. 2006;125(2):193-8.

Ramos JGL, Martins-Costa S, Vettorazzi-Stuczynski J, et al. Níveis de calciúria em gestantes com pressão arterial elevada [Calciuria levels in pregnant women with high blood pressure]. Revista HCPA. 2000;20(2):103-7. Available from: http://www.hcpa.ufrgs.br/downloads/RevistaCientifica/2000/2000_2.pdf. Accessed in 2012 (Aug 7).

Ingec M, Nazik H, Kadanali S. Urinary calcium excretion in severe preeclampsia and eclampsia. Clin Chem Lab Med. 2006;44(1):51-3.

Frenkel Y, Barkai G, Mashiach S, et al. Hypocalciuria of preeclampsia is independent of parathyroid hormone level. Obstet Gynecol. 1991;77(5):689-91.

Halhali A, Díaz L, Avila E, et al. Decreased fractional urinary calcium excretion and serum 1,25-dihydroxyvitamin D and IGF-I levels in preeclampsia. J Steroid Biochem Mol Biol. 2007;103(3-5):803-6.

Seely EW, Wood RJ, Brown EM, Graves SW. Lower serum ionized calcium and abnormal calciotropic hormone levels in preeclampsia. J Clin Endocrinol Metab. 1992;74(6):1436-40.

Rio SMP, Melo VH, Godoy P, Yokota M. Alterações ultra-estruturais do glomérulo na pré-eclâmpsia [Ultrastructural glomerular alterations in preeclampsia]. Rev Bras Ginecol Obstet. 2004;26(3):185-92.

Puschett JB. The role of excessive volume expansion in the pathogenesis of preeclampsia. Med Hypotheses. 2006;67(5):1125-32.

Rizk DE. A study of alpha-human atrial natriuretic peptide in normal pregnancy and in pre-eclampsia. J Obstet Gynaecol. 1997;17(3):234-8.

Khraibi AA. Renal interstitial hydrostatic pressure and sodium excretion in hypertension and pregnancy. J Hypertens Suppl. 2002;20(3):S21-7.

Averina IV, Tapilskaya NI, Reznik VA, et al. Endogenous Na/K-ATPase inhibitors in patients with preeclampsia. Cell Mol Biol (Noisy-le-grand). 2006;52(8):19-23.

Adair CD, Haupert GT Jr, Koh HP, et al. Erythrocyte sodium/potassium ATPase activity in severe preeclampsia. J Perinatol. 2009;29(4):280-3.

Stoupakis G, Klapholz M. Natriuretic peptides: biochemistry, physiology, and therapeutic role in heart failure. Heart Dis. 2003;5(3):215-23.

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Published

2013-03-03

How to Cite

1.
Gasnier R, Valério EG, Vettorazzi J, Martins-Costa SH, Barros EG, Ramos JGL. Natriuria and calciuria levels in preeclampsia: a cross-sectional study. Sao Paulo Med J [Internet]. 2013 Mar. 3 [cited 2025 Mar. 14];131(2):106-11. Available from: https://periodicosapm.emnuvens.com.br/spmj/article/view/1289

Issue

Vol. 131 No. 2 (2013)

Section

Original Article

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