Contents
What is proteinuria?
Proteinuria refers to the “abnormal” presence of protein in the urine. Usually, the urine contains virtually no protein, because these are filtered upstream by the kidneys. The presence of protein in the urine therefore means that the kidneys can no longer fulfill their role of filter. However, it is not only kidney damage that can cause proteinuria: a urinary tract infection, hypertension or diabetes can also cause protein to be present in the urine.
The best known protein found in urine isalbumin. We often speak ofalbuminurie to denote an excess of albumin in the urine, and a fortiori to suggest proteinuria.
We think that the normal proteinuria level in healthy adults is between 0,5 and 1 g / l per 24 hours (i.e. between 50 and 100 mg / l). If a first urine sample reveals excess proteinuria, a 24-hour urine collection can confirm and refine the diagnosis. If proteinuria is found, examinations and additional follow-up will be undertaken.
Pregnancy monitoring: what are urine tests for?
The presence of excess protein in the urine is usually asymptomatic. Also, unless you have regular urine tests, there is no way to tell if proteinuria is normal or not. As during pregnancy, proteinuria can be associated with a health problem threatening both the fetus and the mother-to-be, so it is customary for pregnant women to perform urinalysis every month to check for proteinuria.
Note that the protein level in the urine is generally higher than normal, and preached 200 mg / l per 24 hours in the first trimester. But monitoring for proteinuria is essential throughout pregnancy.
Note that medical analysis laboratories generally set the limit around 150 mg / l, i.e. 0,15 g / l, but this is the limit outside pregnancy. In pregnant women, additional analyzes (collection and measurement of urine over 24 hours, blood pressure monitoring) will often be prescribed. from 0,3 g / l (or 300 mg / l), but it may depend on the doctor or midwife who is monitoring the pregnancy, and the patient’s history.
Too high proteinuria during pregnancy can also be linked to a urinary tract infection. To rule out or confirm this diagnosis, a cytobacteriological examination of the urine (ECBU) may be prescribed.
It should be noted that the urine analyzes performed during pregnancy monitoring also aim to measure the glycosurie, that is to say the level of glucose (sugar) in the urine, in order to diagnose possible gestational diabetes.
Proteinuria during pregnancy: what are the risks
The major risk associated with too high proteinuria during pregnancy ispre-eclampsie, or toxémie gravidique. It is a serious complication of pregnancy due to a dysfunction of the placenta, which is characterized by high blood pressure, proteinuria, sudden weight gain with edema, and other symptoms associated or not (flies in front of the eyes, headaches, abdominal pain…).
If one preeclampsia can theoretically occur at any stage of pregnancy, it is more frequent in the third trimester, a period when it is therefore necessary to be extra vigilant in terms of monitoring proteinuria and blood pressure. Because preeclampsia is a risky situation for both the future mother and the future baby. Placental abruption with risk of hemorrhage, cerebral hemorrhage, eclampsia crisis (convulsions with loss of consciousness), intrauterine growth retardation (IUGR) are among the serious complications of preeclampsia.
To avoid these complications, the management depends on the progress of the pregnancy, but the best “treatment” remains the induction of childbirth, if the term of pregnancy allows it to be considered. If preeclampsia occurs too early during pregnancy, antihypertensive drugs, rest or even hospitalization for close monitoring are offered.