Spot urinary albumin creatinine ratio as a predictor of preeclampsia and dilemma in clinical interpretation

Background: The objective of this study was to evaluate the efficacy of spot urinary albumin creatinine ratio (UACR) as a predictor of preeclampsia and dilemma faced by clinicians in interpretation of lab values expressed in different units, lack of standardization and its further ramifications in long term follow up and prevention of complications of preeclampsia. Wide variation for estimation of UACR leads to confusion in practice guidelines and its interpretation as single International practical information regarding laboratory measurements, calculation, reporting and interpretation doesn’t exist. This prospective randomized study was conducted in Out Patient Department of Obstetrics and Gynaecology in a tertiary care hospital over a period of 1 year after due clearance was obtained from Ethical Committee.Methods: This was prospective study involving 400 ladies reporting for Outpatient ANC services within the given time period as per existing guidelines at a tertiary care hospital. Patients were assessed at first booking visit at 18-20 weeks, and thereafter based on clinical and haematological findings, severity of disease more frequently if desired and were admitted in case of imminent eclampsia. The mean age of the patients was 20.5±0.5 and 24.5±0.5 years and treatment duration were till successful delivery and 06 weeks postpartum for persistent microalbuminuria and exclusion of underlying medical cause for Hypertension. Fetomaternal morbidity and mortality was not a criterion of exclusion.Results: Compared with 24-hour urinary protein excretion, the spot UACR may be a simple, convenient, and accurate indicator of significant proteinuria and future complications in women with preeclampsia with proper and intensive clinical follow up and intervention to prevent feto maternal morbidity and mortality. A strong correlation was evident between spot UACR with high sensitivity and specificity.Conclusions: UACR measurement is a simple, quick, and reasonably reliable method for prediction and assessment of severity of preeclampsia. Spot UACR correlates better than spot UPCR to 24-hour urinary protein excretion to the severity of disease and as predictor of severity of disease