Stettler R W, Cunningham F G
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas 75235-9032.
Am J Obstet Gynecol. 1992 Nov;167(5):1219-24. doi: 10.1016/s0002-9378(11)91692-5.
Although the significance of proteinuria is well-documented for pregnancy complicated by preeclampsia or diabetes, protein excretion of up to 300 mg per day is considered normal for uncomplicated pregnancy. Our purpose was to determine the significance of otherwise "asymptomatic" proteinuria identified during pregnancy.
We reviewed the perinatal outcome of 65 pregnancies in 53 women with the following criteria: (1) proteinuria exceeding 500 mg per day, (2) no previously known renal disease, (3) no reversible renal dysfunction, and (4) no evidence for preeclampsia at discovery.
Renal insufficiency coexisted in 62% of women, and 40% had chronic hypertension. Excluding 8 abortions, 53 (93%) of 57 pregnancies resulted in live infants; 45% of infants were delivered preterm and 23% had growth retardation. Of these 57 women, 62% demonstrated clinical evidence compatible with superimposed preeclampsia, and although the incidence of preeclampsia was increased with isolated proteinuria (29%), it was increased even more when there was associated chronic hypertension (incidence 100%) or renal insufficiency (incidence 58%). All 21 women who eventually underwent renal biopsy had histologic evidence of renal disease. To date, with only a limited follow-up of these 53 women, 11 (20%) have progressed to end-stage renal disease.
"Asymptomatic" proteinuria is associated with a number of adverse pregnancy outcomes and serious long-term maternal morbidity.
虽然蛋白尿对于并发子痫前期或糖尿病的妊娠的重要性已有充分记录，但对于未并发疾病的妊娠，每天蛋白质排泄量高达300毫克被认为是正常的。我们的目的是确定孕期发现的其他“无症状”蛋白尿的重要性。
我们回顾了53名女性65次妊娠的围产期结局，其符合以下标准：（1）蛋白尿超过每天500毫克；（2）既往无已知肾脏疾病；（3）无可逆性肾功能障碍；（4）发现时无子痫前期证据。
62%的女性并存肾功能不全，40%患有慢性高血压。排除8例流产，57次妊娠中有53例（93%）分娩活婴；45%的婴儿早产，23%生长受限。在这57名女性中，62%有与叠加子痫前期相符的临床证据，虽然孤立性蛋白尿时子痫前期的发生率增加（29%），但当伴有慢性高血压（发生率100%）或肾功能不全（发生率58%）时增加得更多。最终接受肾活检的所有21名女性均有肾脏疾病的组织学证据。迄今为止，对这53名女性仅进行了有限的随访，11名（20%）已进展为终末期肾病。
“无症状”蛋白尿与多种不良妊娠结局及严重的长期母体发病相关。
