Nephrotic Range Proteinuria in Preeclampsia Associated With Adverse Pregnancy Outcomes in Comparison to Non-nephrotic...

To compare pregnancy outcomes among pre-eclamptic women with nephrotic and non-nephrotic range proteinuria.

This prospective cohort study was conducted from May 2021 to December 2022 at a tertiary care university hospital in South India. We included a total of 278 women diagnosed with preeclampsia, 56 with and 222 without nephrotic range proteinuria in a 1:4 ratio, respectively. The relative risks (RR) of core maternal and perinatal adverse outcomes for preeclampsia among the two groups were compared. Using logistic regression analysis, we calculated the odds ratio adjusted for maternal characteristics (aOR).

The women with nephrotic range proteinuria had a higher risk of eclampsia (RR 4.29, 95% CI 2.07-8.89, p<0.01), hemolysis, elevated liver enzymes, low platelet (HELLP) syndrome (RR 6.79, 95% CI 2.8-16.46, p<0.01), abruptio placentae (RR 4.95, 95% CI 2.05-11.97, p<0.01), pulmonary oedema (RR 5.94 95% CI 2.55-13.84, p<0.01), acute kidney injury (RR 4.75 95% CI 1.5-15.02, p 0.003), retinal detachment (RR 23.78 95% CI 2.92-193.5, p <0.01), stillbirth (RR 7.48 95% CI 3.52-15.89, p<0.001), small for gestational age (RR 1.45 95% CI 1.27-1.65, p <0.001), respiratory support (RR 2.06 95% CI 1.12-3.76, p<0.02) and neonatal mortality (RR 3.3 95% CI 1.04-10.43, p 0.04) compared to non-nephrotic range proteinuria. Most of the women with nephrotic proteinuria had early-onset preeclampsia (64.28% versus 36.03%, p<0.01), increasing the risk of prematurity and neonatal morbidity and mortality.

In women diagnosed with preeclampsia, the nephrotic range proteinuria was associated with poor maternal and perinatal outcomes and should be considered as a predictor of adverse pregnancy outcomes.