Proteinuria During Acute Pyelonephritis In Pregnancy

Study Overview
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Brief Summary
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The purpose of this research study is to compare the amount of protein excreted by the kidneys in a 24-hour period between patients who have a kidney infection and those who do not have a kidney infection.

Detailed Description
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Preeclampsia is a pregnancy-unique disorder that is cured only with delivery of the baby, even if the pregnancy is premature. Defined by both blood pressure and proteinuria criteria, diagnosis is often obscured by renal processes like systemic lupus erythematosus or nephrotic syndrome that increase urinary protein spillage. Proteinuria is defined as a total protein urinary excretion exceeding 300 mg in a 24-hour urine collection in pregnancy. This is suggested to be double the protein excretion in the non-pregnancy population at 150 mg/day. A mean 24-hour urine protein excretion of 204.3 mg (± 92.5) was found in the non-hypertensive pregnant population. Physiological changes in pregnancy predispose patients to urinary tract infections; ureteral compression by the gravid uterus, progesterone-mediated slowing of ureteral peristalsis and decreased bladder tone, and mechanical compression of the bladder contribute to impaired clearance of bacteria from the urinary tract. Indeed, acute cystitis complicates 2-4% of all pregnancies. While it has been said that urinary tract infections increase proteinuria, it is unknown how much protein spillage should be expected in the general or the pregnant populations. Hence a patient with pyelonephritis may obscure the diagnosis of preeclampsia if she spills urinary protein from her infection. The purpose of this study is to compare the mean of 24-hour urine protein in pregnant patients with and without acute pyelonephritis. The importance of this study will be to determine if urine protein excretion is in fact increased in the setting of pyelonephritis. This will allow for reliable evaluation of urine protein during the work up for preeclampsia in those women also found having a kidney infection.

Official Title
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Quantitating Proteinuria During Acute Pyelonephritis In Pregnancy

Conditions
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Proteinuria

Intervention / Treatment
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* Other: Exposure to pyelonephritis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women ≥ 18 years old admitted at Miller Children and Women's Hospital Long Beach Memorial Medical Center Gestational age between 20 weeks and 0 days to 41 weeks and 0 days Singleton pregnancy Pyelonephritis group: meeting 2 out of 3 criteria: Fever > 100.4 Costovertebral angle tenderness Positive urine culture - without pyelonephritis group: without acute cystitis and pyelonephritis Positive culture defined as: quantitative count of ≥ 100,000 CFU/mL or single catheterized urine specimen with quantitative count of 100 CFU/mL. Exclusion Criteria: Chronic hypertension Pre-gestational diabetes Autoimmune disorders Preexisting renal disease Multiple gestation Vaginal bleeding Preeclampsia Hospital admission > 3 days

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Pyelonephritis Group<br>patients with pyelonephritis | Other: Exposure to pyelonephritis<br>* Pyelonephritis group are patients with exposure to pyelonephritis Without pyelonephritis group are patients without pyelonephritis<br>|
| Without pyelonephritis Group<br>patients without pyelonephritis | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 24-hour urine protein | urine protein will be measured upon patient enrollment to the study (i.e. during the study enrollment hospitalization) | 7 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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urine protein, pregnancy, pyelonephritis, kidney infection