spot urine PCR test

[Betheney]

So I am now 33.5 weeks pregnant and was diagnosed at 29.5 weeks with gestational hypertension.

However now at 33.5 my body stopped responding to my 200mg of labetalol bi-daily and my BP was consistently staying up around the 140-160/100-110 so I was admitted to hospital for medication review changed to 200mg of labetalol 4 times daily and bloods and urine were tested. Bloods came back all clear... but the urine...

Now you ladies might not be able to help me because I'm in Australia where they favor the PCR spot urine test over the 24hr test. But my doctor in hospital said a normal person should have a reading of .03 and mine is .06 he said its enough to diagnose preeclampsia. I can't find anywhere online what this result really is... everything I find has completely different numbers. I asked my midwife who said many hospitals use many diff ways of recording and reading results. But I still just can't find ANYTHING and I just want to know how bad this .06 is. I thought maybe the doctor got it wrong and I done have PE but the doctor the next morning agreed that with those readings I have PE. I thought maybe I miss heard the results but on my discharge papers it says PCR spot urine .06

Like I said its unlikely any of you will be able to help but they seriously never do 24hr urine tests here.

[tracym]

Hi, I'm in Australia too (SA). Mind you it's been a while since I was pg, my youngest is nearly 8...but when I was in hospital prior to delivery with her the midwives seemed to think the spot PCR was becoming the standard for diagnosis, however the Professor of Obstetrics was of the opinion that a 24 hour was more accurate. The PCR is certainly useful to see whether an elevated level of protein is likely to be present, which would then generally be followed up by a 24 hour.

It depends how your results are reported, but I would think that .06 PCR is equal to 600mg in a 24 hour. What are the reference ranges on the report? Any spot tests are dependent on time of day...I'd still request a 24 hour just so you know.

Good luck x

[Betheney]

I did find a few studies where they claim the spot PCR is more accurate, i also found this online. Althought i know this is from the UK but maybe that's why my doctors prefer the PCR test

"Alternatively the concentration of protein in the urine may be compared to the creatine level in a spot urine sample. This is termed the protein/creatinine ratio (PCR). The 2005 UK Chronic Kidney Disease guidelines states PCR is a better test than 24 hour urinary protein measurement."

When you said "Any spot tests are dependent on time of day..." does that mean it depends on how concentrated my urine is... because i went to the bathroom and came out and they said "okay we'd love a urine sample for our test now" i explained that i just went and so don't have any urine to give, so i drank as much water as possible and went to the toilet an hour later for them and gave them a sample, my urine was the total opposite to concentrated and didn't have much colour at all. But then the midwife i chatted to said it didn't really work like that and the concentration of pee or how long it's been since you've been to the bathroom doesn't make a difference.

I wondered if it was the equivelant of 600mg in the 24 hr but when preeclampsia is diagnosed at a level above 300 wouldn't 600 be an incredibly high reading wouldn't it. I mean that would mean my kidneys are pretty darn screwed wouldn't it.

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[tracym]

Hi

600mg in a 24 hour is not insignificant...but not at all high. Mine was 6000+ when it was checked a week prior to delivery and I've heard of others higher still...but not long after that my kidneys really started to struggle and almost stopped producing urine altogether which was what ultimately got me delivered at 33 weeks.

Any spot test will produce results based on the concentration of your urine at the time. The lab won't care, they can still do the test...but first morning urine is always preferable.

Are you going public? You should be seeing a dr now you have a diagnosis if you're not already...when do you go back? Ask them to repeat the test, which they probably will be planning to do anyway.

[Betheney]

Yeah I asked the midwife today about the reading she said it does mean 600 in the readings that I read online. I have read a lot of posts from women who say they're readings are like 280, 250 and it's difficult to get a PE diagnosis so I thought 600 sounded crazy high. But when I talked to the midwife today she said it is high and definitely preeclampsia.I said what does that mean for my kidneys I don't want them to be falling apart when does the protein in urine get so high it itself forces delivery and she said one woman this week it hit 5000 and they delivered her so that's about when. So yes I can now see just like you said while 600 is high it's not mind blowingly high and we got a while until then.

When I got PIH at 29 weeks I was transferred to a high risk maternity clinic. They have me going to twice weekly CTGs and ultrasounds which check fluid levels and umbilical flow. I also have once fortnightly ultrasounds. So as it is I already have tonnes of monitoring so that won't change they just said the only thing that will change will be I will now have once weekly blood tests as well.

In my original post I was actually 32.5 weeks and I'm 33 weeks today. The change from 200mg bi-daily to 200mg four times daily may have worked for the hospital stay but now two days later at another routine check up its back right up around 150; 160/108-110 with one reading of 145/100. So I'm back in hospital for another med review. They've decided to give me 300mg labetalol 4 times daily but the first dose has had no impact an hour later and it was 150/110 it seems I take a while to respond to the labetalol so they've given me an extra 100mg so in a sense making the last dose 400mg which will hopefully bring it down NOW while the 300mg starts to really kick in.

Thank you so much for your replies and support. I'm so lost and a little upset at the moment. Second time in a week I've been admitted for med review and I'm not going to be out tomorrow and it's my daughter's 2nd birthday

[alexis]

300 in 24 hours is considered diagnostic for preeclampsia (along with blood pressure over 140/90). So 600 may sound low in comparison to people with protein in the thousands, but it is still preeclampsia, and well over the diagnostic level. "Severe" vs "mild" is not always a useful distinction but protein is only one of the things used to diagnose that, as well.

Delivery isn't timed solely according to protein level--it's about risk to you and the baby (vs. benefits of staying in) and that risk may go up while your protein levels are still at the lower end of the range. In addition, preeclampsia is unpredictable--it may worsen very slowly over time, or it may progress rapidly. (I went from negative dipstick to protein in the thousands in 2 weeks.)

I'm glad you're being monitored closely.

[Betheney]

Thanks for the info!! Very helpful.

I've noticed my urine yesterday and today has been crazy concentrated. I could definitely be drinking more water but it's still pretty concentrated for the length of time between pees and the amount I am drinking.

Should I ask them to retest my urine? In case it's gotten worse? It's the kidneys that also cause edema isn't it? I still don't have any swelling at all. Last night my fingers seem to of swollen and I nearly couldn't get my wedding rings off but by this morning my hands look normal again

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[Betheney]

For those following my story.....

My BP shot up and I was admitted to hospital for a med review and so a urine test on Tuesday showed I had .06 protein which is the equivalent of 600 in the 24hrs test

I was put back in hospital Friday because my BP had shot up again so I completed a 12hrs urine test on Saturday and the results came back this morning (Sunday) I was told it was 3800! And that to make it the 24hrs equivalent I have to double it to 7600....

The nurse gave me my results so I have to wait for a doctor. She said they have a meeting at 8am (in 1.5hours) and they'll probably come and see me first.

[alexis]

That is a very rapid increase. I'm glad you went back in. Thinking of you and your baby.

[Betheney]

Ok so an update, sorry if it's out of context a bit, it's a summary I sent a friend and have copy pasted here.

What an effing rollercoaster

I finally had a doctor who has seen me before and who I know isnt an idiot. She said my initial spot urine test that gave me a reading of 0.06 and I was told a reading above 0.03 is preeclampsia IS NOT the same measurement as the 12hrs urine test where I got a 0.38

So because I know preeclampsia is diagnosed at 300mg per 24hrs. I assumed .03 = 300mg and so .38 is 3800 and the midwife said i had to double it because it was only 12hrs so for 24hrs it's .76 which I thought was 7600. So the doctor said NO not only does it not have to be doubled but the .38 is the equivalent of 380 NOT 3800.

So I've gone from thinking it's 7600 to having it be 380. Lol. Even if it does need to be doubled 760 also doesn't warrant immediate delivery.

So now I know my kidneys are not being damaged as each day goes by and delivery is not imminent. The midwife yesterday obviously got the figures a lil mixed as she was the one who got me onto the idea my readings were crazy crazy high.

But now that I KNOW the kidneys aren't bad at all. I wonder why the head midwife thinks I'll only last another 1-2weeks. When the doctor said the other day I could go for a lot more weeks.

Not having one straight opinion and answer sucks so much. One doctor said max 37, next doctor said she would never say that it could be 37, 38, 39 if things stay stable. Then I went back into hospital but nothing had changed diagnosis wise my BP just needed to be brought back down. But yet this head midwife has given me 1-2weeks.

Mind * much? Lol.

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