protein-how high is high?

[bacheak]

I was just wondering this for future use. I see so many posts where people were at 1+ protein and induced. I had been at 4+ protein since being "diagnosed". Was at 2+ before that at home but the nurse read it as trace and said that was fine. What are the guidelines for what is a dangerous level of protein (with swelling and high bp). What does the protein actually mean? Is it because the kidneys aren't working well? If so, do they just recover on their own. Last time I checked a couple of weeks ago (4 weeks after delivery) I still had 2+ protein in my urine. The doctor said that was okay it would eventually go away. Why is it still there? Any thoughts? thanks.

Bonnie (Ashley 37 weeks 3 days PE on 11/14/03)

[bacheak]

follow up question-why the edema? I gained 10 lbs the last week before they did the c section. I had only gained 21 lbs the first 7 months and some and then gained 25 more in the last 5 weeks. Why does preeclampsia cause fluid gain? Is it the kidneys? Just want to understand what happened to me. Maybe it will help resolve things in my mind. I guess I always thought I would make it to my due date even though the dr said I'd be in within a week (after diagnosis) to deliver. I really lasted 2 1/2 weeks after diagnosis (4 1/2 after I actually got it because I remember the weekend I swelled up and my bp went up at home and the protein showed up). I know no one knows what causes preeclampsia but what about the symptoms of it?

Bonnie (& Ashley)

[ileana]

Hi Bonnie,

You normally should have the protein as Negative. A Trace is also acceptable.
+1 becomes an alarm sign, and a +2 or more is enough to diagnose preeclampsia.

The dipstick is a qualitative result, not quantitative, and not very precise as it depends on the time of the day and the concentration of urine. It can give both false positives and false negatives.

The women that were induced at a +1 were most likely having high blood pressure or had preeclampsia before or where late enough in pregnancy that the baby and mother would be better delivered than pregnant just waiting for preeclampsia to happen. There is no reason to wait for a full blown preeclampsia or maybe HELLP when the baby's lungs are mature enough to survive outside.

A more precise measurement of protein is the 24h test, where they ask you to pee in a jar for a whole day. This measurement can be:
- <150 mg / 24h - normal
- 150-300 mg/24h - elevated
- >300 mg/24h - preeclampsia is diagnosed
- >3000 mg/24h - nephritic range (kidneys are seriously damaged that a nephrologist should be consulted)
- >5000 mg/24h - severe preeclampsia is diagnosed.

The kidneys should filter almost all the protein in the blood. When they don't it is the first sign that they are having a problem.

Once you have preeclampsia, it is expoected to have remaining protein in urine after delivery until the kidneys are completely healed. My doctor had me wait for 6 months before having another 24h, and as it was still abnormal send me to a nephrologist.

In order to allow the kidneys to heal, you need to keep the blood pressure low at all times. The 140/90 limit for the blood pressure in a patient without kidney disease or diabetes or other chronic disease is decreased to 130/80 for someone with kidney disease.

Now, you need to know that a +2 doesn't mean you have a kidney disease. They ususally diagnose this at levels higher than 1000 mg/24h, but you need to watch it. (I only have about 220mg, and all I do is take a blood pressure medicine to keep the PBs in control).

My doctor advised me to not try to get pregnant again before the kidneys heal completely, but I had it really severe and awfully early.

Hope this helps. I am not a doctor, but the above might help you to have a more meaningfull dicussion with your doctor.

How's Ashley doing? Hope you have great holidays!



Ileana 33
Angel stillborn 24w p-e 2/17/03

[ileana]

On your follow-up, the edema can be caused by the kidneys not excreting enough fluid because they don't work well.

In preeclampsia, the blood vessels become very weak and the plasma leaks out in the tissue. This is where the edema comes from.
Also they had very hard time drawing blood from me. They said this is normal in preeclampsia as well.

Believe me, 37 w is great. Going more than that with preeclampsia would have been really dangerous! Is Ashley healthy?

Ileana 33
Angel stillborn 24w p-e 2/17/03

[bacheak]

Yes Ashley is great and has been from the beginning except a little jaundice. It's hard to believe that my body could be going through so much and she was still perfectly healthy. Thanks for all the information. I never understood what caused anything. They never did a 24 hour urine test on me. I wonder why. Was it just because I was far enough along to deliver? Wouldn't blood show the same thing?

[ileana]

Yes, isn't it amazing how these kids are doing so great even when things aren't right?

I too think that they did not do a 24h on you because it was already late enough that baby could be delivered.

The blood tests have a creatinine measurement as well, that can show if things are going wrong (kidneys are failing), but a better measurement is the creatinine clearance which calculates the difference between the urine creatinine and the blood creatinine - how much is eliminated vs. how much remains in the blood... if one decreases, the other one will increase, so eventually the blood creatinine will get high. The creatinine clearance calculation is included in the 24h... they also draw blood when you get the urine jar. My blood creatinine was normal even when I had 7g of protein in urine... (I suppose I wasn't that sick [:p])


Have a great New Year!


Ileana 33
Angel stillborn 24w p-e 2/17/03