Proteinuria During Acute Pyelonephritis In Pregnancy

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.

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:

1. Fever > 100.4

2. Costovertebral angle tenderness

3. 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