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Re: hypocalciuria in hipertensive disordersFrom: ainsron@msn.comThu Mar 2 09:45:05 2000
Even though we were taught in residency (1975-79) that uric acid is a marker of pre-eclampsia, when did it ever make a difference in how you clinically handle a patient? I would suggest that it never (or rarely) does. I haven't ordered uric acid for many years. In one of the recent ACOG update tapes, V23 #8, when discussing management of hypertensive disorders of pregnancy, the consensus of the discussants regarding laboratory evaluation of HDOP was that only lab tests that really matter in defining the degree of the disease are the platelet count and liver function tests. None of the three panel members ordered it or felt that it was of benefit. >Serum uric acid is a very useful marker of the progress of the >disease - and a lot easier to estimate than collecting a 24 hour >urine for (amongst others) calcium. > >I'm not clear - does urinary excretion of Ca++ increase or >decrease? and does the serum level change in any measurable >way? I looked up this article and was disappointed to find that >there is no value in manipulating Ca++: >N Engl J Med 1997 Jul 10;337(2):69-76 >Steve Raymond > >> I have always liked s. uric acid -- if it starts creeping up-- you have >> a time bomb - at least it has been my experience. At Mon, 28 Feb 2000, >> Luis Sanchez-Ramos wrote: >> >At Sun, 27 Feb 2000, Ronnie Martinez Brignardello wrote: >>>>...what is the real value of knowing....the calciuria in the >>>> management of PHD<< >> >Marked hypocalciuria is characteristic of preeclampsia. Every study >> >that has evaluated urinary calcium excretion >> has shown a significant reduction in excretion. To me it has the same >> value as serum uric acid. it helps with the diagnosis in cases that are >> no "clear cut" or atypical. If you're interested, I will recommend you >> rea a couple of my papers on urianry calcium excretion in preeclampsia. >> Phyllis August was the first to note this finding (N Engl J Med). We >> and several other authors have confirmed it. No, not many people >> utilize it and I don't know why. We order it routinely on all patients >> who undergo 24-hr urine collections in cases of PIH. It has helped me >> tremendously. >> > >LSR > >-- >Steve & Eryl Raymond >P.O. Box 4609 >Empangeni >3880 >
-- Ronald E. Ainsworth, MD
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