Re: hypocalciuria in hipertensive disorders

From: ainsron@msn.com
Thu Mar 2 14:18:55 2000

I agree with you that uric acid is almost always elevated in pre-eclampsia, due to changes in glomerular filtration. This has been recognized since long before any of us were practicing obsetrics. However, even Williams Obstetrics points out that this elevation is "generally of little practical value for diagnosis, management or prognosis." Like many other discussions on this list have pointed out, we often do things because of habit and training that have little supporting data.

>At Thu, 2 Mar 2000, ainsron@msn.com wrote:
>>>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 disagree. There are many patients with a clinical picture which may
>be compatible with preeclampsia yet the signs, symptoms and lab values
>are not indicative. In those circumstances one needs all the help one
>can get in order to make the proper diagnosis. Serum uric acid and
>urinary calcium excretion are both tests which have helped me personally
>make clinical decisions. For example; urinary calcium excretion in
>normal pregnancy is approximately 350-600 mg/volume. Patients with
>preeclampsia often have values <40 mg/volume. Very few condition will
>lead to such a decrease in calcium excretion. I have found uric acid to
>be of assistance in helping with the diagnosis in an otherwise confusing
>case. I have been fortunate enough to train and practice in a
>geographic are with a high incidence of preeclampsia/eclampsia. Believe
>me, these two tests help. Perhaps in a private OB practice with middle
>class patients and a low incidence of preeclampsia they may not be as
>helpful.
>
>LSR

--
Ronald E. Ainsworth, MD



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