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Re: hypocalciuria in hipertensive disordersFrom: ainsron@msn.comThu Mar 2 19:24:11 2000
At Thu, 2 Mar 2000, Luis Sanchez-Ramos, MD wrote: > >At Thu, 2 Mar 2000, ainsron@msn.com wrote: >>>I agree with you that uric acid is almost always elevated in pre-eclampsia, due to changes in glomerular filtration<< > >>>we often do things because of habit and training that have little supporting data<< > >Well, if is "almost always elevated in preeclampsia" it must be helpful >for diagnosistic purposes. Does Williams Obstetric present supporting >data for the statement that uric acid is of little value? >By the way, many believe that uric acid is elevated in preeclampsia >because it is a scavenger for oxy-radicals not because of changes in >GFR. The ACOG technical bulletin on hypertensive disorders of pregnancy do not suggest uric acid as a useful diagnostic test. As we all know, pre-eclampsia can mimic many other diseases processes, ITP, etc. and sometimes it takes a little time to sort it out. I've not seen a clinical situation where I would be forced to act simply because the uric acid was elevated or jumped from 6 to 10 and no other evidence suggested worsening toxemia. On the other hand if the LFTs rose, the platelet count dropped, the proteinuria jumped or the blood pressures skyrocketed, I wouldn't need any corroborating evidence to move towards stabilization and delivery of the patient. No where on the classification of PIH do I see elevated or rising uric acid as distinguishing pre-eclampsia from severe pre-eclampsi or HELP syndrome. Mishell doesn't mention uric acid either, in "Management of Common Problems in Obstetrics & Gynecology," 3rd ed.
-- Ronald E. Ainsworth, MD
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