Re: The end of dipsticks?
From: art fougner, md (evsono@pipeline.com)
Mon Nov 14 20:25:24 2005
The abstract did not contain anything substantive re proteinuria.
art
At Mon, 14 Nov 2005, Anna Meenan, MD wrote:
>
>What do y'all think?
>
>--
> Anna Meenan, MD, FAAFP
>
>Routine dipstix for protein and glucose at each antenatal visit is not
>needed
>
>To identify the scientific evidence to support routine urine screening
>for gestational diabetes and preeclampsia, researchers in Maine, USA
>searched Medline (1966-2004), the Cochrane review, AHRQ National
>Guideline Clearinghouse, the Institute for Clinical Systems Improvement,
>and Google, for studies on proteinuria or glycosuria in pregnancy. They
>found 6 studies investigating glycosuria as a predictor for gestational
>diabetes mellitus, or proteinuria as a predictor for preeclampsia (1
>examined both). Because every study used different dipstick methods of
>determining results, or definitions of abnormal, each was evaluated
>separately.
>
>They found "Glycosuria is found at some point in about 50% of pregnant
>women; it is believed to be due to an increased glomerular filtration
>rate. The renal threshold for glucose is highly variable and may lead
>to a positive test result for glycosuria despite normal blood sugar.
>High intake of ascorbic acid or high urinary ketone levels may result in
>false-positive results. Four published studies assessed the value of
>glycosuria as a screen for gestational diabetes. All used urine
>dipsticks. Three of the four most likely overestimate the sensitivity
>of glycosuria for predicting gestational diabetes."
>
>The researchers concluded "Routine dipstick screening for protein and
>glucose at each prenatal visit should be abandoned. Women who are known
>or perceived to be at high risk for gestational diabetes or preeclampsia
>should continue to be monitored closely at the discretion of their
>clinician"
>
>The Journal of Family Practice November 2005. Vol. 54, No. 11©2005
>Dowden Health Media
>No need for routine glycosuria/proteinuria screen in pregnant women.
>William A. Alto, MD, MPH. Correspondence to William A. Alto
>waalto@dartmouth.edu
>
>Category W. Pregnancy, Childbirth, Family Planning, U. Urinary System,
>T. Endocrine/Metabolic/Nutritional. Keywords: antenatal, screening,
>glycosuria, proteinuria, preeclampsia, diabetes, literature review.
>Synopsis edited by Dr Jim Vause, Blenheim, New Zealand. Posted on
>Global Family Doctor 15 November 2005
>
--
art fougner, md
"I knew I was going to take the wrong train, so I left early."
Lawrence Peter Berra
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