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61JOURNAL OF HEALTH SCIENCES 2012; 2 (1)

Journal of Health Sciences www.jhsci.ba Volume 2, Number 1, April 2012

AbstractIntroduction: Preeclampsia is a disease whose etiology is not very clearly explained. The aim of this study

was to investigate the importance of blood urea nitrogen (BUN)/creatinine ratio in diagnosing preeclampsia

and evaluating prognosis.

Methods: The patients in this research were examined and diagnosed in the Department of Obstetrics and

Gynecology, University Clinical Centre of Kosovo. Control group included 25 pregnant women with a normal

blood pressure and with a gestational age of more than 20 weeks, whereas the investigation group included

25 women diagnosed with preeclampsia. The patients were not administered therapy four days before theexamination. For the determination of biochemical parameters we used end point bichromatic enzymatic rate

and enzymatic conductivity rate.

Results: BUN/Creatinine index in the preeclamptic group was 197.7, uric acid 28070 mol/L, lactate dehy-

drogenase 19863 U/L, while the number of platelets was 1955061 x 109/L. In control group BUN/Creatinine

index was 123, lactate dehydrogenase was 16557 U/L, uric acid 19779 mol/La and the platelet number

was 24361 x109/L. Albumin/Globulin index in the preeclamptic group was 0.80.12, whereas in the control

group it was 0.90.16.

Conclusions: BUN/Creatinine ratio in pregnant women with preeclampsia was signicantly increased (t=-

4.14; p=0.00013) in comparison to the control group. It indicates the prerenal source of azotemia. This index

can be important for the evaluation of preeclampsia severity. 2012 All rights reserved

Keywords: preeclampsia, BUN/Creatinine ratio, Albumin/Globulin ratio.

Blood urea nitrogen/creatinine index is a

predictor of prerenal damage in preeclampsiaHidajet Paarizi1*, Luljeta Begolli1, Shefqet Lulaj2, Zana Gafurri1

1Department of Biochemistry, Faculty of Medicine, University of Prishtina, Mother Teresa n.n, 10000 Prishtina , Kosovo2Department of Obstetrics and Gynecology, University Clinical Centre of Kosovo, Mother Teresa n.n, 10000 Prishtina, Kosovo

Introduction

Preeclampsia is a specific state o pregnant women

which involves an increase o arterial blood pres-

sure, accompanied by proteinuria, oedema or

both. Eclampsia, on the other hand, is defined as

a state with convulsion, coma or both in patients

with preeclampsia signs (1-6). Te incidence o

preeclampsia is 5-7% in all pregnancies (1-6).One o the causes o preeclampsia can be consid-

ered the disbalance between prostacyclin (prosta-

glandin I2) and thromboxane A2, an active metab-

olite o arachidonic acid (1,5,6). Tis disbalance

causes vasospasm, a central change in preeclamp-

sia (1). Presence o brain edema at MR imaging in

patients who were presented with preeclampsia-

eclampsia and neurologic symptoms is associated

with abnormal red blood cell morphology and

elevated LDH levels. Tese findings indicate mi-

croangiopathic hemolysis, which suggests endo-

thelial damage, afer 20th week o pregnancy (7).

A number o biochemical and haematological

parameters change in preeclampsia in compari-son to the normal pregnancy (3,8-10). Tereore,

laboratory evaluation o women who develop

hypertension afer midpregnancy is conducted

and it usually includes: haemoglobin and haema-

tocrit determination, blood smear, platelet count,

urinalysis as well as the determination o serum

oxaloacetic transaminase, lactic acid dehydroge-

nase, serum albumin, uric acid and creatinine (7,

9-13). Te literature suggests that no single marker

is currently adequate to predict the developmento preeclampsia and that a combination o indices

would be most effective (14-16). Increased plasma

* Corresponding author: Hidajet Paarizi,Nn Ta 48A/1 Pshtn, Ksv

Phn: +386 49137 239,e-mail: hidajetp@hotmail.com

Stt 29. Fay 2012 / Apt 19. Ap 2012

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62 JOURNAL OF HEALTH SCIENCES 2012; 2 (1)

HidAjeT PAArizi eT Al.: blood ureA NiTrogeN/creATiNiNe iNdex iS A PredicTor oF PrereNAl dAmAge iN PreeclAmPSiA

urea with normal creatinine concentrations givingrise to high ratios may be seen with any o the pre-renal states (17). However, blood urea nitrogen/creatinine has been used as a crude discriminatorbetween prerenal and postrenal azotemia (17-18).Te purpose o this research was to investigatethat BUN/Creatinine index is a preeclampsia pre-dictor together with the other diagnostic param-eters which would help diagnosing, treatment andprognostic evaluation o preeclamptic women.

Methods

Study SubjectsWe have studied 25 pregnant women o the pre-

eclamptic group and 25 patients o control group.Control group has resulted with no symptomsrelated to preeclampsia while in the preeclampticgroup there were pregnant women with preeclamp-sia signs, hypertension, oedema and proteinuria.Te patients were selected in the Obstetrical andGynaecological Clinics o University Clinical Cen-tre o Kosovo, whereas the sample analysis tookplace in the Department o Biochemistry o theFaculty o Medicine, University o Prishtina, dur-

ing 2011. Te women o the preeclamptic groupwere in the gestational age o 20 weeks, with an ar-terial pressure o over 140 mm Hg or the systolicand over 90 mm Hg or the diastolic. Hyperten-sion appeared during pregnancy. Proteins in urinewere over 0.5 g/L. All the patients had oedema olower extremities while 80% had oedema o upperextremities and ace as well. On the other hand,control group included pregnant women with agestational age o over 20 weeks, normal arterialpressure (

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63JOURNAL OF HEALTH SCIENCES 2012; 2 (1)

HidAjeT PAArizi eT Al.: blood ureA NiTrogeN/creATiNiNe iNdex iS A PredicTor oF PrereNAl dAmAge iN PreeclAmPSiA

trogen/Creatinine ratio in the group with a normalblood pressure and the preeclampsia group, as wellas the A/G ratio between the two groups with t-test.

Discussion

Creatinine, urea and uric acid are non-protein ni-trogenous metabolites that are cleared rom thebody by the kidney ollowing glomerular filtration.Measurements o plasma or serum concentrationo these metabolites are commonly used as indi-cators o kidney unction and other conditions

(14,17). Tereore, their determination in serumduring pregnancy is o a major importance to di-agnose kidney unction especially at women withpreeclampsia signs. Tis would be used to evalu-ate kidney unction as well as the possibility o asecondary source o urea or o the nitrogen parto urea increase (Blood urea nitrogen ) in plasma.Te significant difference between arte-rial systolic and diastolic blood pressure be-tween control group and the pregnant wom-

en with preeclampsia signs is clearly shown(t=-20 and or diastolic t= -13 , able 2).Te difference occurs in BUN/Creatinine ratio,

which is characterized with an increase o thisratio in the pathologic group (BUN/Creatine ra-

tio =198) in comparison to control group BUN/Creatinine=123 (t=-3.92; p=0.00027, able 2).Tis can be explained with the occurrence o mi-croangiopathic haemolysis, which is related tothe injury o endothelium in the group with pre-eclampsia changes (Fig. 1, 1,4,8,20-24,27- 28). Asa consequence, urea synthesis in liver would beincreased as well as the incapability o kidneys toexcrete urea rom blood with such a high concen-tration. Tis way we would have a more complete

data. Tere is no significant difference between theA/G ratio o control group and the preeclampticone, although a tendency or a decrease is seen inthe group with preeclampsia (able 3). Te differ-ence between albumins o CG and those o PG isstatistically significant (p=0.03).Tis is becausethe protein removal in urine, in the group o pre-eclamptic women, is increased with an averageamount o 1.410.9 g/L (able 1) which brings tothe decrease o albumins in serum with an average

value o 273.6 g/L (25). Te level o urea in serum

at the patients o preeclamptic group is significant-

CG PG T p

N 25

Year 286 306 -0.72 0.47

Gestationalage, wk

334 334 0.09 0.928

SATP (mmHG) 1155 17513 -20.77 < 0.0001

DATP (mmHg) 755 11514 -13.49 < 0.0001

ua (/l) 2.460.8 4.61.7 -4.92

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64 JOURNAL OF HEALTH SCIENCES 2012; 2 (1)

HidAjeT PAArizi eT Al.: blood ureA NiTrogeN/creATiNiNe iNdex iS A PredicTor oF PrereNAl dAmAge iN PreeclAmPSiA

ly increased p

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eclampsia: Is it Still a Disappoint-ment? Clinical Medicine. Women'sHealth. 2009;2: 9-15

(22) Hladunewich M, Karumanchi SA,Laayette R. Pathophysiology othe Clinical Maniestations o Pre-eclampsia. Clin J Am Soc Nephrol.

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management o severe preeclamp-sia remote rom term: patient se-lection, treatment, and deliveryindications. Am J Obstet Gynecol.2007;196(6):514-523.

(24) Zeeman GG, Hatab MR, wicklerDM. Increased cerebral blood flowin preeclampsia with magneticresonance imaging. Am J ObstetGynecol. 2004; 191(4): 1425-1429

(25) Paarizi H. Correlation betweenmagnesium, calcium and pre-

eclampsia. University o Prishtina.2007(dissertation).

(26) Chemistry Inormation Manual 1-2,Beckman Coulter Company 1998.

(27) Myatt L, Webster RP. Is vascularbiology in preeclampsia better?Journal o Trombosis and Haemo-

stasis. 2009; 7:375384.(28) Stillman IE, Karumanchi SA. Te

glomerular injury o preeclampsia,Journal o the American Societyo Nephrology. 2007; 18 (8): 22812284.