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CompletedNCT02536638Updated Sep 2, 2020

Proteinuria During Acute Pyelonephritis In Pregnancy

An observational study in Proteinuria, sponsored by MemorialCare Health System. Completed at 1 site in United States. Open to female participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2020-09-02.

Sponsored by MemorialCare Health System · Observational

Study type
Observational
Model
Case-control
Time perspective
Prospective
Enrollment
48
Ages
18 Years and older
Sex
Female
01

Study summary

The purpose of this research study is to compare the amount of protein excreted by the kidneys in a 24-hour period between patients who have a kidney infection and those who do not have a kidney infection.

Read the detailed description

Preeclampsia is a pregnancy-unique disorder that is cured only with delivery of the baby, even if the pregnancy is premature. Defined by both blood pressure and proteinuria criteria, diagnosis is often obscured by renal processes like systemic lupus erythematosus or nephrotic syndrome that increase urinary protein spillage. Proteinuria is defined as a total protein urinary excretion exceeding 300 mg in a 24-hour urine collection in pregnancy. This is suggested to be double the protein excretion in the non-pregnancy population at 150 mg/day. A mean 24-hour urine protein excretion of 204.3 mg (± 92.5) was found in the non-hypertensive pregnant population.

Physiological changes in pregnancy predispose patients to urinary tract infections; ureteral compression by the gravid uterus, progesterone-mediated slowing of ureteral peristalsis and decreased bladder tone, and mechanical compression of the bladder contribute to impaired clearance of bacteria from the urinary tract. Indeed, acute cystitis complicates 2-4% of all pregnancies. While it has been said that urinary tract infections increase proteinuria, it is unknown how much protein spillage should be expected in the general or the pregnant populations. Hence a patient with pyelonephritis may obscure the diagnosis of preeclampsia if she spills urinary protein from her infection.

The purpose of this study is to compare the mean of 24-hour urine protein in pregnant patients with and without acute pyelonephritis.

The importance of this study will be to determine if urine protein excretion is in fact increased in the setting of pyelonephritis. This will allow for reliable evaluation of urine protein during the work up for preeclampsia in those women also found having a kidney infection.

02

Conditions studied

  • Proteinuria

Keywords

  • urine protein
  • pregnancy
  • pyelonephritis
  • kidney infection
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
Female
Accepts healthy volunteers
No
Sampling method
Probability sample

Study population

All patients admitted to inpatient management of acute pyelonephritis meeting the inclusion and exclusion criteria will be enrolled in the study. A 24 hour urine collection with be performed for evaluation of protein.

Inclusion criteria

  • Women ≥ 18 years old admitted at Miller Children and Women's Hospital Long Beach Memorial Medical Center
  • Gestational age between 20 weeks and 0 days to 41 weeks and 0 days
  • Singleton pregnancy
  • Pyelonephritis group:

meeting 2 out of 3 criteria:

  1. Fever > 100.4
  2. Costovertebral angle tenderness
  3. Positive urine culture - without pyelonephritis group: without acute cystitis and pyelonephritis

Positive culture defined as: quantitative count of ≥ 100,000 CFU/mL or single catheterized urine specimen with quantitative count of 100 CFU/mL.

Exclusion criteria

Exclusion Criteria:

  • Chronic hypertension
  • Pre-gestational diabetes
  • Autoimmune disorders
  • Preexisting renal disease
  • Multiple gestation
  • Vaginal bleeding
  • Preeclampsia
  • Hospital admission > 3 days
04

Study design

Observational model
Case-control
Time perspective
Prospective
Enrollment
48 participants (actual)
Patient registry
No
Biospecimen retention
Samples with dna

Groups and cohorts

  • Pyelonephritis Group

    patients with pyelonephritis

    Other: Exposure to pyelonephritis

  • Without pyelonephritis Group

    patients without pyelonephritis

Interventions

  • OtherExposure to pyelonephritis

    Pyelonephritis group are patients with exposure to pyelonephritis Without pyelonephritis group are patients without pyelonephritis

05

What researchers measure

Primary outcomes

  1. 24-hour urine protein

    urine protein will be measured upon patient enrollment to the study (i.e. during the study enrollment hospitalization)

    Time frame: 7 days

06

Study locations

1 site
  • Miller Children's and Women's Hospital at Long Beach Memorial Medical Center
    Long Beach, California 90806, United States
07

References and documents

Publications

  • Lindheimer MD, Kanter D. Interpreting abnormal proteinuria in pregnancy: the need for a more pathophysiological approach. Obstet Gynecol. 2010 Feb;115(2 Pt 1):365-375. doi: 10.1097/AOG.0b013e3181cb9644. PubMed 20093912 ↗
  • Osmundson SS, Lafayette RA, Bowen RA, Roque VC, Garabedian MJ, Aziz N. Maternal proteinuria in twin compared with singleton pregnancies. Obstet Gynecol. 2014 Aug;124(2 Pt 1):332-337. doi: 10.1097/AOG.0000000000000383. PubMed 25004349 ↗
  • Gilstrap LC 3rd, Ramin SM. Urinary tract infections during pregnancy. Obstet Gynecol Clin North Am. 2001 Sep;28(3):581-91. doi: 10.1016/s0889-8545(05)70219-9. PubMed 11512502 ↗
  • Jolley JA, Wing DA. Pyelonephritis in pregnancy: an update on treatment options for optimal outcomes. Drugs. 2010 Sep 10;70(13):1643-55. doi: 10.2165/11538050-000000000-00000. PubMed 20731473 ↗
  • Carter JL, Tomson CR, Stevens PE, Lamb EJ. Does urinary tract infection cause proteinuria or microalbuminuria? A systematic review. Nephrol Dial Transplant. 2006 Nov;21(11):3031-7. doi: 10.1093/ndt/gfl373. Epub 2006 Jul 22. No abstract available. PubMed 16861738 ↗
  • Rubin RH, Shapiro ED, Andriole VT, Davis RJ, Stamm WE. Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Infectious Diseases Society of America and the Food and Drug Administration. Clin Infect Dis. 1992 Nov;15 Suppl 1:S216-27. doi: 10.1093/clind/15.supplement_1.s216. PubMed 1477233 ↗
  • Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM; Infectious Diseases Society of America; American Society of Nephrology; American Geriatric Society. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005 Mar 1;40(5):643-54. doi: 10.1086/427507. Epub 2005 Feb 4. No abstract available. Erratum In: Clin Infect Dis. 2005 May 15;40(10):1556. PubMed 15714408 ↗
  • CLARK LC, THOMPSON H, BECK EI. The excretion of creatine and creatinine during pregnancy. Am J Obstet Gynecol. 1951 Sep;62(3):576-83. doi: 10.1016/0002-9378(51)91156-8. No abstract available. PubMed 14877920 ↗
  • Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013 Nov;122(5):1122-1131. doi: 10.1097/01.AOG.0000437382.03963.88. No abstract available. PubMed 24150027 ↗
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Registry details

Key details

Study ID
NCT02536638
Lead sponsor
MemorialCare Health System
Responsible party
Kenneth Chan, MD (Maternal Fetal Medicine, MemorialCare Health System) — Principal investigator
First posted
Sep 1, 2015
Start date
Jul 2015
Primary completion
Jul 2016
Completion
Jul 2016
Last update
Sep 2, 2020

Study contacts

Kenneth Chan, MD
principal investigator · Maternal Fetal Medicine

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is completed, as verified in Aug 2020. You cannot join it, but the record below documents what was studied.

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