Study of uric acid and microalbuminuria in preeclampsia and normal pregnant women

Introduction and Aim: Pregnancy is complicated by the hypertension disease known as pre-eclampsia. The development of hypertension to a level of 140/90 mmHg or greater in the presence of proteinuria after the 20th week of gestation characterises this condition, a multisystem disorder with an unclear cause. Uric acid and microalbuminuria were assessed in preeclamptic women (PW) and normal pregnant women (NPW). Materials and Methods: For the present study 120 women (60 NPW and 60 PW) were selected from the hospital at Mullana, Ambala, Haryana. The level of uric acid and microalbuminuria were estimated in all subjects. Results: Preeclamptic women had microalbuminuria levels that were substantially (p<0.001) greater than those of normal pregnant women, and their uric acid levels were significantly (p<0.001) higher. Conclusion: Preeclampsia patients had significantly higher uric acid and microalbuminuria levels than normal pregnant women. We deduced from the study that uric acid and microalbuminuria can be helpful in diagnosing preeclampsia risk.


INTRODUCTION
ne of the frequent pregnancy problems is preeclampsia.Preeclampsia affects 4-5% of pregnant women, and its pathogenesis is unknown (1,2).At the 20th week of pregnancy, preeclampsia manifests as hypertension, proteinuria, dyslipidaemia, an intensified systemic inflammatory response, and oedema.It is also associated with thrombocytopenia, disseminated intravascular coagulation, and liver damage in its most severe form (3,4).The primary by-product of purine metabolism is uric acid.Fay stated in 1990 that an increase in the disintegration of placental cells may result from an overproduction of uric acid (5).Jeyabalan et al., (6) reported that elevated levels of serum uric acid in preeclamptic as a result of reduced renal clearance.Pre-eclampsia and gestational hypertension patients share a number of risk factors.The extent of placental cell apoptosis and the severity of the illness are both reflected in an elevated uric acid level.such as older mothers, obesity, low serum Ca and Mg levels, and higher uric acid concentrations (7).It has been suggested that either a reduction in uric acid excretion or an increase in uric acid synthesis is what causes the hyperuricemia in preeclampsia (5,6).
In the absence of clinically evident nephropathy, urine albumin excretion above normal levels are regarded as evidence of microalbuminuria (8)(9)(10).
Urinary albumin levels between 30 and 300 mg/24 hours are considered to indicate the presence of microalbuminuria (11).One of the defining characteristics of preeclampsia is microalbuminuria.It is confirmed that abnormalities in renal function are present in some otherwise symptom-free patients in whom pre-eclampsia would subsequently develop by the presence of microalbuminuria.Microalbuminuria levels in the early stages of pregnancy have a significant negative predictive value as indicators of preeclampsia (12).In pregnancy, persistent microalbuminuria has substantial diagnostic significance as a potential indicator of developing PE because it suggests a high likelihood of kidney glomerular filtration capacity impairment (13).

MATERIALS AND METHODS
The current study was conducted in Maharishi Markandeshwar Institute of Medical Sciences and Researches, Mullana Ambala, Haryana, India, which had 120 participants (60 healthy pregnant women and 60 preeclamptic women), in a hospital setting.The institution's ethical review board had approved the study.Women who were 20 weeks or more gestation and had a systolic blood pressure of less than 140 mm Hg and a diastolic blood pressure of less than 90 mm Hg were deemed to have hypertensionpreeclampsia.The research also excluded participants who refused to take part or who had already given O birth.All patient data, including age and sex, was collected, and the intended proforma was followed while filling out specific information on the patient's previous and present medical history, including any illnesses and medications.
The glucose oxidase peroxidase (GOD) test was used to measure RBS, the urease-GLDH kinetic technique was used to estimate urea, the uricase (14,15) method was used to assess uric acid, and the pyrogallol red method was used to assess microalbuminuria (16).The unpaired t-test was used to analyse the gathered data.For statistical analysis, the statistical package for social sciences software (SPSS) version 27.0 is employed.

RESULTS
In the current study, microalbuminuria and uric acid levels were examined in 120 women, 60 of whom were preeclampsia patients (group 1) and 60 of whom were healthy pregnant women (group In control group (2), 8 (13.3%) females were with Uric Acid less than 2.6 mg/dL and 48 (80.0%) females were within range 2.6 to 6.0 mg/dL and 4 (6.7%)females were above 6.0 mg/dL.Biological indicators including RBS, urea, uric acid, and microalbuminuria levels in both of the studied groups changed significantly (p<0.001)., as shown in Table 3.There was a statistically significant difference between the two groups (p<0.001). in the RBS mean and standard deviation, which were 104.67±24.11 in group 1 and 83.16±18.31 in group 2. Blood urea had a statistically extremely significant difference between groups 1 and 2, with a mean and standard deviation of 22.53±8.15and 17.37±5.43respectively (p<0.001).Uric acid had mean and SD of 5.09±1.10 in Group 1 and 3.79±1.21 in Group 2, respectively.Preeclampsia patients had much higher uric acid levels than normal pregnant women did; this difference was statistically very significant (p<0.0001).Moreover, the mean and SD of microalbuminuria in groups 1 and 2 were 1.37±0.66and 0.52±0.33respectively.Preeclampsia patients have much greater levels of microalbuminuria than typical pregnant women; this difference was statistically highly significant (p<0.0001).4 shows serum uric acid level among preeclampsia.In mild condition, no female was with serum uric acid less than 2.6 mg/dL, 18(90%) females were in the range 2.6 to 6.0 mg/dL and 2(10%) females were above 6.0 mg/dL.
In moderate condition, no female was with serum uric acid less than 2.6 mg/dL, 15(75%) females were in the range 2.6 to 6.0 mg/dL and 5(25%) females were above 6.0 mg/dL.
In severe condition, no female was with serum uric acid less than 2.6 mg/dL, 17(85%) females were in the range 2.6 to 6.0 mg/dL and 3(15%) females were above 6.0 mg/dL.
Here, the serum uric acid was statistically nonsignificant (P >0.05) in preeclampsia cases (on the basis of classification).

DISCUSSION
Preeclampsia is a complicated condition with multiple contributing factors.Insufficient penetration of the uterine wall by trophoblast cells during early pregnancy may be the main factor contributing to the development of a disease.The pathophysiology of disease cannot be explained by any single body of scientific data.However one theory for its pathophysiology is because shallow invasion and lower placental perfusion cause enhanced lipid peroxidation and the production of oxygen radicals without antioxidant protection.Maternal endothelial dysfunction is further exacerbated by this stimulation of neutrophils and macrophages, which further encourages the release of cytokines (17).
The current study demonstrates that preeclampsia patients' uric acid levels are much greater than those of typical pregnant women.Similar to how preeclampsia went from mild to severe, the serum uric acid level rose much more in severe instances than in mild cases.The correlation between elevated uric acid levels and preeclampsia has been documented by Redman et al., (18), Boneu et al., (19), Acien et al., (20), and Yoshimura et al., (21).Moreover, Lim et al., discovered that serum uric acid levels rise as the severity of the condition worsens (22).
Pre-eclampsia has been linked in recent years to significant vascular dysfunction in both the mother and the placenta.( 23) Several biochemical markers were discovered to be elevated in cases of microvascular injury, and among these, microalbumin is frequently utilized due to its low cost and simplicity in estimating.Microalbuminuria may be a reliable indicator of this illness with a high sensitivity but a poor positive predictive value, according to Salako et al., (23).Microalbuminuria early in the third trimester of pregnancy is a good indicator of hypertensive problems in pregnancy, according to Bar et al. study (24,25).
We found in this study that patients with microalbuminuria will experience preeclampsia.It is obvious that additional clinical research is required to confirm the value of micro-albumin in the early detection of preeclampsia.

Limitations and future perspectives
The small sample size of various comparison groups constitutes a key constraint because the present was restricted to the question of whether uric acid was equally as effective as proteinuria at identifying risk in a group of high-risk women.Evaluations of serum uric acid and microalbuminuria will also help to show the relationship between preeclampsia and both conditions.Prior to implementing any practised modifications, however, additional follow-up studies with bigger sample size are first required to corroborate these findings and to investigate maternal risk in order to demonstrate the diagnostic capabilities of uric acid and microalbuminuria.

CONCLUSION
Our study was done in a small group of preeclampsia and normal pregnant women to study the levels of uric acid and microalbuminuria along with measurement of another established marker.We therefore conclude that uric acid and microalbuminuria levels may be helpful to predict severity of disease.Assessing the predictive usefulness of microalbuminuria in pregnant women will be necessary to determine the long-term risk of developing preeclampsia.The incidence of maternal fatalities and systemic problems brought on by preeclampsia may be decreased with early identification.

Table 1
displays the distribution of patients by age group for control and preeclampsia cases.In the control group, there were 2 (3.3%) females under the age of 20, 47 (78.3%) females between the ages of 21 and 30, 10 (16.7%) females between the ages of 31 and 40, and 1 (1.7%) female between the ages of 41 and 50.Most typically pregnant ladies fall within the age range of 21 to 30 years.

Table 1 :
Comparison of age distribution between preeclampsia cases and normal pregnancies.

Table 2 :
Distribution of different parameters among normal pregnant women

Table 3 :
Comparison of different parameters between normal pregnancy and preeclampsia cases by using t-test

Table 4 :
Serum uric acid level among preeclampsia on the basis of classification by using t-test.