ABSTRACT
New-onset proteinuria in pregnancy should alert the clinician to review for evidence of pre-eclampsia. There are generally four primary reasons for its development: glomerular filtration abnormalities; tubular reabsorption abnormalities; overload, for example multiple myeloma or rhabdomyosis; and acute physical stressors. A systematic review investigating the accuracy of visual reading of dipsticks in pregnant women found that +1 proteinuria gave a sensitivity and specificity of 55 per cent and 84 per cent when predicting significant proteinuria on 24-hour urine collection. Urinary tract infection can cause mildly elevated proteinuria on dipstick or spot urine protein/creatinine ratio. Direct microscopic evaluation of the urinary sediment for specific urinary casts will often point to a specific disease process. These would include the following: hyaline cast; red cell casts; white cell casts; and renal tubular casts. Although typical presentations of pre-eclampsia generally do not warrant a renal ultrasound, atypical presentation of proteinuria in pregnancy may benefit from such evaluation.
