ELEVATED SPOT URINE PROTEIN-CREATININE RATIO IN NORMOTENSIVE PREGNANCY: CLINICAL RELEVANCE AND THE ROLE OF CREATININE

Abstract

Proteinuria is a widely recognized marker of renal dysfunction during pregnancy, particularly in the context of hypertensive disorders such as preeclampsia. However, elevated spot urine protein-to-creatinine ratio (PCR) is increasingly being detected even in normotensive pregnant women. This raises concerns about potential overdiagnosis and the risk of unnecessary interventions. The reliability of the PCR largely depends on the concentrations of both urinary protein and creatinine. Notably, fluctuations in urinary creatinine—affected by factors like maternal muscle mass, hydration status, and renal tubular function—can result in an overestimated ratio, even when actual protein excretion remains within normal physiological limits.[1,2]. This case series presents four pregnant women with elevated Spot PCR despite normal blood pressure, highlighting the diagnostic and prognostic challenges in such scenarios. Further research is warranted to refine the clinical utility of Spot PCR beyond hypertensive pregnancy disorders [3].