Protein in urine is referred to as proteinuria. Some physiological loss of protein in the urine occurs normally. Significant proteinuria is daily protein loss greater than 0.3 g (or 300 mg). Protein in urine is suggestive of kidney disease that’s resulting in improper filtering of the blood by the kidneys. Proteinuria can be measured by various methods. Dipstick urine analysis is not very reliable and accurate method and should be avoided. 24-hour urine protein loss and urine protein/creatinine ratio are better tests.

Proteinuria during pregnancy can be either chronic proteinuria (that was present even before the start of pregnancy) or it can be a new onset proteinuria (that first appeared during pregnancy). Proteinuria first identified during pregnancy before 20 weeks of gestation is also likely to be chronic proteinuria due to a preexisting kidney disease. Non pregnancy related kidney diseases can be concomitantly present during pregnancy and result in protein in urine. However, proteinuria after 20 weeks of gestation is more likely to be due to a pregnancy related cause like preeclampsia.

During pregnancy, the presence of proteinuria along with hypertension (the preeclampsia syndrome) increases the risk of numerous complications in the affected women, the most common being HELLP syndrome and eclampsia. The risk of complications increases with increasing 24-hour protein loss. Proteinuria with hypertension is also associated with adverse outcome in the newborn. The adverse outcomes associated are premature birth, low birth weight baby, intrauterine growth restriction, stillbirth and death of the newborn. The significance of isolated proteinuria (i.e. proteinuria without hypertension or any other abnormality) is not known with certainty, but it too is expected to be associated with increased risk of adverse outcomes. Women with isolated proteinuria may develop hypertension later and progress to preeclampsia or eclampsia.

Preeclampsia

Preeclampsia is a syndrome affecting multiple organs and diagnosed by presence of high blood pressure along with loss of protein in urine (> 300 mg per day). The proteinuria and hypertension should occur after the 20 weeks of pregnancy. Preeclampsia can be completely asymptomatic. Severe preeclampsia may present with many symptoms like swelling in face and hands, headaches, abdominal pain (more often on the right side), nausea and vomiting, blurring of vision and decreased urine output. Sever preeclampsia is can result in damage to multiple organs like liver, kidney, heart, brain, eyes and lungs.

Eclampsia

Eclampsia refers to onset of generalized seizures (convulsions) in a woman with preeclampsia. These seizures should not be due to any other previously present cause. The seizures occur before labor, during labor or even after labor. It is an obstetric emergency and requires immediate intervention.

HELLP Syndrome

HELLP stands for: H (hemolysis- breakdown of red blood cells), EL (elevated liver enzymes) and LP (low platelet count)

It generally occurs in women with preeclampsia and eclampsia but sometimes can occur in absence of these syndromes also. Commonly observed symptoms are upper abdominal pain (usually on right side), nausea and vomiting, vague feeling of being ill, headaches, blurring of vision, etc.

HELLP syndrome is a serious condition and can deteriorate very rapidly and result in numerous complications like kidney damage, liver damage, disseminated intravascular coagulation, pulmonary edema (fluid in the lungs), and placental abruption (separation of placenta from the walls of uterus).