Urine plasminogen as predictor of severe preeclampsia

OBJECTIVES: Failure of blood pressure management often leads to early termination of preeclamptic pregnancies. Preeclampsia is - besides hypertension and proteinuria - characterized by renal sodium retention and suppressed renin-angiotensin system. There is a prominent and aberrant glomerular filtration of the plasma zymogen plasminogen to urine with subsequent activation to plasmin. Urine with plasmin from preeclamptic patients activates the epithelial sodium channel (ENaC) in vitro and there is a positive correlation between urinary total plamin(ogen) and blood pressure in preeclamptic women. It was hypothesized that urine total plasmin/plasminogen activity are biomarkers in preeclampsia that can predict severe preeclampsia. A study was conducted to test if u-plasmin(ogen) could be used as a predictive marker for the development of severe preeclampsiaMETHODS: Longitudinal observational study with consecutive inclusion of 91 women with preeclampsia. Patients were stratified into severe (SPE) and non-severe preeclampsia (non-SPE) (Severe: systolic ⩾160mmHg and/or diastolic ⩾110mmHg and ⩾ +1 for albuminuria on urine dipstick or HELLP syndrome). Blood pressure, plasma, urine and clinical data were collected at debut of preeclampsia and again at follow up and at delivery.RESULTS: Of the listed covariates only a difference in gestational age were observed. There was a significant lower gestational age at SPE debut (inclusion samples) p-value 0.00022 and also at delivery p-value 0.004. A clear indication of a weak correlation was found between u-albumin and u-plasmin(ogen)CONCLUSIONS: In this small cohort u-total plasmin(ogen)/creatinine ratio did not predict the onset of severe preeclampsia. Significant difference in gestational age at debut and delivery in the severe and non-severe preeclampsia groups could support the theory of different phenotypes.DISCLOSURES: B. Frederiksen-Møller: None. B.L. Jensen: None. M.H. Falk: None. J.V. Hjelmborg: None. J.S. Jørgensen: None.