Kidney Injury Biomarkers in Preeclampsia

Study design: * Type of the study: Aprospective cross sectional study .All patients will be enrolled in the study after obtaining a written consent. * Setting: This study will be carried in the Emergency room of Assiut university Hospital \&Luxor International Hospital Statistical Methods: Inclusion criteria: * the presence of informed consent * Prim gravid or multi gravid \<5 * age:18-35 ys * Singleton pregnancy with gestational age \>34weeks. Exclusion criteria: * Serious maternal illness. * Smokers * women with pregnancy complicated by nephritic syndrome, diabetic mellitus, or gestational diabetes * women known to have renal disease * oliguria * Methods : 200 patients with severe peclampsia will be recorded in Assiut university hospital and luxor international hospital in aperiod of 6 months initial assessement: Blood pressure will be measuerd in ER urine analysis will be done in ER by Urine Dipstick Analysis 40 cases will be randomized selected where urine sample will be collected to analyze the markers to be studied The women will be subjected to the following: 1. Detailed history taking 2. Clinical examination: 1. General examination: pulse, temperature, blood pressure, body weight and height, body mass index. 2. Abdominal examination. 3. obestetric Ultrasonography to calculate gestational age,viability , amniotic fluid ,placental site and to exclude any congenital malformation. 4. Assessemet of renal function :urine output,blood urea,serum creatinine, u/s 5. All routine investigations: C.B.C., Rh, blood grouping, kidney functions tests, liver enzymes. 6. sample collection : Freshly obtained urine specimens were centrifuged at 1,500 rpm for 10 min within 30 min of collection, aliquoted, and stored at \_70°C until assayed. Dipstick detection for urine protein, pH, and gravity. Urine protein, pH, gravity, etc. were detected by Dipstick (Uri-Trak-3) in all urine specimens before being aliquoted for storage at \_70°C. Urine protein was positive for all study subjects in mild and severe preeclamptic groups. Biomarkers evaluated in urine specimens including podocyte glycoproteins nephrin and podocalyxin, All biomarkers were measured by ELISA. Assay information for sources of ELISA kits, standard cure range, sample dilution factors, etc. All assays will be performed following the manufacture's instructions. All specimens will be measured in duplicate. Personnel who performed the assays of analyteswere blinded to the clinical information. 6\. postnatal visits: Postnatal investigation, monitoring and treatment (including after discharge from critical care) Blood pressure Weekly till the end of puerperium.the postatal visits will iclude: * Measurement of blood pressure * U/S kidney * Askig about urinary symptoms as amout of urine ,colour of urine ,and burning sensation. Postnatal care will be done according to NICE clinical guidelines at the nearby patients health care centre .the patients will be handed on information sheet containing instructions about postnatal care. the patients will be followed up by telephone to report any abnormalities that may occur