A comparison of the inactive urinary kallikrein:creatinine ratio and the angiotensin sensitivity test for the prediction of pre-eclampsia


Correspondence: Dr P. M. Kyle, Queen Charlotte's and Chelsea Hospital, Goldhawk Road, London W6 OXG, UK.


Objective To determine the relation between the inactive urinary kallikreimcreatinine ratio (IUK:Cr) and the angiotensin sensitivity test (AST) at 28 weeks of gestation and to assess each as a screening test for pre-eclampsia.

Design Prospective interventional study.

Subjects Four hundred and fifty-nine normotensive nulliparous women recruited from hospital antenatal clinics.

Setting John Radcliffe Maternity Hospital, Oxford, and Queen Charlotte's and Chelsea Hospital, London.

Interventions A urine sample for IUK:Cr measurement was provided before performing the AST at 28 weeks of gestation. Those women who demonstrated increased sensitivity to angiotensin II were entered into a randomised placebo controlled trial of low dose aspirin for the prevention of pre-eclampsia (CLASP).

Main outcome measures The development of pre-eclampsia.

Results The IUK:Cr ratio was significantly lower in those women who showed increased sensitivity to angiotensin II (P < 0.0001 Student's t test). The sensitivity and specificity for detecting pre-eclampsia were, respectively, 22% and 85% for the AST and 67% and 75% for the IUK:Cr. Low-dose aspirin (60 mg) had no effect on the pregnancy outcome.

Conclusion There appears to be some relation between the IUK:Cr and AST tests in pregnancy. However, in this population, the IUK:Cr ratio was a better screening test for pre-eclampsia than the AST, but overall neither test was a powerful predictor for the syndrome.