Details
Category: Volume 06 Issue 08 August 2018
Hits: 1089

Title: A Study of Serum Lactate Dehydrogenase and Uric Acidlevel in Pre-Eclampsia in a Tertiary Health Care Centre in North-East India

Authors: Moumita Saha, S.M. Rohman, K.K Das

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i8.205

Abstract

Introduction: Pre-Eclampsia is a multi-system disorder of unknown aetiology, unique to pregnancy, onset after 20 weeks of gestation with hypertension to the extent of 140/90 mm Hg or more, and proteinuria (≥300mg/day) and edema. FOGSI (The Federation of Obstetric & Gynaecological Societies of India) and other studies show the incidence of Pre-Eclampsia in India ranges between 11-13%. And in North-East region of India it is very much common. NFHS has been conducted in India for three successive rounds. Among states highest prevalance found in Tripura (87.5%) and lowest prevalance state Haryana (33.3%). Lactate Dehydrogenase (LDH) is mainly an intracellular enzyme. It is responsible for interconversion of pyruvate and lactate in the cells. Its levels are several times greater inside the cells than in the plasma. LDH levels are increased in the scenario of increased cell leakiness, hemolysis and cell death. Pre-Eclampsia is a multisystem disorder and leads to a lot of cellular death. So, serum LDH levels can be used to assess the extent of cellular death and thereby the severity of disease.  Uric Acid is a catabolic product of purine Nucleotide. Hyperuricemia is found to be one of the largest laboratory manifestations of Pre-Eclampsia.  It is likely to be resulted from reduced Uric Acid clearance from reduced glomerular filtration rate and reduced tubular secretion. Hence, Serum LDH Levels and Uric Acid can be used as tool in making decision, regarding the management strategies to improve the maternal and fetal outcome.

Materials and Methods: The subjects for the study were divided into 3 groups:

Group I – Control groups = 60 normal pregnant women of >20weeks of gestation, age between 18 to 35 years.

Group II – Case group 1 = 30 newly diagnosed cases of Mild Pre-Eclampsia women of >20weeks of gestation, age between 18 to 35 years.

Group III – Case group 2 = 30 newly diagnosed cases of Severe Pre-Eclampsia women of >20weeks of gestation, age between 18 to 35 years.

Results: To compare Serum LDH levels in normal pregnant women and in women with Pre-Eclampsia. To compare Serum Uric Acid levels in normal pregnant woman and in woman with Pre- Eclampsia. To find out any possible correlation of their levels with the severity of the disease.

Conclusion: On the basis of our results we conclude the study that, there is a significant elevation of Serum LDH and Uric Acid in both Mild Pre-Eclampsia and Severe Pre-Eclampsia patients compared to normal pregnant women. Increased levels of Serum LDH and Uric Acid acts as efficient biomarkers for early diagnosis of Pre-Eclampsia and its subsequent course of the disease.  So, Serum LDH Levels and Uric Acid can be used as tool in making decision, regarding the management strategies to improve the maternal and fetal outcome.

Keywords: Mild and Severe Pre-Eclampsia, LDH, Uric acid.

References

  1. Cunningham F, Lenevo K, Bloom S, Hauth J, Gilstrap L, Wenstrom K. ln Maternal physiology. Williams Obstetrics 23rd edn. New York 2011; Mc Graw Hill: 107-131.
  2. Cengiz C, Kimya Y Maternal Fizyoloji. Temel Kadın Hastalıklarıve Dogum Bilgisi (Eds Kisnisçi et al) Günes; Ankara.1997: 242-243.
  3. Chapman JF, Tsongalis GJ. Pregnancy and fetal development. Clinical Chemistry. 1996; Kaplan LA, Pesce AJ eds Missouri Mosby: 799-810.
  4. Herrera E, Gomez DC, Lasuncion MA. Lipid metabolism in pregnancy. Biol Neonate.1987; 52(2): 70-77.
  5. Park K. Textbook of preventive and social medicine 21st edn. Preventative medicine in obstetrics, pediatrics & geriatrics. 2011; M/s Banarasidas Bhanot publishers: 514-517.
  6. Cunningham F, Lenevo K, Bloom S, Hauth J, Gilstrap L, Wenstrom K. ln Maternal physiology. Williams Obstetrics 23rd edn. New York 2011; Mc Graw Hill: 707.
  7. Packer CS. Biochemical markers and physiological parameters as indices for identifying patients at risk of developing pre-eclampsia. J Hypertens. 2005; 23(1): 45-46.
  8. Duley L. Pre-eclampsia and the Hypertensive disorders of pregnancy. Br Med J. 2003; 67: 161.
  9. Make every mother and child count. The World Health Report. 2005; Geneva Switzerland: World Health Organization.
  10. Bansal S. Hypertension in pregnancy. In: Desai P, Malhotra N, Shah D eds. Principles & practice of Obstetrics & Gynaecology for post-graduates. 3rd ed. Jaypee Brothers, New Delhi, 2008; 100-107.
  11. International Institute for Population Sciences & Macro International: National Family Health Survey (NFHS-3), 2005–06: India: Vol. I. Mumbai, IIPS; 2007.
  12. Agrawal, Walia. J Womens Health Issues Care. 2014; 3: 6 http://dx.doi.org/10.4172/23259795.100016
  13. S Qublan, Ammarin V, Bataineh O, Al Shraideh Z, Tahat Y, Awamleh I et al. Lactic dehydrogenase as a biochemical marker of adverse pregnancy outcome in severe pre-eclampsia. Med Sci Monit. 2005; 11(8): CR393-397.
  14. Jaiswar S.P, Gupta Amrit, Sachan Rekha, Natu S.N, Shaili Mohan. Lactic Dehydrogenase: A biochemical AMrker for preeclampsia-eclampsia. JOGI. Nov-Dec 2011, 61(6): 645-648.
  15. Sonagra A.D, Dattatreya. K, Jayaprakash Murthy D.S. Serum LDH,ALP and Uric Acid in Hypertensive Disorders of Pregnancy. IJPBS. July-Sept 2012; 2(3): 201-209.
  16. Tsoi S, Zheng J, Xu F, Kay H. Differential expression of lactate dehydrogenase isozymes (LDH) in human placenta with high expression of LDH-A(4) isozyme in the endothelial cells of pre-eclampsia villi. 2001; 22(4): 317-322.
  17. Sharma J, Sharma A, Bahadur A, Vimala N, Satyam A,et al. Oxidative stress markers and antioxidant levels in normal pregnancy and pre-eclampsia. International Journal of Gynecology and Obstetrics. 2006; 94: 23-27.
  18. Krefetz RG. Enzymes. Clinical Chemistry, 4th ed. Lippincott Williams and Wikins. Philadelphia 2000; 196-198.
  19. Vasudevan D, Sreekumari S, Vaidyanathan K (eds). Kidney function tests. Textbook of biochemistry, 6th edn. Jaypee Brothers, New Delhi. 2011; 314-328.
  20. Davison J, Homuth V, Jeyabalan A, Conrad K, Karumanchi A,et al. New aspects in the pathophysiology of preeclampsia. J Am Soc Nephrol. 2004; 15: 2440–2448.
  21. Cunningham F, Lenevo K, Bloom S, Hauth J, Gilstrap L, Wenstrom K. ln Maternal physiology. Williams Obstetrics 23rd edn. New York 2011; Mc Graw Hill: 712-713.
  22. Sharma J, Sharma A, Bahadur A, Vimala N, Satyam A,et al. Oxidative stress markers and antioxidant levels in normal pregnancy and pre-eclampsia. International Journal of Gynecology and Obstetrics. 2006; 94: 23-27.
  23. Gary Cunningham F, Kenneth J Leveno, steven l Bloom, John C Hauth, Dwight J Rouse, Catherine Y Sponge editors. Wlliams Obstetrics. 23rd The McGraw Hill Company; 2010: 1261.
  24. Yucesoy G, Ozkan S, Bodur H, Tan T, Caliskan E, Vural B, et al. Maternaland perinatal outcome in pregnancies complicated with hypertensive disorder of pregnancy: a seven year experience of atertiarycare center. Arch Gynecol Obstet. 2005; 273(1):43-9.
  25. Norwitz ER, Hsu CD, Repke JT. Acute complications of preeclampsia. Clin Obstet Gynecol.2002; 45: 308–29.
  26. M Munde, Hazari N.R, Thorat A.P, Gaikwad S.B, Hatolkar V.S. Gamma Glutamyl Transferase and Lactate Dehydrogenase as biochemical markers of severity of Pre-Eclampsia. International Journal of Medical, Health, Biomedical, Bioengineering and Pharmaceutical Engineering. 2014; 8(1): 50-53.
  27. Vyakaranam S, Bhongir Verma A, Patlolla D. Study of serum Uric Acid and creatinine in hypertensive disorders of pregnancy. International Journal of Medical Science and Public Health. 2015; 4(10): 1424-1428.
  28. Sirjwala B.H, Sharma D, Agravatt A.M. Astudy of seru, total calcium and Uric Acid in Pre-Eclampsia. Indian Journal of Basic and Applied Medical Research. 2013; 1(3): 50-56.
  29. Mansi Gandhi. International Journal of Biomedical Research. 2015; 6(01): 25-28.
  30. Datta D. Hypertensive disorders in pregnancy. In: Konor H. ed. DC Datta’s Textbook of obstetrics. 7th ed. New Central book agency (P) Ltd. Kolkata 2011; 219-240.
  31. Pregnancy hypertension. In : Cunningham F, Lenevo K, Bloom S, Hauth J, Gilstrap L, Wenstrom K, edts. Williams Obstetrics, 23rd edn. Mc Graw Hill, New York 2011, pp706-728.
  32. Bainbridge SA, Von Versen-Hoynck F RJ. Uric acid inhib­its placental system an amino acid uptake. Placenta. 2009;30: 195–200.
  33. Livingston JR, Payne B, Brown M, Roberts JM, Côté A, Magee LA, et al. Uric acid as a predictor of adverse maternal and perinatal outcomes in women hospitalized with preeclampsia. J Obstet Gynecol 2014;7: 870–7.
  34. Saleh F, Shukar-ud-Din S, Soomro N. Serum uric acid as predictor model for preeclampsia. Pak J Surg 26(3): 246-251, (2010).s

Corresponding Author

Moumita Saha

MD Biochemistry, Dept of Biochemistry, Gauhati Medical College & Hospital, Guwahati, Assam, India