Does protein in urine always mean preeclampsia?

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Can you have pre eclampsia if you have protein ++ in your urine, but never high blood pressure or any other symptoms at all?

Does anyone know if it's medically possible?

I had protein in my urine in all 4 of my pregnancies. I had no other signs of pre-eclampsia.

you need protein in urine and high bp for it to be pre-eclampsia.

all other symptoms vary but they are the 2 that give the diagnosis

without the high bp the protein could be an infection

Just to add, the doctors just told me I had leaky kidneys - I don’t know if that’s a medical term, or an explanation for an idiot!

Protein can also be from a UTI or injection, so not an indication of pre eclampsia by itself

I didn't have a good experience with the care in my first pregnancy. I was pretty traumatised from a rape that happened one year before my due date, that I got pregnant from, had that pregnancy terminated and then conceived my DS by accident (with my partner, used a condom which broke and got the morning after pill, I thought I would have been outside the danger zone as I was so messed up from the termination I didn't want to risk getting pregnant again, but no one told me that ovulation can be different after a termination and so the morning after pill also failed.)

I also have a high BMI. Because of this the midwives and doctors wanted me to give birth on the labour ward with continuous monitoring and told me the one that could go in the water or that I could walk around with was broken, so I would have to stay on the bed.

Because what happened I was very anxious about the birth, mainly having an instrumental delivery, having an epidural and not being able to feel part of my body, and having internal examinations and things done to my body without my consent.

I really wanted a water birth, in the birth centre attached to the hospital. They wouldn't allow this.

In the end I chose to have a home water birth, as I felt it was the safest place for me to give birth, and only a 4 minute drive from the hospital. At that point they suddenly said I could actually have a water birth in the birth centre, but at that point I felt so mistrustful of the team I chose to go ahead with the home birth.

At 10 days overdue I hadn't felt DS for a couple of hours so went in to be checked, of course as soon as I got there he started kicking away and was fine on the monitor and on a scan as well. Everything else looked great.

When I got back to the carpark they called me and said actually there was protein in my urine, so to come back up and they would re check it in the lab.

They said it came back ++ and so meant I had pre eclampsia. My blood pressure was still normal, it had never been high once during my pregnancy. My urine didn't have a trace of protein in it the day before when i saw my midwife for a routine appointment.

They said the baby needed to come out asap, with either an induction or a c section.

I believed that because I had pre eclampsia and had gone overdue that that would be the safest thing. I chose a c section as knew the statistics on the cascade of intervention with an induction and felt the known risks of a c section would best preserve my mental health.

DS was born the next day. It was a nice c section, as c sections go, but still had a negative impact on my mental health having the lower half of my body numbed, having a catheter in etc.

But I thought I was doing what was safest for me and my baby.

I've always had a niggle in my mind as to whether they were being entirely truthful about me having pre eclampsia.

I'm now 28 weeks with our second baby, and am seeing the perinatal mental health team because the lack of mental health support from my GP and developing PND when DS was a few months old has meant my mental health has taken a nose dive. I've been having panic attacks sometimes daily, nightmares about what happened and uncontrollable emotions which are affecting my relationships.

I'm due to have a pre birth planning meeting with my midwife, mental health nurse and a consultant dr next week to discuss the birth.

I am even more anxious this time around about being forced to do something I don't want to do. This time I feel that the birth centre is the safest place for me compared to a home birth, with the risk of scar rupture post c section, but the idea that I will not feel safe is starting to really worry me, especially if what I fear is true in that I was lied to about having pre eclampsia so that I wouldn't have a home birth which was against their guidelines.

Wow that was long. Sorry, I'm just trying really hard not to panic and push back the feelings of mistrust against every HCP. Feeling like I've been tricked or lied to or manipulated is a really big thing for me, I know it's been nearly 3 years now since I was assaulted but I'm still not over it yet, if anything it's worse than after it just happened because then I pushed it all down and thought I was fine, because it wasn't violent or as bad as what other women go through.

But then I found out I was pregnant, then had it terminated, and while I know that was the right choice for me it still destroyed me, and then I had DS who wasn't planned I didn't want to get pregnant at all but then how could I terminate a baby that came from love when I had just terminated another one, I couldn't do it again. But it made everything so much harder and it was all so much to deal with. Sometimes I feel like I'm going to explode, there's so much inside me that I can barely contain.

Can anyone help or advise? If it's medically possible to have pre eclampsia with normal blood pressure I can put my mind at rest and try to focus on this birth.

But if it's not I have to do something. It seems too far fetched to be real, this sort of thing can't happen right?

my midwife and consultant said they make the diagnoses if there is protein and high blood pressure together. I suffer with the high blood pressure that I never had before with pregnancy. Only ever had protein in urine once which they sent off to lab to get exact measurements and had to meet a certain threshold for the diagnosis. Luckily in my case it was under so haven't been diagnosed 🙂

No, I had protein in my wee a few weeks back, no pre-eclampsia. They did a wee sample again a week later and no longer any protein

Diagnostic criteria for preeclampsia requires protein and elevated hb. Elevated can mean above a specified limit, or a certain amount above bp at booking. If you normally have fairly low bp this means you could get a correct diagnosis without stereotypically high bp. Especially if bp had been going up steadily without reaching 'high'.

There's also a blood test I don't have much knowledge of but it doesn't sound like you had that.

Peeclampsia causes increased bp, high bp causes protenuria. In that order. You can technically have preeclampsia without high hb (although no hcp would agree), but it wouldn't be diagnosed as such because it isn't significant enough to impact on you or baby. In that scenario the protienurea is related to something else and should be treated separately.

Very high bp alone is a concern in itself (and can cause eclampsia and hellp) and would be treated similarly. Protein alone is a concern, but more likely to lead to antibiotics than anything else.

If bp had been consistent throughout pregnancy, then I can't see how they arrived at a preeclampsia diagnosis.

There are published diagnostic criteria for preeclampsia, there's also something on what preeclampsia actually is (rather than just the symptoms/diagnostics) which makes it easier to understand. I'll see if I can find either but it was a few years ago when I read up on it.

(btw I'm not a doctor/midwife)

And, whilst not necessarily your situation, doctors/midwives can and do lie. Either because they believe it themselves, or because they disagree with you and believe the ends justify the means. It's not as uncommon as you'd like to think. You are always free to ask for evidence (where appropriate) or a second opinion, use that right if you have doubts.

I had ++++ protein in my urine at 36 weeks with DS and no pre-eclampsia. The protein stayed at that level until I had him 2 weeks later.

Ok, sounds like something could potentially be up. I don't know who to talk to next about this.

My BP was 110/90 when I had ++ protein and they made the diagnosis. All of my notes say pre eclampsia, I was kept in for two nights for monitoring but BP was fine after delivery as well.

Thank you all so much for your information.

I was induced due to protein in my urine. I never had high blood pressure. They called it “brewing preeclampsia” and offered to induce the next day.

www.bmj.com/content/366/bmj.l2381 it's hard reading, but basically preeclampsia is when the placenta isn't good enough at getting what it needs out of your blood so drives an increase in bp to get access to more blood and therefore easier access to nutrients, untreated hypertension leads (eventually) to organ failure, an early symptom being protienurea.

www.oaa-anaes.ac.uk/assets/_managed/cms/files/Clinical%20Guidelines/WAC068_Pre_eclampsia_v8%20.pdf
hoping pdf links work. So reading this you can diagnose based on very abnormal pcr and mica (urine contents ratios), which isn't at all the same as a measure of the protein but is a test that would normally follow a ++ urine sample. It's entirely possible that the Dr either understood the results without understanding the test, or simplified the explanation when telling you (leading to confusion).

So based on the first I would be very surprised at a correct diagnosis without elevated bp. But based on the second the Dr wasn't wrong (in the moral sense) to make the diagnosis based only off of a urine test, as long as it was an appropriate test.

Thank you for the links, the second one doesn't work but read through the first.

My notes say my PCR was 104, but there isn't a unit of measurement with that so I have no idea what just the number means.

It's the only thing going around in my head right now, I can't concentrate on anything else. It is terrifying just the idea that it wasn't real, that the people I was so frightened of hurting me or taking advantage of me or doing something I didn't want done to my body might have lied to me. I trusted them. It was so hard to do and went against what was screaming inside of me but I did it and now the possibility that I was wrong to do that has completely thrown me.

There's just this voice in my head saying over and over 'don't trust them, don't trust them, run away, run away, get safe, get safe' but I don't know where that is.

The link says that creatinine over 80 would be sufficient to diagnose severe preeclampsia, so at 104 that would have been the correct diagnosis for you in that trust (Dartford). After 37 weeks treatment for preeclampsia is delivery within 24-48 hours, delivery is the only cure. It does talk a lot about managing bp too though.

PCR is protein creatinine ratio, often considered unitless but there are units in the link below. If you see creatinine it's almost always refering to pcr in this context as levels alone are largely meaningless.

www.gloshospitals.nhs.uk/our-services/services-we-offer/pathology/tests-and-investigations/albumincreatinine-ratio-acr-and-proteincreatinine-ratio-pcr/
Anything over 30 would be considered high. But it's also clear that it should be considered alongside a full clinical review. And diagnostics should be based on acr (what I previously called mica) in hypertensive women. And known false positives in cases of infection.

Try searching "pre-eclampsia guidelines [trust name]" or "pregnancy hypertension guidelines [ trust name]" and see if yours publishes anything, some are more open than others. If you can get hold of that document you'll know what should have happened given your results. Worryingly it seems to vary by trust. In your position, with understandable trust issues, I think it might be easier to have it in writing rather than asking in the first instance.

My non-medically-trained opinion is that it probably wasn't pre-eclampsia. That doesn't necessarily mean that it was a lie though. They could have been misinformed or good people following bad policy.

@TamSamLam thank you so much for this information, and for such a measured response, I think I needed that, I don't want to let my (probably understandingly) extreme emotions and anxieties cloud my judgement.

Sorry you feel like you’ve been lied to, have you tried to organise speaking to someone through your maternity services? They should have a service where the notes from your previous pregnancy and delivery are available for a midwife to go through with you to fill any missing gaps and answer any questions that you might have.
It sounds like this might be beneficial for you.

Why would they lie to you? Sounds like they were concerned about you and the baby, they have nothing to gain from lying to you ?