Abstract

A slight rise in creatinine level during pregnancy may indicate progression of renal disease and thus serum creatinine has greater predictive ability compared with urea for the determination of the adverse outcomes of kidney disease. The aim of this study was to determine creatinine levels among pregnant women at Buea Regional Hospital.

A prospective cross-sectional study design was employed for this study in which 160 subjects were selected based on their willingness to participate in the study. The sampling technique was prospective and a non-probability convenient sampling technique in which pregnant women who were come for antenatal care were sampled.

About 3mls of blood was collected into a container without anticoagulant and allowed to clot. The blood was centrifuged at 3000 rpm for 5 minutes to obtain serum. Two sets of three test tubes were labeled B as Blank, S as Standard, and T as Test. After 2.0 ml reagents were added into B, S, and T.

After 0.2 ml of distilled water was added to B as Blank, 0.2 ml of the standard into S, and 0.2 ml of sample into T as Test. They were mixed and allowed at room temperature for 90 minutes. For the results creatinine was higher among nonpregnant women (80.91 µmol/l) compared to their pregnant counterparts (63.91 µmol/l).

Creatinine decreases with trimester where it was highest among women in their first trimester (66.02 µmol/l) and lowest among those in their third trimester (58.52 µmol/l). Lastly, it increases with an increase in an age where those of the age group 36-40 years had the highest (67.32µmol/l) and least (55.23µmol/l) among those of the age group 20-25 years.

CHAPTER ONE

INTRODUCTION

Background of the Study

Creatinine is essentially a metabolite of creatine phosphate, a compound that acts as a source of energy in muscle. This molecule is produced at a fairly constant rate in the body, although this does vary depending on muscle mass. Men tend to have higher creatinine levels than women, due to their greater skeletal mass.

The main route of creatinine excretion is through the kidneys, where creatinine is filtered by the glomerulus and also secreted by the proximal tubule. It is a useful indicator of renal health because it is excreted in the urine unchanged and easily measured by-product of muscle metabolism.

In a healthy kidney, little or no creatinine is reabsorbed, whereas, in kidney disease, the creatinine concentration in the blood may increase. The creatinine concentration in the urine and blood can therefore be used to calculate the rate at which the kidney is clearing creatinine that is creatinine clearance (CrCl) rate. This creatinine clearance rate is correlated with the glomerular filtration rate (GFR), which is important in the clinical assessment of renal function (Bowers et al., 1980).

Human pregnancy takes about 40 weeks to complete starting from the last menstrual cycle to the time of delivery of the baby and is made of three intervals known as first, second, and third trimesters. The first trimester starts from the first day of conception up to the 13th week and miscarriages are most likely to occur at this stage.

The second trimester is from the 13th week to the 26th week, where the movement of the fetus may also be felt by monitoring and assessment by ultrasound. The third trimester starts from the 26th week to the end of pregnancy which is usually around the 40th week and marks the beginning of viability (Patricia et al., 2013).

At the time of pregnancy, pregnant women’s body undergoes substantial physiological and anatomical alterations making it possible to nurture and accommodate the developing fetus, and these alterations which commence after conception affects every organ system (Soma et al., 2016).

This physiological phenomenon with many biochemical alterations (ranging from alterations in fluid and electrolyte concentrations to more complex modifications in cortisol and calcium metabolism) helps in the nurturing and survival of the developing fetus.

During the first half of pregnancy, there is an increase in cardiac output, accompanied by a marked increase in intravascular and extracellular volume. This is accompanied by enlargement of the kidneys due to fluid retention and failure of urine to properly drain from the kidney to the bladder, which is attributable to proliferation in the kidney’s interstitial fluid volume and vascular system rather than proliferation in the number of nephrons (Cheung et al., 2013).

Hydronephrosis which may be observed in pregnancy, maybe due to increased levels of progesterone and sudden changes in the hormonal and hemodynamic environment during pregnancy. This enlargement of the kidneys is prominent in the right kidney as a result of the angle at which it crosses the iliac and ovarian vessels at the point of its entry to the pelvis and becomes more pronounced as the pregnancy advances through the trimesters due to fluid retention which predisposes the woman to urinary stasis, culminating in the increased risk of urinary tract infections.

Structural changes in the kidneys during pregnancy is also influenced by both hormonal and mechanical factors where elevated progesterone concentration in plasma creates a force of contraction on the uterus leading to a compression effect exerted by the weight of the uterus as the pregnancy advances (Maynard et al., 2009).

The physiological state of pregnancy brings about a lot of changes that affect the metabolism of various biochemical parameters. These changes are largely thought to provide a conducive environment for the growing fetus but may affect the health of the woman and could also lead to problems with metabolism and excretion of biochemical markers of renal impairment.

Furthermore, during pregnancy cardiac output and renal blood flow are increased together with a physiological increase in glomerular filtration rate resulting in increased clearance of creatinine, hence pregnant women with serum creatinine levels closer to the upper limit of reference interval should be examined for further possible renal impairment (Cheung et al., 2013).

A slight rise in creatinine level during pregnancy may indicate progression of renal disease and thus serum creatinine has greater predictive ability compared with urea for the determination of the adverse outcomes of kidney disease (Maynard et al., 2009).

Statement of the Problem

Among pregnant women, serum creatinine concentrations quickly dropped in the first trimester, reached a plateau in the second, and slowly rose in the third trimester toward the pre-pregnancy concentration. creatinine-based equations used to estimate glomerular filtration may misclassify renal function during pregnancy, as they depend on a steady state of creatinine balance (Ziv et al., 2021).

Renal disease and dysfunction have a significant impact on maternal health and pregnancy outcomes. As more women pursue pregnancy at older ages and with more preexisting medical conditions than past generations, the underlying renal disease has become a greater concern for women of reproductive age (Harel et al., 2021).

A slight rise in creatinine level during pregnancy may indicate progression of renal disease and thus serum creatinine has greater predictive ability compared with urea for the determination of the adverse outcomes of kidney disease. During pregnancy cardiac output

and renal blood flow is increased together with a physiological increase in glomerular filtration rate resulting in increased clearance of creatinine, hence pregnant women with serum creatinine levels closer to the upper limit of reference interval should be examined for further possible renal impairment (Cheung et al., 2013).

A slight rise in creatinine level during pregnancy may indicate progression of renal disease and thus serum creatinine has greater predictive ability compared with urea for the determination of the adverse outcomes of kidney disease (Maynard et al., 2009). This necessitated this work to be carried out among pregnant women at Buea Regional Hospital.

Objectives

Main objective

To determine the creatinine level of pregnant women at Buea Regional Hospital South West Region Cameroon.

Specific objectives

1. To compare the creatinine level of pregnant and nonpregnant women at Buea Regional Hospital South West Region Cameroon.
2. To determine the creatinine level of pregnant women with respect to age at Buea Regional Hospital.
3. To determine the creatinine level of pregnant women with respect to a trimester at Buea Regional Hospital.