# Introduction ypertension is one of the common complications met with pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. There is generalised vasospasm leading to systemic disorders involving all the vital organs of the body. Severity of Hypertensive disease in pregnancy is controllable with proper management in most of the cases and mortality is avoidable. PIH is a term used to describe new hypertensions which appear after midterm pregnancy (20 weeks) and resolves after delivery. PIH is defined as raised blood pressure recorded at least on two occasions at 6 hours apart (2). It may be either diastolic >90 mm of Hg or systolic >140 mm of Hg. Preeclampsia is also associated with significant proteinuria >300 mg/ 24 hours (3). Gestational hypertension shows an exaggerated B.P. reference detected first time after mid pregnancy without proteinuria. It is thought that preeclampsia develop when the pregnancy induced systemic response causes one or more maternal system to decompensate. In its clinical phase preeclampsia is a hypocalciuric state and it has been reported that hypocalciuria predicts preeclampsia (9). The pregnant women's body provides daily doses of 50-330 mg calcium to supports development of foetal skeleton (7). This high foetal demand for calcium is facilitated by profound physiological interactions between mother and foetus. Studies of blood calcium level during pregnancy found significantly decreases in total serum as pregnancy progressed (6). Regulation of intracellular calcium plays a key role in hypertension half of the pregnant women with hypertension have preeclampsia. Pregnant women who develop severe preeclampsia have significant low dietary calcium intake compared to normotensive women. A calcium supplement has been hypothesized to reduced chances of PIH and preeclampsia (16). Biochemical changes in PIH are increased plasma Creatinine, urea and uric acid concentration with proteinuria due to renal glomerular endotheliosis leading to impaired glomerular perfusion and filtration. Many studies have been conducted to rule out the etiology , early screening and diagnostic tests, like lipid profile, oxidant and antioxidant status but among these serum and urine calcium levels and calcium metabolism have been studied extensively in PIH and preeclampsia and various conflicting results are given. Study is conducted to know alterations in serum and urinary calcium levels in all PIH cases of hypertension induced in pregnant women in and around Chitradurga. # II. Materials and Methods a) Inclusion Criteria 50 pregnant women at period (18-20 weeks) of gestation both from out patients and inpatient of BMC Hospital who were following up with their with regular antenatal checkups, followed with regular routine blood and Urine investigations -i.e. Hb, RBS, VDRL, urine routine examination for protein, sugar, pus cells, epithelial cells are examined. # b) Exclusion criteria Pregnant women who are previously known diabetic, hypertensive and suffering from any illness (mainly renal and hepatic) are excluded from the study. i. Methods Study group will be followed up every four weeks from 28th week of gestation and 24hour/random urine sample will be collected for Biochemical evaluation of urinary Calcium (12), Creatinine (13) and protein by multiple strips (dipsticks) by Roche's Urine Analyser. 3 ml venous blood sample was collected from both PIH cases and normal pregnant women as per the criteria into plane vaccutainers. Blood samples are used for serum Calcium (12), serum Uric acid (14) and serum Creatinine (13). The results were statistically analysed with Students "test". A case control comparative study was done with PIH and normal pregnant women accordingly to the criteria. # III. # Results The present study included a total number of 100 subjects consists of 50 PIH cases and 50 normal pregnant women. The Urinary protein levels in PIH cases is significant increase (p<0.001) as compared to normal pregnant women. The proteinuria in PIH cases as compared to normal pregnant women is probably due to renal glomerular endotheliosis leading to impaired glomerular perfusion and filtration. Total protein excretion in urine is considered as abnormal in pregnant women when it exceeds 300mg/24 hours. The urinary creatinine levels in PIH cases decreased as compared to (p<0.001) normal pregnant women. GFR and renal blood flow raised markedly during pregnancy results in physiological fall in the serum Creatinine concentration. Urine protein excretion increases substantially due to combination of increased GFR, increased permeability of glomerular basement membrane. The protein/Creatinine ratio in PIH cases is marginally increased as compared to normal pregnant women. Thus the pathogenesis of hypocalciuria in PIH is controversial and theoretically may be due to decreased calcium uptake by the foetus and/or increased renal tubular absorption of calcium (5). The serum uric acid levels are significantly increased (p<0.001) in PIH cases compared to normal pregnant women (Table -2) and this supports the theory of uric acid role in vascular damage and in oxidative stress, the renal lesion of glomerular endotheliosis is mostlikly caused by circulating anti endothelial factors such as soluble fms-like tyrosinekinase-1, it is conceivable that uric acid may synergise with soluble fms-like tyrosinekinase-1, to induce endothelial dysfunction also the afferent arteriolar disease is seen in individuals with PIH, which explains development of hypertension in PIH (4). In this study, it was found that significant hypocalciuria was associated with preeclampsia, suggests that, calcium measurement may be useful in screening for the PIH cases. ![of pregnancy. Nippon Jinzo Gakkai Shi. 31; 327-334. 16. Zemel M. B. 2001. Calcium modulation of hypertension and Obesity. Journal of American College of Nutrition. 20 (5); 4285-4355.](image-2.png "") 1and Normal pregnant womenUrinary CalciumUrinary ProteinUrinary CreatinineProtein/CreatinineParameter(mg/dl)(gm/day)(gm/day)ratioNormal pregnant390.420.0801.290.05women±±±±(n=50)34.360.0260.330.03PIH Cases (n=50)342.92*** ± 52.10.333*** ± 0.130.76** ± 0.110.43* ± 0.17Note: 1.The number in parenthesis shows the number of samples.2. Values are expressed as their Mean ± SD.3. p-value * p<0.05, ** p<0.01, *** p<0.001.Table -2 shows, the serum levels of Uric acid,Calcium and Creatinine in PIH cases and compared withnormal pregnant women. 2pregnant womenParameterSerum Uric acidSerum CalciumSerum Creatinine(Mg/dl)(Mg/dl)(Mg/dl)Normal pregnant women (n=50)5.62 ± 1.018.95 ± 0.880.80 ± 0.13PIH Cases (n=50)7.64*** ± 1.398.29** ± 0.470.898 ± 0.16Note: 1.The number in parenthesis shows the number of samples.2. Values are expressed as their Mean ± SD.3. p-value * p<0.05, ** p<0.01, *** p<0.001. - * Kumar Jaypee Publications New Delhi 1st Edn * Hypertension in pregnancy CW GRedman Oxford textbook of medicine 2003 4 * ;Edn TMDa Warrel JPCox Firth Oxford University press 2 New York * Uric acid and Preeclampsia Kee-HakChunlam DukheeLim S AnathKang Karumanchi Seminars in Nephrology. Pg * Hypocalciuria of preeclampsia is dependent of parathyroid hormone YFrankle GBarkai SMashiach Obstet Gynecol 77 1991 * Maternalfetal Calcium and Bone Metabolism during pregnancy, Puerperium and Lactation CSKova KeronenBerg HM Endocrine Reviews 18 6 1997 * Randomised plasibo Controlled Calcium Supplementation Study in pregnant Gambian women MALanding Annpyankubas American Journal of Clinical Nutrition 83 30 2006 * Reported Calcium intake is reduced in women with preeclampsia JGRamos EBrietzke Martins-Costa Sh Hypertens pregnancy 25 3 2006 * Urinary calcium in asymptomatic primigravida who later developed preecampsia VRSuarez JGTrelles JMMiyahira J. Obstet. Gynecol 87 1996 * Calcium excretion in preeclampsia LSanchez-Ramos SSandroni FJAndres J Obstet Gynecol 77 1991 * Hypocalciuria in preeclampsia PATaufield KLAles LMResnick N. Engl J Med 316 1987 * Determination of serum calcium and Urinary Calcium "practical Clinical Chemistry HVarley AHGowenlock MBell 4th edn * Determination of Creatinine in Urine" practical Clinical Chemistry HVarley AHGowenlock MBell 1 4th edn * DSYoung Clin. Biochem. Revs 4 1982 * AYoshida KMorozumi TSuganuma KSato JAoki TOlkava TPujinami Urinary Calcium References Références Referencias 1989 * Urine calcium excretion in preeclampsia TBilgin OKultu YKimya T kin J Obstet Gynecol 10 2000 * Hypertensive disorders in pregnancy" in Essentials of Obstetrics, Arulkumaran S, Sivanesarantnam V, and Pratap In a conclusion, hypocalciuria and hyperproteinuria is important feature of severe preeclampsia and probably indirectly related to the altered renal function seen in toxaemia of pregnancy AChatterjee GithaBasu 2004