Uric Acid as an Additional Biomarker for Preeclampsia Beyond Renal Dysfunction

Abstract

Preeclampsia (PE) is a kind of pregnancy-associated hypertensive disorder that affects different organ systems during pregnancy
and contributes as one of the important factors in contributing to both maternal and perinatal morbidity and mortality. On
the other hand,"it" can lead to stroke, acute renal failure, HELLP syndrome, placental abruption, intrauterine fetal growth
restriction, intrauterine fetal demise (IUFD), etc. PE occurs in 8-10% of all pregnancies in India. Earlier, the lack of advanced
diagnostic approaches leads to its poor prediction at an early stage. During the past decade, there have been several studies
in the diagnosis of PE by establishing simple, cheap, and cost-effective tools for diagnosis and prediction. Study of the blood
uric acid levels in preeclampsia patients is quite prevalent, and considerable research in the same respect has been done in
recent years. Nevertheless, experts suppose that high levels of uric acid in the blood are just a sign of a low kidney cleansing
ability. In this regard, the authors of the article declare that they will present evidence showing that high levels of uric acid
in preeclamptic patients can have sources other than the impairment of kidney function, with the activities of the placental
ischemia-associated xanthine oxidase activity, the disruption of the trophoblast cell activity, and the activities of the NLRP3
inflammasome among such sources. Literature was identified through PubMed, Scopus, Embase, Google Scholar, and the
WHO Global Health Library, guided by PRISMA principles adapted for narrative synthesis. Evidence from a large metaanalysis
(196 studies, n ~ 39,540) indicates that serum UA is, on average, higher in PE than in normotensive pregnancy
across gestation, with the difference increasing with advancing gestational age. Findings from several Indian clinical cohorts
and international studies from Italy, China, Vietnam, and Colombia are summarized alongside comparative evidence for the
established angiogenic markers sFlt-1 and PlGF. Reported diagnostic performance of UA is heterogeneous, with sensitivity
generally in the range of 64–88% and specificity in the range of 48–93% depending on the population, cut-off, and gestational
timing, indicating that UA functions best as a complementary rather than a standalone biomarker. This review discusses these
findings cautiously, highlights conflicting and limiting evidence, and considers the potential role of point-of-care UA testing
as an adjunct triage tool pending further prospective validation.