Changes in urinary excretion of six biochemical parameters in normotensive pregnancy and preeclampsia

Hayashi, Masatoshi; Ueda, Yoshihiko; Hoshimoto, Kazunori; Ota, Yoriko; Fukasawa, Ichio; Sumori, Keijiro; Kaneko, Ikuyo; Abe, Shirou; Uno, Masaya; Ohkura, Takeyoshi; Inaba, Noriyuki

doi:10.1053/ajkd.2002.30561

Cited by 54 publications

(35 citation statements)

References 31 publications

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“…Urinary protein excretion is further increased during labor, but the ACR during this time point still remained within the normoalbuminuria range (44). Furthermore, another study did demonstrate that the protein/creatinine ratio exceeded the ACR more than might be expected (45). Thus, excretion of an alternate proteinaceous material may be responsible for the small augmentation in total proteinuria noted during healthy pregnancy and the method of choice for measurement of proteinuria may factor into this sometimes confusing clinical literature (46).…”

Section: Tubular Functionmentioning

confidence: 99%

Obstetric Nephrology

Odutayo

Hladunewich

2012

Clinical Journal of the American Society of Nephrology

172

106

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SummaryGlomerular hyperfiltration, altered tubular function, and shifts in electrolyte-fluid balance are among the hallmark renal physiologic changes that characterize a healthy pregnancy. These adjustments are not only critical to maternal and fetal well being, but also provide the clinical context for identifying gestational aberrations in renal function and electrolyte composition. Systemic vasodilation characterizes early gestation and produces increments in renal plasma flow and GFR, the latter of which is maintained into the postpartum period. In addition, renal tubular changes allow for the accumulation of nutrients and electrolytes necessary for fetal growth such that wasting of proteins, glucose, and amino acids in urine is limited in pregnancy and total body stores of electrolytes increase throughout gestation. Substantial insight into the mechanisms underlying these complex adjustments can be gleaned from the available animal and human literature, but our understanding in many areas remains incomplete. This article reviews the available literature on renal adaptation to normal pregnancy, including renal function, tubular function, and electrolyte-fluid balance, along with the clinical ramifications of these adjustments, the limitations of the existing literature, and suggestions for future studies.

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Section: Tubular Functionmentioning

confidence: 99%

Obstetric Nephrology

Odutayo

Hladunewich

2012

Clinical Journal of the American Society of Nephrology

172

106

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“…Glomerular barrier dysfunction, characterized by glomerular endotheliosis 1,2 and podocyte loss, 3,4 has been emphasized in severe preeclampsia because marked albuminuria is a hallmark feature of disease. 5,6 However, inflammation and injury to the proximal tubule also contributes to disease pathogenesis in many kidney disorders. [7][8][9][10] Considering that the tubulointerstitium accounts for >90% of kidney volume and that tubulointerstitial disease may occur independent of glomerular disease, 11 it is critical that urinary protein assessment in preeclampsia consider both glomerular and nonglomerular patterns of injury.…”

mentioning

confidence: 99%

Complement Activation and Kidney Injury Molecule-1–Associated Proximal Tubule Injury in Severe Preeclampsia

et al. 2014

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We enrolled 25 cases with severe preeclampsia, 25 controls with chronic hypertension, and 25 healthy controls without hypertension from a cohort of women receiving care at Brigham and Women's Hospital from March 2012 through March 2013. Institutional review board approval was obtained through the Partners Human Research Committee, and subjects gave informed consent. All procedures followed were in accordance with institutional guidelines. Methods Abstract-Kidney injury with proteinuria is a characteristic feature of preeclampsia, yet the nature of injury in specific regions of the nephron is incompletely understood. Our study aimed to use existing urinary biomarkers to describe the pattern of kidney injury and proteinuria in pregnancies affected by severe preeclampsia. We performed a case-control study of pregnant women from Brigham and Women's Hospital from 2012 to 2013. We matched cases of severe preeclampsia (n=25) 1:1 by parity and gestational age to 2 control groups with and without chronic hypertension. Urinary levels of kidney injury molecule-1 and complement components (C3a, C5a, and C5b-9) were measured by enzyme-linked immunosorbent assay, and other markers (albumin, β2 microglobulin, cystatin C, epithelial growth factor, neutrophil gelatinase-associated lipocalin, osteopontin, and uromodulin) were measured simultaneously with a multiplex electrochemiluminescence assay. Median values between groups were compared with the Wilcoxon signed-rank test and correlations with Spearman correlation coefficient. Analysis of urinary markers revealed higher excretion of albumin and kidney injury molecule-1 and lower excretion of neutrophil gelatinase-associated lipocalin and epithelial growth factor in severe preeclampsia compared with chronic hypertension and healthy controls. Among subjects with severe preeclampsia, urinary excretion of complement activation products correlated most closely with kidney injury molecule-1, a specific marker of proximal tubule injury (C5a: r=0.60; P=0.001; and C5b-9: r=0.75; P<0.0001). Taken together, we describe a pattern of kidney injury in severe preeclampsia that is characterized by glomerular impairment and complement-mediated inflammation and injury, possibly localized to the proximal tubule in

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“…Furthermore, several earlier studies on urinary Ca/Cr, 4 -7,28 -30 TP/Cr, 8,9,30 Malb/Cr 10,11,29,31 NAG/ Cr 11,32,33 and b 2 -mG/Cr ratios 11,34 in the second or third trimester of pregnancy have produced different results. We did not find significant differences in these biochemical parameters, except for urinary TP/Cr and Malb/Cr ratios.…”

Section: Discussionmentioning

confidence: 94%

Increases in urinary creatinine and blood pressure during early pregnancy in pre-eclampsia

et al. 2010

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Background: It is important to predict the development of pre-eclampsia (PE) during early pregnancy to prevent its occurrence later on. In this study, we studied urinary biochemical parameters and blood pressure (BP) during and after pregnancy to find useful parameters for predicting PE. Methods: A case-control study was performed in 25 PE patients and 172 normotensive pregnant women. Twelve biochemical parameters were measured in spot urine, and the systolic and diastolic BPs were measured using an automated device during pregnancy and six to eight weeks after birth. Results: A multiple logistic regression analysis showed that the combinations of urinary creatinine (Cr) and systolic BP (SBP) in the first trimester of pregnancy (8.9 + 2.6 weeks), and of urinary inorganic phosphorus (IP)/Cr and SBP in the second trimester of pregnancy (19.0 + 1.6 weeks) were useful for predicting PE. The area under the curve in the receiver operator characteristic curve of the combination of urinary Cr and SBP in the first trimester was 0.85 (95% confidence interval [CI] 0.74-0.96), and that of the combination of urinary IP/Cr and SBP in the second trimester was 0.91 (95% CI: 0.86-0.97). When used 249 mg/dL in urinary Cr and 128 mmHg in SBP as their cut-off points, the combination in the first trimester increased the accuracy (sensitivity 75% and specificity 95%) in predicting PE, as compared with that of urinary Cr (29%, 99%) or SBP (50%, 98%). Conclusions: Combination of urinary Cr and SBP in early pregnancy and that of urinary IP/Cr and SBP in mid-pregnancy are useful for the prediction of PE.

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Changes in urinary excretion of six biochemical parameters in normotensive pregnancy and preeclampsia

Cited by 54 publications

References 31 publications

Obstetric Nephrology

Obstetric Nephrology

Complement Activation and Kidney Injury Molecule-1–Associated Proximal Tubule Injury in Severe Preeclampsia

Increases in urinary creatinine and blood pressure during early pregnancy in pre-eclampsia

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