From preeclampsia to renal disease: a role of angiogenic factors and the renin-angiotensin aldosterone system?

Graaf, Anne Marijn van der; Toering, Tsjitske J.; Faas, Marijke M.; Lely, A. Titia

doi:10.1093/ndt/gfs278

Cited by 33 publications

(27 citation statements)

References 60 publications

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“…A meta-analysis showed that the occurrence of micro-albuminuria is as high as 31 % in women with previous PE compared with 7 % in controls at a weighted mean of 7.1 years postpartum [2]. In addition, this study showed a graded relationship between microalbuminuria and the severity of PE, with a 4-fold increase after mild PE and a 8-fold increased after severe PE.…”

Section: Proteinuriamentioning

confidence: 54%

“…In the meta-analysis of McDonald et al there were no significant differences in serum creatinine values, creatinine clearance and eGFR in formerly preeclamptic women compared with healthy parous controls [2] and Mangos et al [23] did not report eGFR changes 4-5 years postpartum. Only recently, subtle changes in renal function and renal haemodynamics in formerly preeclamptic women were reported.…”

Section: Kidney Function and Renal Haemodynamicsmentioning

confidence: 93%

“…This increased risk of CVD is accompanied by disturbances in renal function [2,3]. In the past 5-10 years, it has also been shown that women with a history of PE have an approximate 5-12-fold increased risk of developing end-stage renal disease (ESRD) in later life [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Long-term renal and cardiovascular risk after preeclampsia: towards screening and prevention

et al. 2016

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Preeclampsia (PE) is a hypertensive pregnancy disorder complicating up to 1-5% of pregnancies, and a major cause of maternal and fetal morbidity and mortality. In recent years, observational studies have consistently shown that PE carries an increased risk for the mother to develop cardiovascular and renal disease later in life. Women with a history of PE experience a 2-fold increased risk of long-term cardiovascular disease (CVD) and an approximate 5-12-fold increased risk of end-stage renal disease (ESRD). Recognition of PE as a risk factor for renal disease and CVD allows identification of a young population of women at high risk of developing of cardiovascular and renal disease. For this reason, current guidelines recommend cardiovascular screening and treatment for formerly preeclamptic women. However, these recommendations are based on low levels of evidence due to a lack of studies on screening and prevention in formerly preeclamptic women. This review lists the incidence of premature CVD and ESRD observed after PE and outlines observed abnormalities that might contribute to the increased CVD risk with a focus on kidney-related disturbances. We discuss gaps in current knowledge to guide optimal screening and prevention strategies. We emphasize the need for research on mechanisms of late disease manifestations, and on effective screening and therapeutic strategies aimed at reducing the late disease burden in formerly preeclamptic women.

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Section: Proteinuriamentioning

confidence: 54%

Section: Kidney Function and Renal Haemodynamicsmentioning

confidence: 93%

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Long-term renal and cardiovascular risk after preeclampsia: towards screening and prevention

et al. 2016

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“…In this regard, its definitions and the related uncertainties recall the discussion about the generic term of CKD [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Both conditions share frequent micro-vascular involvement, may be characterized by various combinations of hypertension and proteinuria, are related to pregnancy and one condition may mask or favour the development of the other [19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

A best practice position statement on the role of the nephrologist in the prevention and follow-up of preeclampsia: the Italian study group on kidney and pregnancy

Piccoli

Cabiddu

Castellino³

et al. 2017

J Nephrol

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Preeclampsia (PE) is a protean syndrome causing a transitory kidney disease, characterised by hypertension and proteinuria, ultimately reversible after delivery. Its prevalence is variously estimated, from 3 to 5% to 10% if all the related disorders, including also pregnancy-induced hypertension (PIH) and HELLP syndrome (haemolysis, increase in liver enzyme, low platelets) are included. Both nephrologists and obstetricians are involved in the management of the disease, according to different protocols, and the clinical management, as well as the role for each specialty, differs worldwide. The increased awareness of the role of chronic kidney disease in pregnancy, complicating up to 3% of pregnancies, and the knowledge that PE is associated with an increased risk for development of CKD later in life have recently increased the interest and redesigned the role of the nephrologists in this context. However, while the heterogeneous definitions of PE, its recent reclassification, an emerging role for biochemical biomarkers, the growing body of epidemiological data and the new potential therapeutic interventions lead to counsel long-term follow-up, the lack of resources for chronic patients and the increasing costs of care limit the potential for preventive actions, and suggest tailoring specific interventional strategies. The aim of the present position statement of the Kidney and Pregnancy Study Group of the Italian Society of Nephrology is to review the literature and to try to identify theoretical and pragmatic bases for an agreed management of PE in the nephrological setting, with particular attention to the prevention of the syndrome (recurrent PE, presence of baseline CKD) and to the organization of the postpartum follow-up.

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“…Therefore, this suggests that these women might have a higher risk for developing ESRD (33). The exact mechanisms underlying the increased risk for cardiovascular disease and ESRD in formerly preeclamptic women are not completely understood (30).…”

mentioning

confidence: 99%

Higher filtration fraction in formerly early-onset preeclamptic women without comorbidity

Toering

Graaf

Visser

et al. 2015

American Journal of Physiology-Renal Physiology

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Formerly preeclamptic women have an increased risk for developing end-stage renal disease, which has been attributed to altered renal hemodynamics and abnormalities in the renin-angiotensin-aldosterone system. Whether this is due to preeclampsia itself or to comorbid conditions is unknown. Renal hemodynamics and responsiveness to ANG II during low Na ϩ intake (7 days, 50 mmol Na ϩ /24 h) and high Na ϩ (HS) intake (7 days, 200 mmol Na ϩ /24 h) were studied in 18 healthy normotensive formerly early-onset preeclamptic women (fPE women) and 18 healthy control subjects (fHP women), all selected for absence of comorbidity. At the end of each diet, renal hemodynamics and blood pressure were measured before and during graded ANG II infusion. Both HS intake and former preeclampsia increased filtration fraction (FF) without an interaction between the two. FF was highest during HS intake in fPE women [0.31 Ϯ 0.12 vs. 0.29 Ϯ 0.11 in fHP women, generalized estimating equation analysis (body mass index corrected), P ϭ 0.03]. The renal response to ANG II infusion was not different between groups. In conclusion, fPE women have a higher FF compared with fHP women. As this was observed in the absence of comorbidity, preeclampsia itself might exert long-term effects on renal hemodynamics. However, we cannot exclude the presence of prepregnancy alterations in renal function, which, in itself, lead to an increased risk for preeclampsia. In experimental studies, an elevated FF has been shown to play a pathogenic role in the development of hypertension and renal damage. Future studies, however, should evaluate whether the subtle differences in renal hemodynamics after preeclampsia contribute to the increased long-term renal risk after preeclampsia. preeclampsia; postpartum; renal hemodynamics; renin-angiotensinaldosterone system; Na ϩ intake COMPLICATING up to 8% of pregnancies, preeclampsia (PE) is a major cause of maternal and fetal morbidity and mortality worldwide (27). PE is characterized by the de novo development of hypertension and proteinuria during the second half of pregnancy. Although it is a pregnancy-specific disease, evidence has mounted that PE has important long-term implications for maternal health, in particular, cardiovascular and renal health (2,24,33). It is, however, uncertain whether the increased renal and cardiovascular risk in formerly preeclamptic women is explained by PE itself or by underlying common (prepregnant) risk factors and comorbidity. Recent data have shown that formerly preeclamptic women have a 5-to 14-fold higher risk for developing end-stage renal disease (ESRD) (33, 36). Moreover, women who experienced multiple preeclamptic pregnancies have an even higher risk for ESRD (33). The risk for developing cardiovascular disease is especially high for women who have a history of early-onset PE (before 34 wk of gestational age) (2). It is unknown whether this also applies for the risk of developing ESRD. However, in a large Norwegian cohort study, the association between former PE and developing ESRD...

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From preeclampsia to renal disease: a role of angiogenic factors and the renin-angiotensin aldosterone system?

Cited by 33 publications

References 60 publications

Long-term renal and cardiovascular risk after preeclampsia: towards screening and prevention

Long-term renal and cardiovascular risk after preeclampsia: towards screening and prevention

A best practice position statement on the role of the nephrologist in the prevention and follow-up of preeclampsia: the Italian study group on kidney and pregnancy

Higher filtration fraction in formerly early-onset preeclamptic women without comorbidity

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