High-Normal Estimated Glomerular Filtration Rate in Early-Onset Preeclamptic Women 10 Years Postpartum

Abstract

Abstract-Women with a history of preeclampsia have a 5-to 12-fold increased risk to develop end-stage kidney disease.Previous observations in small cohorts suggest that former preeclamptic (fPE) women have subtle abnormalities in renal hemodynamics and renal function, which might predispose them to renal failure in later life. In this study, we analyzed renal function in a cross-sectional cohort consisting of former early-onset preeclamptic (fPE, n=339) and former healthy pregnant women (fHP, n=332), overall with a mean age of 39 years at 10 years postpartum. Estimated glomerular filtration rate (eGFR), assessed by the modification of diet in renal disease (MDRD) and chronic kidney disease-epidemiology (CKD-epi) equations, and urinary protein:creatinine ratios were assessed 10 years postpartum. Median MDRD and CKD-epi eGFR did not significantly differ between fHP and fPE groups, whereas a comparison of distribution of eGFR revealed a shift toward a high-normal MDRD eGFR in the fPE group (χ 2 , P=0.02) with the same trend for CKD-epi eGFR (χ 2 , P=0.18). The odds ratio for fPE women having MDRD eGFR >110 mL/min per 1.73 m 2 was 1.6 (1.1-2.4). In addition, the median urinary protein:creatinine ratio was slightly higher in fPE (8.5 versus 7.1 mg/mmol; P<0.01) and correlated positively with both MDRD and CKD-epi eGFR in fPE women. No increased incidence of CKD in fPE women was observed.In conclusion, we demonstrate subtle changes in renal function in former early-onset preeclamptic women 10 years postpartum, characterized by a high-normal eGFR and a slightly higher protein excretion. Whether these subtle differences predispose to or predict long-term renal function loss in fPE women remains to be investigated. Clinical Trial Registration-URL: http://www.trialregister.nl. Unique identifier: NTR2668.

Association of serum copeptin and urinary uromodulin with kidney function, blood pressure and albuminuria at 6 weeks post-partum in pre-eclampsia

“…Specifically, while copeptin was not associated with SBP in patients with prior PE, we observed a positive association in healthy controls, in line with prior evidence aside from pregnancy ( 28 ). A similar modulating effect of PE was observed regarding the relationship between copeptin and eGFR, although clinical interpretation is rendered tedious by the glomerular hyperfiltration described in the post-partum period whether after PE or a healthy pregnancy ( 37 , 38 ).…”

Kidney Function After a Hypertensive Disorder of Pregnancy: A Longitudinal Study

“…Previous studies report on kidney function in women with a history of HDP at different set time points postpartum, mostly shortly after preeclampsia, and show either subtle alterations or no differences in kidney function and kidney hemodynamics. [7][8][9][10][11] At 10 years postpartum, a high-normal eGFR is reported in women with a history of preterm preeclampsia, 9,21 which is speculated to represent a state of hyperfiltration as compensation for loss in kidney function leading to kidney function loss in the long term. In the present study, we observed a slightly lower eGFR instead of a high-normal eGFR, which might be explained by the approximately 10-year older age at the start of follow-up, during which hyperfiltration is not compensating for loss in kidney function anymore.…”

Acute Kidney Injury in Pregnancy: The Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Prevention and Care of Pregnancy-Related AKI, in the Year Dedicated to Women and Kidney Diseases

“…Evidence of the long-term effect of p-AKI on the future development of CKD is limited. However, there is a growing number of studies addressed to describing the relationship between PE and the hypertensive disorders of pregnancy and the development of cardiovascular diseases and CKD [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 ]. The data from the literature are somewhat conflicting, as a result of the heterogeneity of the studies and the differences in the definitions they adopt.…”