Hypertension in Pregnancy Is a Risk Factor for Microalbuminuria Later in Life

Kattah, Andrea; Asad, Reem; Scantlebury, Dawn C.; Bailey, Kent R.; Wiste, Heather J.; Hunt, Steven C.; Mosley, Thomas H.; Kardia, Sharon L.R.; Turner, Stephen T.; Garovic, Vesna D.

doi:10.1111/jch.12116

Cited by 42 publications

(27 citation statements)

References 40 publications

(89 reference statements)

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“…(26) Although this injury is thought to be transient,(27) some evidence suggests that moderately increased albuminuria is present for up to 20 years after the hypertensive pregnancy. (28–30) Podocyturia may be sustained in the post-partum period in some women with preeclampsia, which could reflect ongoing kidney damage or even systemic endothelial dysfunction. (31, 32) Third, women with preeclampsia are at increased risk of hypertension, and may develop hypertension earlier than women with normotensive pregnancies, suggesting that hypertension may be an important mediating factor on the causal pathway from preeclampsia to ESRD.…”

Section: Discussionmentioning

confidence: 99%

Preeclampsia and ESRD: The Role of Shared Risk Factors

Kattah

Scantlebury

Agarwal

et al. 2017

American Journal of Kidney Diseases

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Background Several registry-based studies, using diagnostic codes, have suggested that preeclampsia is a risk factor for end-stage renal disease (ESRD). However, because the two diseases share risk factors, the true nature of their association remains uncertain. Our goals were to conduct a population-based study to determine the magnitude of the association between preeclampsia and ESRD and to evaluate the role of shared risk factors. Study Design Population-based, nested case-control study Setting & Participants The US Renal Data System was used to identify women with ESRD from a cohort of 34,581 women who gave birth in 1976–2010 in Olmsted County, Minnesota. Forty-four cases of ESRD were identified and each one was matched to 2 controls based on year of birth (± 1 year), age at first pregnancy (± 2 years), and parity (± 1 or ≥ 4). Predictor Preeclamptic pregnancy, confirmed by medical record review. Outcome End-stage renal disease. Measurements Pre-pregnancy serum creatinine and urine protein measurements were recorded. Comorbidities existing prior to pregnancy were abstracted from medical records, and included kidney disease, obesity, diabetes, and hypertension. Results There was evidence of kidney disease prior to the first pregnancy in 9 of 44 cases (21%) and 1 of 88 controls (<1%). Per chart review, 8 of 44 (18%) cases vs 4 of 88 controls (5%) had preeclamptic pregnancies (unadjusted OR, 4.0; 95% CI, 1.21–13.28). The results were similar after independent adjustment for race, education, diabetes, or hypertension prior to pregnancy. However, the association was attenuated and no longer significant after adjustment for obesity (OR, 3.25; 95% CI, 0.93 −11.37). Limitations The limited number of ESRD cases and missing data on pre-pregnancy kidney function. Conclusions Our findings confirm that there is a sizable association between preeclampsia and ESRD; however, obesity is a previously unexplored confounder. Pre-existing kidney disease was common, but not consistently coded or diagnosed.

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Section: Discussionmentioning

confidence: 99%

Preeclampsia and ESRD: The Role of Shared Risk Factors

Kattah

Scantlebury

Agarwal

et al. 2017

American Journal of Kidney Diseases

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“…Clinical studies support that women with a history of pre-eclampsia have an increased future risk of albuminuria, chronic kidney disease (CKD), and end stage renal disease (ESRD). 104–108 It is unclear whether this association is independent of risk factors that may be common to pre-eclampsia and renal disease (Figure 3). In a mouse model of selective podocyte depletion using diphtheria toxin, 109 a single episode of podocyte injury resulted in glomerular destabilization and persistent podocyte loss.…”

Section: Pre-eclampsia Podocyte Injury and Future Chronic Renal Dismentioning

confidence: 99%

Advances in the pathophysiology of pre-eclampsia and related podocyte injury

Craici

Wagner

Weissgerber

et al. 2014

Kidney International

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122

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Pre-eclampsia is a pregnancy-specific hypertensive disorder that may lead to serious maternal and fetal complications. It is a multisystem disease that is commonly, but not always, accompanied by proteinuria. Its cause(s) remain unknown, and delivery remains the only definitive treatment. It is increasingly recognized that many pathophysiological processes contribute to this syndrome, with different signaling pathways converging at the point of systemic endothelial dysfunction, hypertension, and proteinuria. Different animal models of pre-eclampsia have proven utility for specific aspects of pre-eclampsia research, and offer insights into pathophysiology and treatment possibilities. Therapeutic interventions that specifically target these pathways may optimize pre-eclampsia management and may improve fetal and maternal outcomes. In addition, recent findings regarding placental, endothelial, and podocyte pathophysiology in pre-eclampsia provide unique and exciting possibilities for improved diagnostic accuracy. Emerging evidence suggests that testing for urinary podocytes or their markers may facilitate the prediction and diagnosis of pre-eclampsia. In this review, we explore recent research regarding placental, endothelial, and podocyte pathophysiology. We further discuss new signaling and genetic pathways that may contribute to pre-eclampsia pathophysiology, emerging screening and diagnostic strategies, and potential targeted interventions.

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“…Baseline urine albumin excretion was significantly associated with the risk for developing hypertension (Odds ratio 2.29; 95% confidence interval 1.77 to 2.95 per 10-fold increase of urine albumin excretion). Kattah AG et al (2013) In this study, we present evidence that women with a history of hypertension in pregnancy are at significantly increased risk for microalbuminuria later in life as compared to those with normotensive pregnancies.…”

Section: Observations In Microalbuminuria Tested Patients At 18-22 Wementioning

confidence: 56%

“…It may be concluded that early pregnancy levels of microalbuminuria can be used as predictors of pre-eclampsia with high negative predictive value. (9,10) Out of 200 Subjects included at 18-22 Weeks  186 women could be investigated by 23-28 weeks.  2 women aborted.…”

Section: Resultsmentioning

confidence: 99%