Preeclampsia: A close look at renal dysfunction

Sani, Hakimeh Moghaddas; Vahed, Sepideh Zununi; Ardalan, Mohammadreza

doi:10.1016/j.biopha.2018.10.082

Cited by 81 publications

(43 citation statements)

References 109 publications

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“…The venous congestion and reduced arterial perfusion can lead to renal, placental and fetal ischemia [34]. In the clinical stage of PE, renal dysfunction is mostly present with reduced clearance, albuminuria and oliguria [35]. The observation that the prevalence of PE is higher in severely obese women and in multiple pregnancies, together with the increase in the frequency of PE towards the end of gestation, suggests that increased IAP is part of its pathophysiologic process [3,[36][37][38][39].…”

Section: Increase In Iap During Pregnancy Might Induce Venous Congestmentioning

confidence: 99%

Increased Intra-Abdominal Pressure During Laparoscopic Pneumoperitoneum Enhances Albuminuria via Renal Venous Congestion, Illustrating Pathophysiological Aspects of High Output Preeclampsia

Dreesen

Schoutteten

Velde

et al. 2020

JCM

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Intra-abdominal hypertension (IAH) causes severe organ dysfunction. Our aim is to evaluate the effect of increased intra-abdominal pressure (IAP) on renal function, hypothesizing that venous congestion may increase proteinuria and fluid retention without endothelial dysfunction. Three urine samples were collected from 32 non-pregnant women undergoing laparoscopic-assisted vaginal hysterectomy (LAVH) and from 10 controls placed in Trendelenburg position for 60 min. Urine sampling was done before (PRE), during or immediately after (PER), and two hours after (POST) the procedure. Urinary albumin, protein and creatinine concentrations were measured in each sample, and ratios were calculated and compared within and between groups. During LAVH, the albumin/creatinine ratio (ACR) increased and persisted POST-procedure, which was not observed in controls. A positive correlation existed between the LAVH duration and the relative change in both ACR and protein/creatinine ratio (PCR) PER- and POST-procedure. Iatrogenic IAH increases urinary ACR and PCR in non-pregnant women via a process of venous congestion. This mechanism might explain the presentation of one specific subtype of late-onset preeclampsia, where no drop of maternal cardiac output is observed.

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Section: Increase In Iap During Pregnancy Might Induce Venous Congestmentioning

confidence: 99%

Increased Intra-Abdominal Pressure During Laparoscopic Pneumoperitoneum Enhances Albuminuria via Renal Venous Congestion, Illustrating Pathophysiological Aspects of High Output Preeclampsia

Dreesen

Schoutteten

Velde

et al. 2020

JCM

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“…However, there has been no study on infants' neurological development focused on PE with maternal renal dysfunction. PE is related to renal dysfunction owing to deficiency in podocyte-specific VEGF ( 47 ). Placental hypoxic condition in PE cases causes elevated levels of fms-like tyrosine kinase 1 (sFlt-1) and a soluble receptor of VEGF.…”

Section: Discussionmentioning

confidence: 99%

Pre-eclampsia Complicated With Maternal Renal Dysfunction Is Associated With Poor Neurological Development at 3 Years Old in Children Born Before 34 Weeks of Gestation

Yoneda

Tsuda

et al. 2021

Front. Pediatr.

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Objective: The purpose of this study was to investigate perinatal factors associated with a poor neurodevelopmental outcome in preterm infants.Methods: A retrospective study was conducted by searching our clinical database between January 2006 and December 2016. A total of 165 singleton children who were born between 23 and 33 weeks of gestation were included. We defined poor neurological development outcomes as follows: cerebral palsy; intellectual disability; developmental disorder including autism and attention-deficit/hyperactivity disorder; low score (<85 points) on Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III); or low score of Kyoto Scale of Psychological Development corrected at 3 years old. We diagnosed maternal renal dysfunction according to the Clinical Practice Guideline for chronic kidney disease 2018 and the Best Practice Guide 2015 for Care and Treatment of Hypertension in Pregnancy.Results: The rate of poor neurological development was 25/165 (15.2%): cerebral palsy (n = 1), intellectual disability (n = 1), developmental disorder (n = 2), low score of Bayley-III (n = 20), and low score of Kyoto Scale of Psychological Development (n = 1). Preeclampsia complicated with maternal renal dysfunction (P = 0.045) and delivery at <30 weeks of gestation (P = 0.007) were independent risk factors for poor neurological development.Conclusions: In addition to previous risk factors such as delivery at <30 weeks of gestation, preeclampsia complicated with renal dysfunction was also associated with poor neurodevelopmental outcomes corrected at 3 years old.

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“…sFlt-1 produced by M1s may have acted to neutralize VEGF and KTP-ELP-VEGF, further explaining the relative insensitivity of M1s to VEGF. Elevated sFlt-1 levels have been shown to be detrimental in the kidney, causing glomerular injury and damage to the filtration barrier [40-42]. Given the extensive infiltration of M1 macrophages in chronic renal injury [26], it is possible that secretion of sFlt-1 by M1s may drive the suppression of VEGF signaling and subsequent MV injury in RVD.…”

Section: Discussionmentioning

confidence: 99%

Recovery of Renal Function following Kidney-Specific VEGF Therapy in Experimental Renovascular Disease

Engel

Williams

et al. 2020

Am J Nephrol

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Background: Chronic renovascular disease (RVD) can lead to a progressive loss of renal function, and current treatments are inefficient. We designed a fusion of vascular endothelial growth factor (VEGF) conjugated to an elastin-like polypeptide (ELP) carrier protein with an N-terminal kidney-targeting peptide (KTP). We tested the hypothesis that KTP-ELP-VEGF therapy will effectively recover renal function with an improved targeting profile. Further, we aimed to elucidate potential mechanisms driving renal recovery. Methods: Unilateral RVD was induced in 14 pigs. Six weeks later, renal blood flow (RBF) and glomerular filtration rate (GFR) were quantified by multidetector CT imaging. Pigs then received a single intrarenal injection of KTP-ELP-VEGF or vehicle. CT quantification of renal hemodynamics was repeated 4 weeks later, and then pigs were euthanized. Ex vivo renal microvascular (MV) density and media-to-lumen ratio, macrophage infiltration, and fibrosis were quantified. In parallel, THP-1 human monocytes were differentiated into naïve macrophages (M0) or inflammatory macrophages (M1) and incubated with VEGF, KTP-ELP, KTP-ELP-VEGF, or control media. The mRNA expression of macrophage polarization and angiogenic markers was quantified (qPCR). Results: Intrarenal KTP-ELP-VEGF improved RBF, GFR, and MV density and attenuated MV media-to-lumen ratio and renal fibrosis compared to placebo, accompanied by augmented renal M2 macrophages. In vitro, exposure to VEGF/KTP-ELP-VEGF shifted M0 macrophages to a proangiogenic M2 phenotype while M1s were nonresponsive to VEGF treatment. Conclusions: Our results support the efficacy of a new renal-specific biologic construct in recovering renal function and suggest that VEGF may directly influence macrophage phenotype as a possible mechanism to improve MV integrity and function in the stenotic kidney.

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Preeclampsia: A close look at renal dysfunction

Cited by 81 publications

References 109 publications

Increased Intra-Abdominal Pressure During Laparoscopic Pneumoperitoneum Enhances Albuminuria via Renal Venous Congestion, Illustrating Pathophysiological Aspects of High Output Preeclampsia

Increased Intra-Abdominal Pressure During Laparoscopic Pneumoperitoneum Enhances Albuminuria via Renal Venous Congestion, Illustrating Pathophysiological Aspects of High Output Preeclampsia

Pre-eclampsia Complicated With Maternal Renal Dysfunction Is Associated With Poor Neurological Development at 3 Years Old in Children Born Before 34 Weeks of Gestation

Recovery of Renal Function following Kidney-Specific VEGF Therapy in Experimental Renovascular Disease

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