Structural and Functional Changes in the Renal Circulation after Complicated Pregnancy

Abstract

Angiographic and histological studies of the intrarenal circulation have been undertaken in 20 patients following complicated pregnancies: 12 patients had had hypertension of pregnancy (group 1); 7 acute renal failure due to either ante- or post-partum haemorrhage and 1 patient post-partum renal failure (group 2). 3 months after delivery all patients had angiographic evidence of structural and functional abnormalities involving intrarenal blood vessels and cortical blood flow. The severity of the structural changes was related to the degree of microangiopathic haemolytic anaemia noted in the acute obstetric complication but not to the height of the blood pressure at this stage. Histological abnormalities of the cortical blood vessels were minimal. At the time of the renal angiogram and biopsy, 3 of the 12 group 1 patients were hypertensive and 3 had impaired renal function, compared with 5 and 1, respectively, in the 8 group 2 patients. Although during the follow-up period (mean 5 years) no further deterioration in renal function in either group has been observed, hypertension developed in 50% of the group 1 patients compared with only 1 of the patients in group 2. The relationship between the late onset of hypertension and the intrarenal vascular and haemodynamic abnormalities is discussed.

Persistent Abnormalities of Fibrinolytic Activity and Platelet Function in Patients With Reversible Oestrogen‐associated Hypertension

“…The significance of these abnormalities in relation to the development of hypertension and to the intrarenal vascular disease found in these patients is discussed.PREVIOUS studies from this department showed the presence of both structural and haemodynamic abnormalities of the intrarenal circulation in patients with a previous history of oestrogen-associated hypertension . Similar abnormalities were also noted in patients with the loin-pain-haematuria syndrome and in patients with a previous history of pregnancy-associated hypertension (Aber, 1978;Burden et al, 1979). In the latter two groups of patients, abnormalities of platelet function and fibrinolysis and/or platelet sequestration by the kidneys were found (Jones et al, 1977;Al-Khader et a,, 1979).…”

Tenofovir Use and Renal Insufficiency among Pregnant and General Adult Population of HIV-infected, ART-Naïve Individuals in Lilongwe, Malawi

“…The lack of significant factors associated with CrCl<50 mg/dl and pregnancy could possibly be due to the renal changes that occur during pregnancy [29], [30], [31]. BMI, hemoglobin, and serum creatinine levels change during pregnancy [32], [33] and these changes could possibly affect creatinine clearance.…”

Pregnancy-Associated Disease of the Renal Microcirculation

“…Previous studies in this Department have shown both structural and haemodynamic abnormalities of the intrarenal circulation in patients with a history of pregnancy-associated hypertension, who were known to be normotensive both before and after the pregnancy, and in whom there was no evidence of pre-existing renal disease (Burden, Boyd & Aber, 1979). Although the precise pathology and pathogenesis of these lesions is still uncertain, their severity appeared to be related to both the duration of hypertension and the magnitude of platelet consumption recorded during the Correspondence: Dr G. M. Aber, Department of Nephrology, North Staffordshire Royal Infirmary, Stoke-on-Trent, Staffordshire, U.K. acute obstetric complication.…”