Superimposed Preeclampsia in Women with Chronic Kidney Disease

Abstract

Aim: To evaluate whether pregnant women with chronic kidney disease (CKD) adapt poorly to increases in renal blood flow. This can exacerbate renal function and impair perinatal outcome, as there is a major interplay between CKD and preeclampsia (PE). Methods: We analyzed the outcomes of 90 pregnant women with preexisting CKD. The estimated glomerular filtration rate (eGFR) was measured along with the levels of angiogenic factors, soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor, which might act in the pathophysiology of PE. Results: In pregnancies with CKD, PE and preterm delivery were increased and the increased blood pressure worsened the perinatal outcomes much more than the increased proteinuria. All pregnancies with severe renal insufficiency were delivered preterm because of impaired renal function. The eGFR was correlated significantly with 24-hour creatinine clearance (r = 0.830). Significant differences in sFlt-1 and placental growth factor levels were found between severe PE without any complications and severe superimposed PE (p < 0.05), and between women with and without declining renal function in superimposed PE (p < 0.01). Conclusion: Pregnancies with CKD have a high risk of obstetrical complications. The eGFR might serve for evaluating renal function during pregnancy. Angiogenic factors might be potential markers for a differential diagnosis between PE and worsening renal function.

Expression and Clinical Significance of ATP-Binding Cassette Transporter 1 in Serum and Placental Tissue in Chinese Patients with Preeclampsia

“…In several previous studies [5,6,22], patients with PE were found to have an increased peroxidation substrate level in their serum when compared with normal pregnant women. There was a twofold increase in TG and free fatty acid content, while the amount of HDL synthesized declined tremendously and the amount of lipid peroxidase in HDL increased significantly.…”

“…Although a key issue in obstetrics, the etiology and pathogenesis of PE have not yet been fully elucidated, making the prevention and the treatment of this disease difficult [4]. A number of studies have reported the prevalence of lipid metabolism disorder in patients with PE [5,6]. Lipid peroxidation has been shown to damage vascular endothelial cells and is associated with acute atherosclerosis in uterine spiral arteries and placental bed arterioles, resulting in stenosis and increased vascular resistance of uterine spiral arteries [7,8].…”

Preeclampsia: Updates in Pathogenesis, Definitions, and Guidelines

“…Hence, the incorporation of angiogenic markers may help to risk stratify women with high suspicion for preeclampsia. Similarly, angiogenic markers have proved to be useful in distinguishing between confounding diagnoses, such as chronic hypertension, CKD, and lupus nephritis (12)(13)(14)(15). The potential to target sFlt as a therapy is also exciting and currently being studied using an apheresis technique (16).…”

“…Interestingly, none of the societies address this issue in their guidelines. However, the angiogenic markers (as mentioned above in Angiogenic Factors) sFlt-1 and PlGF have been shown to be able to distinguish preeclampsia from CKD (13,14) and thus, may be potentially incorporated in practice for more clarity.…”

Total and Differential Leukocyte Count Percentiles in Healthy Singleton Term Women during the First Stage of Labor

“…The reason for excluding cesarean section was to form a more uniform cohort of very low risk parturient women with minimal obstetric intervention. Complications of pregnancy were defined as serious problems that are associated with pregnancy such as hypertensive disorders, preeclampsia [10], gestational diabetes, thromboembolic events, hyperthyroidism [11], etc. Complications of pregnancy were not exclusion criteria but rather their presence precluded inclusion in the study.…”