Chronic kidney disease may be differentially diagnosed from preeclampsia by serum biomarkers

Abstract

Preeclampsia, affecting 5-8% of pregnancies, is the main cause of fetal-maternal mortality and morbidity. The differential diagnosis with chronic kidney disease (CKD) is a challenge owing to the overlapping clinical features. No biomarker has been found to discriminate between the two conditions. Here, we tested whether maternal serum levels of placental growth factor (PlGF) and soluble FMS-like tyrosine kinase-1 (sFlt-1), markers of preeclampsia, could be used to discriminate between 34 patients with preeclampsia, 23 patients with CKD during pregnancy, and 38 healthy pregnant women. Serum levels of PlGF and sFlt-1 were determined during the third trimester by commercially available immunoassays. In preeclampsia, sFlt-1 levels were significantly increased in comparison with that in CKD and in the control women. Serum levels of PlGF in preeclampsia were significantly decreased relative to both controls and patients with CKD. The sFlt-1 to PlGF ratio was significantly increased in preeclampsia (median 436) compared with controls (median 9.4) and CKD (median 4.0). No differences were found between controls and patients with CKD. Thus, our study suggests that it is possible to discriminate between preeclampsia and CKD during pregnancy by determining maternal serum levels of sFlt-1 and PlGF and their ratio.

Preeclampsia: Updates in Pathogenesis, Definitions, and Guidelines

“…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.…”

“…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).…”

Angiogenic Factors in Preeclampsia

“…[67][68][69][70][71] Angiogenic markers have also been shown to be promising in preeclampsia-related disorders, such as idiopathic fetal growth restriction and stillbirth. 72,73 To demonstrate clinical use of these biomarkers, we led a large clinical study to evaluate the role of angiogenic biomarkers in the prediction of preeclampsia-related adverse outcomes among women evaluated at our institution for suspected preeclampsia.…”

Molecular Mechanisms of Preeclampsia

“…Several groups have shown that sFlt-1 and free PlGF levels can be used to differentiate preeclampsia from diseases that mimic preeclampsia, such as chronic hypertension, gestational hypertension, kidney disease, and gestational thrombocytopenia (Salahuddin et al 2007;Sunderji et al 2010;Perni et al 2012;Rolfo et al 2012;Verdonk et al 2012).…”