Evaluation of Hemolysis as a Severe Feature of Preeclampsia

Burwick, Richard M.; Rincón, Mónica; Beeraka, Sridivya S.; Gupta, Megha; Feinberg, Bruce B.

doi:10.1161/hypertensionaha.118.11211

Cited by 27 publications

(29 citation statements)

References 27 publications

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“…28,29 In the 4 additional cases, collapsing glomerulosclerosis was associated with TMA; these patients developed acute kidney injury in the postpartum period. 30,31 The association with TMA [31][32][33] is intriguing. TMA is frequently found in preeclampsia, and some experts consider glomerular endotheliosis a specific variant of TMA.…”

Section: Discussionmentioning

confidence: 99%

Collapsing Lesions and Focal Segmental Glomerulosclerosis in Pregnancy: A Report of 3 Cases

Guillén

Silva

González

et al. 2019

American Journal of Kidney Diseases

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The relationship between focal segmental glomerulosclerosis (FSGS) and pregnancy is complex and not completely elucidated. Pregnancy in patients with FSGS poses a high risk for complications, possibly due to hemodynamic factors, imbalance between angiogenic and antiangiogenic factors, and hormonal conditioning. Although poor clinical outcomes associated with collapsing FSGS are common outside of pregnancy, the prognosis during pregnancy is not well documented. We report 3 patients who developed collapsing FSGS during pregnancy, 2 of whom had presumed underlying FSGS. Two patients underwent biopsy during pregnancy, and 1, during the puerperium. None of the 3 patients improved spontaneously after delivery, and 1 experienced a rapid deterioration in kidney function and proteinuria after delivery. Aggressive immunosuppressive therapy led to a full response in 1 case (without chronic lesions) and to partial responses in the remaining 2 cases. These cases suggest that collapsing lesions should be considered in patients with FSGS who develop a rapid increase in serum creatinine level or proteinuria during pregnancy and that these lesions may at least partially respond to treatment.

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Section: Discussionmentioning

confidence: 99%

Collapsing Lesions and Focal Segmental Glomerulosclerosis in Pregnancy: A Report of 3 Cases

Guillén

Silva

González

et al. 2019

American Journal of Kidney Diseases

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“…Diagnosis of PE was based on the International Society for the Study of Hypertensive Disorders in Pregnancy (ISSHP) classification [1] in terms of diastolic blood pressure of 90 mm Hg or above or systolic blood pressure of 140 mm Hg or above, and proteinuria of 2+ in dipstick. In the case of no proteinuria, the criteria of thrombocytopenia, hemolysis, renal insufficiency, impaired liver function, or pulmonary edema were applied [1,[6][7][8][9].…”

Section: Preeclampsia (Pe) Fetal Growth Restriction (Fgr) and Pretermentioning

confidence: 99%

“…Preeclampsia (PE) is a major pregnancy complication associated with high morbidity and mortality [1][2][3][4][5]. Diagnosis of PE is made if a previously normotensive woman develops hypertension after 20 weeks gestation accompanied by proteinuria [6], and/or thrombocytopenia [7], elevated liver enzymes or hemolysis, along with the occasional involvement of other organs, mainly the cardiovascular system, the eyes, and the brain [1][2][3][4][5][6][7][8][9]. National societies of Maternal and Fetal Medicine and individual medical centers have established protocols to guide proper clinical management for saving the life of the mother and fetus/neonate and reducing morbidity [3,4].…”

Section: Introductionmentioning

confidence: 99%

Pro- and Anti-Angiogenic Markers as Clinical Tools for Suspected Preeclampsia with and without FGR near Delivery—A Secondary Analysis

et al. 2021

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Objective—the objective of this study was to assess the accuracy of placental growth factor (PlGF), soluble Fms-like Tyrosine Kinase 1 (sFlt-1), and endoglin (sEng) in the diagnosis of suspected preeclampsia (PE) with and without fetal growth restriction (FGR) near delivery. Methods—this is a secondary analysis of a dataset of 125 pregnant women presenting at the high risk pregnancy clinic with suspected PE, FGR or PE + FGR in the University Medical Center of Slovenia. The dataset included 31 PE cases, 16 FGR cases, 42 PE + FGR cases, 15 cases who developed with unrelated complications before 37 weeks (wks) (PTD), and 21 unaffected controls who delivered a healthy baby at term. We also analyzed a sub-group of women who delivered early (<34 wks) including 10 PE, 12 FGR, 28 PE + FGR, and six PTD. Clinical management adhered to hospital guidelines. Marker levels were extracted from the dataset and were used to develop Receiver Operating Characteristic (ROC) curves and to calculate the area under the curve (AUC), the detection rates (DRs), and the false positive rates (FPRs). Previously published marker cutoffs for yes/no admission to hospital wards were extracted from the literature. Negative and positive predictive values (NPVs and PPVs) were evaluated for their value in determining whether hospital admission was required. Non-parametric tests were applied for statistical analysis; p < 0.05 was considered significant. Results—near delivery, all the pro-and anti-angiogenic markers provided diagnostic (ROC = 1.00) accuracy for the early (<34 wks) group of FGR. Diagnostic or near diagnostic (ROC = 0.95) accuracy was achieved by all marker for early PE + FGR but lower accuracy was achieved for early PE. For all cases, all markers, especially PlGF reached diagnostic or near diagnostic accuracy for FGR and PE + FGR. At this accuracy level, they can contribute to the clinical management of FGR, and PE + FGR. All the markers were less accurate for all PE cases. The use of published cutoffs was adequate for clinical management of FGR, whether early or for all cases, using an NPV > 90%. For PE + FGR, the PPV value approached 100%, especially for early cases, and can thus be implemented in clinical management. Neither NPV nor PPV were high enough for managing all cases of PE. There was no added value in measuring the PlGF/(sFlt-1 + sEng) ratio. Conclusion—This is the first study on a Slovenian population. It shows that near-delivery angiogenic biomarkers tests may be useful for confirming the diseases in cases where there is a diagnostic doubt. However, the clinical use of the biomarkers needs to be weighed against resources available and degree of certainty of the diagnosis made with and without them for managing suspected FGR and PE + FGR requiring delivery <34 wks, where they are very accurate, and furthermore in the management of all cases of FGR and FGR+PE. The markers were less accurate for the clinical diagnosis of PE.

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“…In normotensive FGR, the damage may remain local, affecting primarily the developing fetus, whereas in cases of disrupted blood-placenta barrier, free hemoglobin could leak to the maternal circulation exerting systemic oxidative stress on the endothelium. Thus, free hemoglobin in the maternal circulation could be fetal hemoglobin originating from the placenta, or adult free hemoglobin originating from hemolysis of maternal red blood cells [14,41]. In both cases, free hemoglobin contributes to the oxidative stress and vasoconstriction seen in PE.…”

Section: Pathophysiological Mechanismsmentioning

confidence: 99%

Hemopexin and α1-microglobulin heme scavengers with differential involvement in preeclampsia and fetal growth restriction

et al. 2020

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Hemopexin and α 1-microglobulin act as scavengers to eliminate free heme-groups responsible for hemoglobin-induced oxidative stress. The present study evaluated maternal and fetal plasma concentrations of these scavengers in the different phenotypes of placentamediated disorders. Singleton pregnancies with normotensive fetal growth restriction [FGR] (n = 47), preeclampsia without FGR (n = 45) and preeclampsia with FGR (n = 51) were included prospectively as well as uncomplicated pregnancies (n = 49). Samples were collected at delivery and ELISA analysis was applied to measure the hemopexin and α 1-microglobulin concentrations. In maternal blood in preeclampsia with and without FGR, hemopexin was significantly lower (p = 0.003 and p<0.001, respectively) and α 1-microglobulin was significantly higher (p<0.001 in both) whereas no difference existed in normotensive FGR mothers compared to controls. In contrast, in fetal blood in growth restricted fetuses with and without preeclampsia, both hemopexin and α 1-microglobulin were significantly lower (p<0.001 and p = 0.001 for hemopexin, p = 0.016 and p = 0.013 for α 1-microglobulin, respectively) with no difference in fetuses from preeclampsia without FGR in comparison to controls. Thus, hemopexin and α 1-microglobulin present significantly altered concentrations in maternal blood in the maternal disease-preeclampsia-and in cord blood in the fetal disease-FGR-, which supports their differential role in placenta-mediated disorders in accordance with the clinical presentation of these disorders.

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Evaluation of Hemolysis as a Severe Feature of Preeclampsia

Cited by 27 publications

References 27 publications

Collapsing Lesions and Focal Segmental Glomerulosclerosis in Pregnancy: A Report of 3 Cases

Collapsing Lesions and Focal Segmental Glomerulosclerosis in Pregnancy: A Report of 3 Cases

Pro- and Anti-Angiogenic Markers as Clinical Tools for Suspected Preeclampsia with and without FGR near Delivery—A Secondary Analysis

Hemopexin and α1-microglobulin heme scavengers with differential involvement in preeclampsia and fetal growth restriction

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