Postpartum persistent proteinuria after preeclampsia: a single-center experience

Unverdi, Selman; Çeri, Mevlüt; Ünverdǐ, Hatǐce; Yılmaz, Rahmi; Akçay, Ali; Duranay, Murat

doi:10.1007/s00508-013-0320-8

Cited by 23 publications

(23 citation statements)

References 13 publications

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“…37 These women should be evaluated with respect to continuing proteinuria, persistent hematuria, or impaired renal function and a percutaneous renal biopsy should be performed in women who have positive signs of underlying renal disease. 30 Limitation of our study-We did not study the diagnosis-todelivery interval, but those with early delivery in our group had late postpartum recovery, indicating that they had severe/complicated preeclampsia that had demanded early termination.…”

Section: Discussionmentioning

confidence: 88%

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Preeclampsia: Postpartum Resolution of Hypertension, Proteinuria and Serum N-terminal B-type Natriuretic Peptide

Gupta¹,

Gupta²,

Saini³

et al. 2019

Indian Journal of Medical Biochemistry

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Background: Postpartum persistent proteinuria and hypertension (HT) is associated with development of chronic kidney disease and cardiovascular disease in later life. AIMS & OBJECTIVES: To evaluate blood pressure, proteinuria and serum NT-pro-BNP in proteinuric preeclamptic (PE) women and study their postpartum resolution till 3 months and determine the associated risk factors. Material and methods: 100 PE women enrolled included 66 women with mild (group A) and 34 with severe PE (group B). BP, urinary protein:creatinine(P/C) ratio, S.NT-pro-BNP were evaluated at labor room admission, postpartum day 1, 6 weeks and 3 months. Results: Group B women had significant higher baseline BP, urine P/C ratio and S. NT-pro-BNP compared to group A. Resolution of BP, proteinuria and S. NT-pro-BNP was complete in group A women at 6 weeks postpartum. Persistent hypertension was observed in 25 and 4 women at postpartum 6 weeks and 3 months respectively. Proteinuria persisted in 25 and 10 women at postpartum 6 weeks and 3 months respectively. Resolution of NT-pro-BNP was complete at 3 months. In logistic regression model persisting hypertension and proteinuria at 3 months was correlated with increasing age, higher BMI and lower gestational age at delivery. Negative predictive value of 100% was observed with baseline P/C ratio <5, BP <120 mm Hg diastolic and S.NT-pro-BNP <1000 pg/mL for development of persistent proteinuria and hypertension. Conclusion: Women with severe PE should be followed up for persistent proteinuria and hypertension. These women require evaluation for chronic kidney disease and preventive strategies for cardiovascular disease.

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Section: Discussionmentioning

confidence: 88%

“…Four patients (29%) were diagnosed with MPGN, four patients (29) were diagnosed with IgA nephropathy (IgAN), one patient (7 %) was diagnosed with FSGS, and one patient (7 %) was diagnosed with amyloidosis. 30 Thus persistent proteinuria in PE women require further investigations and should not be overlooked.…”

Section: Discussionmentioning

confidence: 99%

Preeclampsia: Postpartum Resolution of Hypertension, Proteinuria and Serum N-terminal B-type Natriuretic Peptide

Gupta¹,

Gupta²,

Saini³

et al. 2019

Indian Journal of Medical Biochemistry

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“…Therefore, the primary underlying problem may lie in the kidneys in a greater proportion of cases with preeclampsia, especially among women who first develop proteinuria. In addition, among 14 patients with preeclamptic Turkish women with persistent proteinuria after delivery, biopsy-proven underlying renal diseases were present in 10 patients: membranoproliferative glomerulonephritis in four (29%), IgA nephropathy in four (29%), FSGS in one and amyloidosis in one in results of a recent study by Unverdi et al [10].…”

Section: Discussionmentioning

confidence: 90%

Hidden renal disease in a female patient with long-lasting isolated gestational proteinuria followed by hypertension

Kawabata¹,

Akaishi²,

Nozaki³

et al. 2013

OJOG

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Background: The prevalence of asymptomatic renal scarring, such as a focal segmental glomerulosclerosis (FSGS), was suggested to be high in women who develop preeclampsia. FSGS is a risk factor for endstage renal disease. Objective: To document preeclamptic women with proteinuria that developed eight weeks prior to hypertension with confirmed FSGS postpartum. Case: A 20-year-old nulliparous Japanese woman with a negative dipstick test result at gestational week (GW) 18 exhibited proteinuria 1+ on dipstick test at GW 22. Proteinuria determined from the random urine protein to creatinine ratio (P/Cr, g/g) was increased from 3.7 at GW 26 to 4.6 and 8.9 at GW 28 and 30, respectively. She developed hypertension (142/66 mmHg) at GW 30. Due to increased edema, emergency cesarean section was performed at GW 33. She gave birth to an otherwise healthy female small-for-gestational-age infant, weighing 1290 g. Postpartum course was uneventful except for persisting proteinuria: P/Cr of 9.8 just before delivery decreased to 3.6 and 1.7 on postpartum weeks 9 and 17, respectively. Renal biopsy on postpartum week 13 revealed FSGS in this patient. Conclusion: Hidden FSGS may have manifested as preeclampsia in this patient. This case highlighted the need to determine the prevalence of asymptomatic FSGS among women who later develop preeclampsia.

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“…Unverdi et al [10] reported that proteinuria and/or hematuria persisted after 3 months postpartum in 7.3 % (34/463) of women with PE; 14 patients without history of previous glomerulonephritis consented to kidney biopsy, and 29 % (4/14)…”

Section: Discussionmentioning

confidence: 99%

Increased antiangiogenetic factors in severe proteinuria without hypertension in pregnancy: is kidney biopsy necessary?

et al. 2013

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Acute onset of severe proteinuria during pregnancy obliges physicians to clinically discriminate between gestational proteinuria (GP) and new onset of nephritis. A multiparous woman developed severe proteinuria (5.8 g/ day) without hypertension at 32 weeks of gestation. We measured the maternal level of soluble fms-like tyrosine kinase 1 (sFlt-1) and soluble endoglin (sEng), which were extremely high (41.3 and 54.8 ng/ml, respectively), leading us to consider this condition as GP rather than acute onset of nephritis. Thus, we did not perform a kidney biopsy and did not administer a steroid agent. Non-reassuring fetal status required emergency Cesarean section at 33 weeks. Proteinuria decreased to 0.36 g/day at 12 weeks after delivery, and finally disappeared 26 weeks postpartum. Measurement of sFlt-1 and sEng in a pregnant woman with severe proteinuria without hypertension may assist in differential diagnosis of GP from acute onset of nephritis, and thus help to decide whether to perform kidney biopsy during pregnancy.

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Postpartum persistent proteinuria after preeclampsia: a single-center experience

Cited by 23 publications

References 13 publications

Preeclampsia: Postpartum Resolution of Hypertension, Proteinuria and Serum N-terminal B-type Natriuretic Peptide

Preeclampsia: Postpartum Resolution of Hypertension, Proteinuria and Serum N-terminal B-type Natriuretic Peptide

Hidden renal disease in a female patient with long-lasting isolated gestational proteinuria followed by hypertension

Increased antiangiogenetic factors in severe proteinuria without hypertension in pregnancy: is kidney biopsy necessary?

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