Preeclampsia and Glomerulonephritis: A Bidirectional Association

Leo, Vincenzo Di; Capaccio, Flavia; Gesualdo, Loreto

doi:10.1007/s11906-020-1033-9

Cited by 13 publications

(14 citation statements)

References 64 publications

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“…Changes in angiogenic factors could contribute to renal injury in PE. Also, although preexisting renal disease such as glomerulonephritis could play a role in the development of PE, PE could mediate glomerular injury and affect the course of glomerulonephritis, suggesting a bidirectional association between the two conditions (39). For example, glomerulonephritis would compromise renal function, make the kidney less responsive to the physiological changes that occur during pregnancy, and cause maternal vascular inflammation, thereby increasing the risk for PE.…”

Section: Proangiogenic and Antiangiogenic Factorsmentioning

confidence: 99%

Vascular mechanisms and molecular targets in hypertensive pregnancy and preeclampsia

Khalil

2020

American Journal of Physiology-Heart and Circulatory Physiology

100

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Preeclampsia is a major complication of pregnancy manifested as hypertension and often intrauterine growth restriction, but the underlying pathophysiological mechanisms are unclear. Predisposing genetic and environmental factors cause placental maladaptations leading to defective placentation, apoptosis of invasive cytotrophoblasts, inadequate expansive remodeling of the spiral arteries, reduced uteroplacental perfusion pressure and placental ischemia. Placental ischemia promotes the release of bioactive factors into the maternal circulation, causing an imbalance between anti-angiogenic soluble fms-like tyrosine kinase-1 and soluble endoglin, and pro-angiogenic vascular endothelial growth factor, placental growth factor and transforming growth factor-β. Placental ischemia also stimulates the release of proinflammatory cytokines, hypoxia-inducible factor, reactive oxygen species, and angiotensin type 1 receptor agonistic autoantibodies. These circulating factors target the vascular endothelium, causing generalized endotheliosis in systemic, renal, cerebral and hepatic vessels, leading to decreases in endothelium-derived vasodilators such as nitric oxide, prostacyclin and hyperpolarization factor, and increases in vasoconstrictors such as endothelin-1 and thromboxane A2. The bioactive factors also target vascular smooth muscle and enhance the mechanisms of vascular contraction including cytosolic Ca2+, protein kinase C and Rho-kinase. The bioactive factors could also target matrix metalloproteinases and the extracellular matrix causing inadequate vascular remodeling, increased arterial stiffening, and further increases in vascular resistance and hypertension. As therapeutic options are limited, understanding the underlying vascular mechanisms and molecular targets should help design new tools for the detection and management of hypertension in pregnancy and preeclampsia.

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Section: Proangiogenic and Antiangiogenic Factorsmentioning

confidence: 99%

Vascular mechanisms and molecular targets in hypertensive pregnancy and preeclampsia

Khalil

2020

American Journal of Physiology-Heart and Circulatory Physiology

100

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“…In preeclampsia, the secretion of humoral factors, such as soluble fms-like tyrosine kinase-1 (sFlt-1) and endotheline-1 (ET-1), is increased, which induces dysfunction of epithelial and endocapillary cells and leads to podocyte shedding. Some reports state that preeclampsia also induces chronic kidney disease (CKD) and/or end-stage kidney disease through several humoral factors ( 18 , 19 ). The concentration of sFlt-1 is particularly increased in IgAN, and the level of elevation is related to the severity of proteinuria ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

A Pregnant Woman with IgA Nephropathy Showing Histological Preeclampsia Findings without Hypertension Treated with Steroids: A Case Report and Literature Review

et al. 2023

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A 35-year-old woman pregnant with twins developed nephrotic syndrome (NS) at 33 weeks' gestation, but her blood pressure remained within the normal range throughout gestation and puerperium. At 34 weeks' gestation, she delivered healthy twins via Caesarean section. After delivery, she developed massive proteinuria (21.1 g/day) and severe hypoalbuminemia (1.0 g/dL). A renal biopsy performed 19 days after delivery revealed IgA nephropathy (IgAN) and preeclampsia. She was treated with steroids, and the NS gradually resolved. This is a rare case of massive gestational proteinuria with IgAN and preeclampsia pathologically that did not meet the clinical criteria for preeclampsia.

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“…28 In addition, there is evidence that these proinflammatory factors can cause glomerular damage, leading to proteinuria, which can worsen renal function or favor the development of preeclampsia. 15,29 Some of these studies report that the decline in kidney function is even worse among patients with CKD stages 3 to 5, while other studies did not see any worsening of renal function in stages 1 to 3. 15,18 These data in the literature still lacks consensus and require further investigation.…”

Section: Discussionmentioning

confidence: 99%

Perinatal Outcomes in Women with Chronic Kidney Diseases

Zilli

Borovac-Pinheiro

Costa

et al. 2022

Rev Bras Ginecol Obstet

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Objective To assess maternal and neonatal outcomes in women with chronic kidney disease (CKD) at a referral center for high-risk pregnancy. Methods A retrospective cohort of pregnant women with CKD was followed at the Women's Hospital of Universidade Estadual de Campinas, Brazil, between 2012 and 2020. Variables related to disease etiology, treatment duration, sociodemographic variables, lifestyle, other associated diseases, obstetric history, and perinatal outcomes were assessed. The causes of CKD were grouped into 10 subgroups. Subsequently, we divided the sample according to gestational age at childbirth, as preterm and term births, comparing maternal and neonatal outcomes, and baseline characteristics as well as outcomes among such groups. Results A total of 84 pregnancies were included, in 67 women with CKD. Among them, six pregnancies evolved to fetal death, five to miscarriage, and one was a twin pregnancy. We further analyzed 72 single pregnancies with live births; the mean gestational age at birth was 35 weeks and 3 days, with a mean birth weight of 2,444 g. Around half of the sample (51.39%) presented previous hypertension, and 27.7% developed preeclampsia. Among the preterm births, we observed a higher frequency of hypertensive syndromes, longer maternal intensive care unit (ICU) stay in the postpartum period, higher incidence of admission to the neonatal ICU, higher neonatal death, lower 5-minute Apgar score, and lower birth weight. Conclusion This study demonstrates increased adverse outcomes among pregnancies complicated by CKD and expands the knowledge on obstetric care among such women in an attempt to reduce maternal risks and identify factors related to prematurity in this population.

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Preeclampsia and Glomerulonephritis: A Bidirectional Association

Cited by 13 publications

References 64 publications

Vascular mechanisms and molecular targets in hypertensive pregnancy and preeclampsia

Vascular mechanisms and molecular targets in hypertensive pregnancy and preeclampsia

A Pregnant Woman with IgA Nephropathy Showing Histological Preeclampsia Findings without Hypertension Treated with Steroids: A Case Report and Literature Review

Perinatal Outcomes in Women with Chronic Kidney Diseases

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