Renal Hemodynamics and Tubular Function in Normal Human Pregnancy

Davison, John M.; Dunlop, W.

doi:10.1097/00006254-198104000-00002

Cited by 72 publications

(94 citation statements)

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“…5 Despite the increase in heart rate, blood volume, and cardiac output, normal pregnancy is usually associated with a significant decrease in arterial blood pressure and total peripheral resistance. 6 This normal pregnancyassociated decrease in peripheral resistance has been explained by several mechanisms, including an increase in the metabolic requirements of both maternal and fetoplacental tissues and/or a decrease in vascular reactivity.…”

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confidence: 99%

Enhanced Vascular Reactivity During Inhibition of Nitric Oxide Synthesis in Pregnant Rats

et al. 1998

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Abstract-Pregnancy-induced hypertension has been suggested to be mediated by several mechanisms, including reduced nitric oxide (NO) synthesis. In this study, the effects of chronic treatment with the NO synthase inhibitor N G -nitro-L-arginine methyl ester (L-NAME) on blood pressure and the underlying changes in vascular reactivity were investigated in virgin and late-pregnancy Sprague-Dawley rats. The systolic blood pressure was 120Ϯ2, 124Ϯ5, 116Ϯ4, and 171Ϯ5 mm Hg in untreated virgin, virgin treated with L-NAME, untreated pregnant, and pregnant treated with L-NAME rats, respectively. The rats were killed, and the thoracic aorta was cut into strips for measurement of active stress in response to ␣ 1 -adrenergic stimulation with phenylephrine and membrane depolarization by high KCl. In pregnant rats, the maximal active stress to phenylephrine (0.31Ϯ0.03ϫ104 N/m 2 ) and the high-KCl-induced active stress (0.55Ϯ0.09ϫ10 4 N/m 2 ) were smaller than those in virgin rats. By contrast, in the L-NAME-treated pregnant rats, the maximal phenylephrine-induced active stress (0. 76Ϯ0.1ϫ10 4 N/m 2 ) was greater than that in virgin rats (0.52Ϯ0.1ϫ10 4 N/m 2 ), whereas the high-KCl-induced active stress (1.08Ϯ0.14ϫ10 4 N/m 2 ) was indistinguishable from that in virgin rats (1. 03Ϯ0.14ϫ10 4 N/m 2 ). Treatment with L-NAME did not affect the phenylephrine-releasable Ca 2ϩ stores in pregnant rats and had minimal effect on active stress in virgin rats. Thus, reduction of NO synthesis during late pregnancy is associated with a significant increase in blood pressure and vascular responsiveness to ␣-adrenergic stimulation, which can possibly be explained in part by enhanced Ca 2ϩ entry from extracellular space. However, other mechanisms such as increased myofilament force sensitivity to Ca 2ϩ and/or activation of a completely Ca 2ϩ -independent mechanism cannot be excluded. (Hypertension. 1998;31:1065-1069.) Key Words: blood pressure Ⅲ calcium Ⅲ muscle, smooth Ⅲ contraction N ormal pregnancy is associated with many hemodynamic changes such as increased heart rate and cardiac output, 1 increased plasma volume, and an increase in uterine 2-4 and renal blood flow.5 Despite the increase in heart rate, blood volume, and cardiac output, normal pregnancy is usually associated with a significant decrease in arterial blood pressure and total peripheral resistance. 6 This normal pregnancyassociated decrease in peripheral resistance has been explained by several mechanisms, including an increase in the metabolic requirements of both maternal and fetoplacental tissues and/or a decrease in vascular reactivity. 7 Several explanations have been proposed for the decrease in vascular reactivity during normal pregnancy, such as decreased pressor response to vasoconstrictors, 8 -10 specific alterations within the vascular wall, 11 and an increase in nitric oxide (NO) synthesis.12,13 Also, Conrad and Vernier 14 have found that the plasma level, metabolic production, and urinary excretion of cGMP, a second messenger of NO and a cellular mediator of va...

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confidence: 99%

Enhanced Vascular Reactivity During Inhibition of Nitric Oxide Synthesis in Pregnant Rats

et al. 1998

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“…14,15 In this study, the relatively low GFR in the normal pregnant individuals was still higher than the GFR of non-pregnant. This can be partially explained by the physiological decline in late pregnancy towards nonpregnant GFR and the creatinine clearance which had been corrected with the body surface area to ease the comparisons and so led to reduction in its values.…”

Section: Discussionmentioning

confidence: 53%

Effect of pre-eclampsia on glomerular filtration rate in Sudanese women

et al. 2017

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Background: Creatinine clearance is safest method to measure glomerular filtration rate (GFR) in pregnancy. The objectives was to study a case-control study conducted in Omdurman Maternity Hospital aimed to assess GFR, using creatinine clearance and magnitude of changes of serum creatinine in pre-eclampsia.Methods: Pre-eclamptic were 70, normal pregnant 96 and non-pregnant 63. Investigations were done at St Hellier's hospital London. Serum and urine creatinine were measured using Jaffé reaction and spectrophotometer. 24-hour urine output was measured and creatinine clearance calculated to find GFR. GFR was calculated in ml/min/mm2 using John Hopkins’ method.Results: The mean serum creatinine in pre-eclamptic (68.6µmol/L) was less than non-pregnant (75.5µmol/L) (P=0.001) but was higher than normal pregnant (62.4µmol/L) (P=0.003). Mean GFR pre-eclamptic (68.6ml/min.1.73m2) was less than non-pregnant (87.0ml/min/1.73m2) (P=0.0001) and normal pregnant (89.0ml/min/1.73ml/min/1.73m2) (P =0.0001).Conclusions: GFR decreased at term in normal pregnancy and even more in pre-eclampsia. Serum creatinine levels increased and did not correlate with GFR changes in pre-eclampsia.

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“…These diverse criteria make comparisons between studies difficult. In addition, worsening proteinuria during pregnancy is common in women with diabetic nephropathy [29] due to increases in the glomerular filtration rate [30]. Studies are needed to determine whether the recently expanded ACOG criteria for diagnosing preeclampsia in pregnant women who do not have proteinuria [5] also have diagnostic utility among women with preexisting proteinuria.…”

Section: Preeclampsia In Women With Type 1 or Type 2 Diabetesmentioning

confidence: 99%

Preeclampsia and diabetes

1997

American Journal of Obstetrics and Gynecology

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Renal Hemodynamics and Tubular Function in Normal Human Pregnancy

Cited by 72 publications

References 0 publications

Enhanced Vascular Reactivity During Inhibition of Nitric Oxide Synthesis in Pregnant Rats

Enhanced Vascular Reactivity During Inhibition of Nitric Oxide Synthesis in Pregnant Rats

Effect of pre-eclampsia on glomerular filtration rate in Sudanese women

Preeclampsia and diabetes

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