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Kidney Week

Abstract: SA-OR115

Clinical, Angiogenic, and Immune System Markers Predict Preeclampsia in Women with CKD During Pregnancy

Session Information

Category: Women’s Health and Kidney Diseases

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Sarween, Nadia, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
  • Hodson, James, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
  • Knox, Ellen M., Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
  • Drayson, Mark Trehane, University of Birmingham, Birmingham, United Kingdom
  • Lipkin, Graham W., University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
Background

Pre-eclampsia (PE) is associated with immune activation and altered circulating angiogenic factors (with elevated soluble FMS-like tyrosine kinase-1/placental growth factor or sFLT-1/PlGF ratio). There are currently limited data in pregnant women with CKD. Longitudinal changes of markers inflammation, immunity & angiogenic factors during CKD pregnancy were assessed in this study & their relationship to the development PE explored.

Methods

Women with CKD were recruited from a UK renal-obstetric clinic between 2011-2016. Baseline demographics, serial serum samples and pregnancy outcomes were recorded. Samples were analysed for IgG/A/M, high-sensitivity CRP, serum free light chains (sFLC), Beta-2 Microglobulin (B2M), complement factors 3 & 4 (C3/4), uric acid (UA), creatinine, cystatin-C & sFLT-1/PlGF using the Roche Cobas® platform. Gestational periods were split into five groups.

Results

PE was diagnosed in 23% of the 164 pregnancies (136 women) with rates increasing with CKD stage (p=0.011). White ethnicity, non-smoking, SLE, chronic hypertension and previous PE were independent predictors of PE. sFLC, B2M, creatinine, cystatin-C & UA increased significantly over the antenatal period and were higher in the PE group. The greatest predictive accuracy for PE was seen at 16-21 weeks, for sFLC & cystatin-C (AUROC 0.745, 0.810 respectively). Antenatal levels of C3 increased (p<0.001) and IgA fell (p=0.015) more rapidly in the PE vs. non-PE group. The sFlt-1/PlGF ratio was predictive for PE developing at 22-27 weeks gestation (AUROC=0.728, p=0.005) (figure 1).

Conclusion

In women with CKD, an elevated sFLT-1/PlGF ratio is predictive of PE at 22-27 weeks gestation, but not at later gestations. Its predictive accuracy is comparable to markers of kidney function, sFLC and B2M levels.