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Kidney Week

Abstract: PO2601

Low Nephron Endowment and Pregnancy-Related Renal Maladaptation in the Pathogenesis of Preeclampsia

Session Information

Category: Women’s Health and Kidney Diseases

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Visentin, Silvia, Dept. of Woman's and Child's Health, Obstetrical and Gynecological Clinic, University of Padova, Padova, Italy
  • Gosetto, Alessandra, Dept. of Woman's and Child's Health, Obstetrical and Gynecological Clinic, University of Padova, Padova, Italy
  • Genzone, Giulia, Dept. of Woman's and Child's Health, Obstetrical and Gynecological Clinic, University of Padova, Padova, Italy
  • Ragazzi, Eugenio, Dept. of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
  • Capone, Valentina, Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico,, Milano, Italy
  • Cosmi, Erich, Dept. of Woman's and Child's Health, Obstetrical and Gynecological Clinic, University of Padova, Padova, Italy
  • Ardissino, Gianluigi, Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico,, Milano, Italy
Background

Pre-eclampsia (PE), whose pathogenesis is still unclear, complicates 2-8% of pregnancies and is responsible of significant maternal and/or perinatal morbidity and mortality. Given the following premises: 1.the high frequency of PE in renal patients (including solitary kidney); 2.the majority of patients with PE, are healthy before pregnancy and return to well-being after delivery; 3.the familial recurrence of PE and the increased PE recurrence risk in subsequent pregnancies; 4.the increased risk in PE patients of developing hypertension and CKD later in life; 5.the association between intrauterine poor environment, reduced nephron mass and risk of hypertension and CKD. We hypothesize that PE, in otherwise healthy women, is the expression of poor kidney adaptation to the increased functional requirements of pregnancy in subjects with a reduced nephron endowment.

Methods

To test this theoretical explanation, the changes in serum creatinine (sCr) during pregnancy (31st gestational week), used as marker of renal functional adaptation, were analysed in a cohort of 22 pregnant women (mean age 34.7 years; 36% nulliparous).

Results

The 9 uncomplicated pregnancies showed sCr decrease of 12.6±11.2 µmol/L (-18.8±16.9%) compared to 4.2±12.1 µmol/L (-3.8±17.5%); p=0.0361 (van der Waerden test) in the 13 pregnancies later on complicated by PE (or pregnancy-related hypertensive disorder).

Conclusion

In conclusion, women who later on developed PE lack the expected pregnancy-related decrease in sCr. It can be speculated that hypertension and proteinuria are due to sub-optimal renal clearance and accumulation of placental-derived metabolites toxic to the endothelium in otherwise healthy subjects with limited nephron endowment thus reduced renal functional reserve