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Kidney Week

Abstract: PO2609

Identification of Renal Disease in Women with Hypertensive Pregnancies

Session Information

Category: Women’s Health and Kidney Diseases

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Martin, Hayley, King's College Hospital NHS Foundation Trust, London, London, United Kingdom
  • Kibble, Henry A., King's College Hospital NHS Foundation Trust, London, London, United Kingdom
  • Palmer, Kieran R., King's College Hospital NHS Foundation Trust, London, London, United Kingdom
  • Kountouris, Emmanouil, King's College Hospital NHS Foundation Trust, London, London, United Kingdom
  • Holloway, Amelia Mary, King's College Hospital NHS Foundation Trust, London, London, United Kingdom
  • Bramham, Kate, King's College Hospital NHS Foundation Trust, London, London, United Kingdom
  • Clark, Katherine Rose, King's College Hospital NHS Foundation Trust, London, London, United Kingdom
Background

Hypertension in pregnancy can be associated with renal injury, which may be masked by gestational change. Additionally, pregnancy affords an opportunity to diagnose asymptomatic renal disease. Postpartum assessment enables detection of on going renal abnormalities. We aimed to determine prevalence of renal disease in postpartum women with chronic hypertension, pregnancy induced hypertension or pre-eclampsia in a previous or current pregnancy.

Methods

Women with singleton pregnancies seen in a specialist clinic for hypertension with estimated GFR (CKD-EPI) below 90mls/min/1.73m2 and/or proteinuria at six-weeks postpartum were offered specialist renal midwifery clinic follow-up.

Results

143/341 women offered follow-up attended renal clinic (Median 185 (IQR 246.25) days after delivery). 82 (57.3%) women had proteinuria and/or low eGFR. Subgroup analysis according to hypertensive group is shown in Table 1.

Conclusion

Over half of women with proteinuria and/or reduced eGFR at six weeks postpartum had sustained evidence of renal disease regardless of hypertensive diagnosis. Postpartum assessment may afford an opportunity to detect renal disease.

Table 1
 Chronic Hypertension (N=33)PIH in current pregnancy (N=20)PE in current pregnancy (N=80)History of PE/PIH (N=10)
Six Week Postpartum Visit
Systolic BP (mmHg)132.8 (14.5)129.3 (13.3)129.0 (21.6)120.6 (8.9)
Diastolic BP (mmHg)85.1 (9.0)80.25 (11.8)81.7 (14.9)71.8 (7.8)
eGFR (mL/min/1.73m2)101.4 (22.1)108.0 (18.3)109.4 (22.2)82.3 (25.5)
PCR >15mg/mmol or ACR >3mg/mmol n(%)24 (72.7)14 (70.0)63 (78.8)3 (30.0)
Longer-term follow-up n(%)
ACR (mg/mmol)
A1: <323 (69.7)18 (90.0)29 (58.0)6 (60.0)
A2: 3-309 (27.3)2 (10.0)41 (51.3)2 (20.0)
A3: >301 (3.0)010 (12.5)2 (20.0)
eGFR (ml/min/1.73m2)
G1: ≥ 9026 (78.8)17 (85.0)68 (85.0)4 (40.0)
G2: 60 – 895 (15.2)3 (15.0)11 (13.8)5 (50.0)
G3a: 45 – 591 (3.0)01 (1.2)0
G3b: 15 - 290001 (10.0)
G4: <151 (3.0)000

BP: Blood Pressure PE:Pre-eclampsia; PIH: Pregnancy induced hypertension; PCR: Protein Creatinine Ratio; ACR: Albumin Creatinine Ratio