Suetsugu Yasuko, Tokudome Goro, Sugano Naoki, Yoshizawa Takeo, Endo Satoshi, Hara Yoichiro, Takane Koki, Kuriyama Satoru, Hosoya Tatsuo
Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
Nihon Jinzo Gakkai Shi. 2011;53(8):1139-49.
Pregnancy in chronic kidney disease (CKD) patients is often associated with hypertension and/or the worsening of renal function and neonatal death. The present study explored the clinical characteristics of predictive factors for hypertension in biopsy-proven IgA nephropathy patients with superimposed preeclampsia (SPE).
The subjects were 34 Japanese women with IgA nephropathy whose renal specimen for histological tests was obtained before pregnancy. We retrospectively investigated the relevant clinical factors to explain a rise in blood pressure (BP). The histological findings were evaluated with respect to the quantitative measurements of both global glomerulosclerosis and interstitial damage.
Renal biopsies before pregnancies showed that the global glomerular sclerosing index and interstitial damage in the SPE group were significantly higher than in the normal group. The prevalence of SPE was 38.2 % (normal pregnancy 21, SPE 13 cases). The neonatal death rate was 3.0 % (1/34)overall. Just before conception, systolic blood pressure (SBP), serum creatinine (Cr)and blood urea nitrogen (BUN) concentration in the SPE were significantly higher than in normal pregnancies. In contrast, CCr and eGFR were lower in the SPE group than in the normal group. At delivery, serum Cr, BUN and uric acid (UA) concentration in the SPE group were significantly higher than in the normal group. In contrast, CCr and eGFR were lower in the SPE than in the normal group. At delivery, correlation analysis revealed a significant correlation between SBP or diastolic BP (DBP) and the histological severity, between SBP or DBP and daily protein excretion, and between SBP or DBP and serum Cr concentration. With respect to the birth weight of newborns, there was a significant negative correlation between the birth weight and the global glomerular sclerosing rate, and between the birth weight and serum Cr concentration or BUN. A stepwise multiple regression analysis showed that predictive factors for a rise in SBP during pregnancy were the degree of interstitial damage and daily urinary protein excretion. These results suggest that renal function, the magnitude of urinary protein excretion, serum Cr, BUN, UA concentrations, and the severity of histological abnormalities are all associated with SPE occurrence. The predictors of a rise in BP were interstitial damage and urinary protein excretion at pregnancy. In addition, Receiver Operating Characteristic (ROC) analysis showed that both glomerular sclerosis and interstitial damage could be potential predictors for SPE.
Histological severity in renal biopsy, urinary protein excretion and renal function are associated with SPE in patients with IgA nephropathy. Among these associations, the histological findings and urinary protein excretion may serve as useful predictors for a rise in BP.
慢性肾脏病（CKD）患者妊娠常伴有高血压和/或肾功能恶化以及新生儿死亡。本研究探讨了经活检证实的IgA肾病合并子痫前期（SPE）患者高血压预测因素的临床特征。
研究对象为34名日本IgA肾病女性，其妊娠前已获取肾脏组织标本用于组织学检查。我们回顾性调查了相关临床因素以解释血压（BP）升高的原因。组织学结果通过对全球肾小球硬化和间质损伤的定量测量进行评估。
妊娠前肾活检显示，SPE组的全球肾小球硬化指数和间质损伤显著高于正常组。SPE的发生率为38.2%（正常妊娠21例，SPE 13例）。总体新生儿死亡率为3.0%（1/34）。受孕前，SPE组的收缩压（SBP）、血清肌酐（Cr）和血尿素氮（BUN）浓度显著高于正常妊娠组。相比之下，SPE组的肌酐清除率（CCr）和估算肾小球滤过率（eGFR）低于正常组。分娩时，SPE组的血清Cr、BUN和尿酸（UA）浓度显著高于正常组。相比之下，SPE组的CCr和eGFR低于正常组。分娩时，相关性分析显示SBP或舒张压（DBP）与组织学严重程度、SBP或DBP与每日尿蛋白排泄量以及SBP或DBP与血清Cr浓度之间存在显著相关性。关于新生儿出生体重，出生体重与全球肾小球硬化率之间以及出生体重与血清Cr浓度或BUN之间存在显著负相关。逐步多元回归分析显示，妊娠期间SBP升高的预测因素是间质损伤程度和每日尿蛋白排泄量。这些结果表明，肾功能、尿蛋白排泄量、血清Cr、BUN、UA浓度以及组织学异常的严重程度均与SPE的发生有关。血压升高的预测因素是妊娠期间的间质损伤和尿蛋白排泄量。此外，受试者工作特征（ROC）分析表明，肾小球硬化和间质损伤均可能是SPE的潜在预测因素。
肾活检的组织学严重程度、尿蛋白排泄量和肾功能与IgA肾病患者的SPE有关。在这些关联中，组织学结果和尿蛋白排泄量可能是血压升高的有用预测因素。
