Paauw Nina D, Joles Jaap A, Drost José T, Verhaar Marianne C, Franx Arie, Navis Gerjan, Maas Angela H E M, Lely A Titia
From the Department of Obstetrics, Wilhelmina Children's Hospital Birth Center (N.D.P., A.F., A.T.L.) and Department of Nephrology and Hypertension (J.A.J., M.C.V.), University Medical Center Utrecht, The Netherlands; Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (J.T.D.); Department of Nephrology, University Medical Center Groningen, The Netherlands (G.N.); and Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands (A.H.E.M.M.).
Hypertension. 2016 Dec;68(6):1407-1414. doi: 10.1161/HYPERTENSIONAHA.116.08227. Epub 2016 Oct 31.
Women with a history of preeclampsia have a 5- to 12-fold increased risk to develop end-stage kidney disease. Previous observations in small cohorts suggest that former preeclamptic (fPE) women have subtle abnormalities in renal hemodynamics and renal function, which might predispose them to renal failure in later life. In this study, we analyzed renal function in a cross-sectional cohort consisting of former early-onset preeclamptic (fPE, n=339) and former healthy pregnant women (fHP, n=332), overall with a mean age of 39 years at 10 years postpartum. Estimated glomerular filtration rate (eGFR), assessed by the modification of diet in renal disease (MDRD) and chronic kidney disease-epidemiology (CKD-epi) equations, and urinary protein:creatinine ratios were assessed 10 years postpartum. Median MDRD and CKD-epi eGFR did not significantly differ between fHP and fPE groups, whereas a comparison of distribution of eGFR revealed a shift toward a high-normal MDRD eGFR in the fPE group (χ, P=0.02) with the same trend for CKD-epi eGFR (χ, P=0.18). The odds ratio for fPE women having MDRD eGFR >110 mL/min per 1.73 m was 1.6 (1.1-2.4). In addition, the median urinary protein:creatinine ratio was slightly higher in fPE (8.5 versus 7.1 mg/mmol; P<0.01) and correlated positively with both MDRD and CKD-epi eGFR in fPE women. No increased incidence of CKD in fPE women was observed. In conclusion, we demonstrate subtle changes in renal function in former early-onset preeclamptic women 10 years postpartum, characterized by a high-normal eGFR and a slightly higher protein excretion. Whether these subtle differences predispose to or predict long-term renal function loss in fPE women remains to be investigated.
URL: http://www.trialregister.nl. Unique identifier: NTR2668.
有子痫前期病史的女性患终末期肾病的风险增加5至12倍。先前在小队列中的观察表明，曾患子痫前期（fPE）的女性在肾血流动力学和肾功能方面存在细微异常，这可能使她们在晚年易患肾衰竭。在本研究中，我们分析了一个横断面队列的肾功能，该队列由曾患早发型子痫前期的女性（fPE，n = 339）和曾有正常妊娠的女性（fHP，n = 332）组成，产后10年时总体平均年龄为39岁。在产后10年评估了通过肾病饮食改良（MDRD）方程和慢性肾脏病流行病学（CKD-epi）方程估算的肾小球滤过率（eGFR）以及尿蛋白：肌酐比值。fHP组和fPE组之间的MDRD和CKD-epi eGFR中位数无显著差异，而eGFR分布的比较显示fPE组的MDRD eGFR向高正常范围偏移（χ，P = 0.02），CKD-epi eGFR有相同趋势（χ，P = 0.18）。fPE女性的MDRD eGFR>110 mL/（min·1.73 m²）的比值比为1.6（1.1 - 2.4）。此外，fPE女性的尿蛋白：肌酐比值中位数略高（8.5对7.1 mg/mmol；P<0.01），且与fPE女性的MDRD和CKD-epi eGFR均呈正相关。未观察到fPE女性中慢性肾脏病发病率增加。总之，我们证明了曾患早发型子痫前期的女性在产后10年肾功能存在细微变化，其特征为eGFR高正常和蛋白排泄略高。这些细微差异是否会使fPE女性易患或预测长期肾功能丧失仍有待研究。
