Vadalà Carmela, Cernaro Valeria, Siligato Rossella, Granese Roberta, Laganà Antonio Simone, Buemi Michele, Santoro Domenico
Unità di Nefrologia e Dialisi, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, Messina, Italia.
Unità di Ginecologia e Ostetricia, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, Messina, Italia.
G Ital Nefrol. 2017 Dec 5;34(Nov-Dec):2017-vol6.
Pre-eclampsia (PE) is an important cause of acute renal failure and an important risk marker for subsequent chronic kidney disease. In normal pregnancy, there are marked changes in the renin-angiotensin system (RAS) including considerably elevated angiotensin II (ang II) levels. However, vascular resistance decreases markedly during normal pregnancy, suggesting that pregnant individuals are less sensitive to ang II than non-pregnant individuals. In contrast, during PE decreased circulating components of the RAS with enhanced sensitivity of ang II infusion have been reported. Patients with a history of PE have an increased risk of microalbuminuria with a prevalence similar to subjects with type 1 diabetes mellitus. Women with gestational or chronic hypertension were at a high risk of end-stage renal disease (ESRD) vs. normotensive ones, but the risk is much greater for women who had PE or eclampsia than those who had gestational hypertension only. A previous episode of PE should suggest long-term follow-up, especially with respect to hypertension and microalbuminuria within 6-8 weeks of delivery, and should require a nephrological consult if these disorders do not resolve. Pregestational diabetes was also associated with long-term increased risk of ESRD and death. Lastly, women who have PE and give birth to offspring with low birth weight and short gestation have a substantially increased risk for having a later kidney biopsy. For all these reasons, short and long-term evaluation of kidney function should be suggested in women with previous complicated pregnancy.
子痫前期（PE）是急性肾衰竭的重要病因，也是后续慢性肾脏病的重要风险标志物。在正常妊娠期间，肾素 - 血管紧张素系统（RAS）会发生显著变化，包括血管紧张素II（ang II）水平大幅升高。然而，在正常妊娠期间血管阻力会显著降低，这表明孕妇对ang II的敏感性低于非孕妇。相比之下，据报道，在子痫前期期间，RAS的循环成分减少，而ang II输注的敏感性增强。有子痫前期病史的患者微量白蛋白尿风险增加，其患病率与1型糖尿病患者相似。与血压正常的女性相比，患有妊娠期高血压或慢性高血压的女性患终末期肾病（ESRD）的风险较高，但患有子痫前期或子痫的女性比仅患有妊娠期高血压的女性风险要大得多。既往有子痫前期发作史应提示进行长期随访，尤其是在分娩后6 - 8周内关注高血压和微量白蛋白尿情况，如果这些病症未缓解，则应进行肾脏科会诊。孕前糖尿病也与ESRD和死亡的长期风险增加有关。最后，患有子痫前期并生下低体重和早产后代的女性后期进行肾脏活检的风险大幅增加。基于所有这些原因，对于既往有复杂妊娠史的女性，建议进行短期和长期的肾功能评估。
