Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy.
Curr Hypertens Rep. 2020 Mar 21;22(5):36. doi: 10.1007/s11906-020-1033-9.
We focus on the current understanding of preeclampsia (PE) in order to examine how it mediates glomerular injury and affects the course of glomerulonephritis (GNs). In addition, this review discusses the role of GNs on the development of PE.
In PE, the dysfunctional utero-placental perfusion causes the release into the mother's circulation of anti-angiogenic substances, leading to systemic endotheliosis. In preeclamptic patients, the imbalance between pro- and anti-angiogenic factors is responsible for the kidney injury, and PE may reveal a silent pre-existent GN or may induce the development of the disease. Moreover, in women with chronic kidney disease (CKD), it could accelerate the disease progression. In any case, GNs compromise renal function, making the kidney less responsive to physiological changes that occur during pregnancy and, at the same time, cause maternal vascular inflammation, representing a risk factor for PE development. Although a bidirectional correlation between GNs and PE has been demonstrated, the data are limited, and further large studies are warranted. Close collaboration between a multidisciplinary team of obstetricians and nephrologists is essential to establish the correct diagnosis and safely manage these vulnerable women and their fetuses.
本文重点关注子痫前期（PE）的现有认识，以探讨其如何介导肾小球损伤，并影响肾小球肾炎（GN）的病程。此外，本文还讨论了 GN 对 PE 发展的作用。
在 PE 中，子宫胎盘灌注功能障碍导致抗血管生成物质释放到母体循环中，引起全身血管内皮功能障碍。在子痫前期患者中，促血管生成和抗血管生成因子之间的失衡导致了肾脏损伤，PE 可能揭示了隐匿性的预先存在的 GN，也可能诱导疾病的发生。此外，在慢性肾脏病（CKD）妇女中，它可能会加速疾病的进展。无论如何，GN 会损害肾功能，使肾脏对妊娠期间发生的生理变化反应迟钝，同时引起母体血管炎症，这是 PE 发展的一个危险因素。尽管已经证明 GN 和 PE 之间存在双向相关性，但数据有限，需要进一步开展大型研究。妇产科医生和肾病学家的多学科团队之间的密切合作对于正确诊断和安全管理这些脆弱的妇女及其胎儿至关重要。
