Antenatal Hypertension Clinic, King's College Hospital, London, UK.
Department of Women and Children's Health, King's College London, London, UK.
J Nephrol. 2021 Oct;34(5):1641-1649. doi: 10.1007/s40620-021-01134-7. Epub 2021 Sep 24.
Hypertensive disorders of pregnancy are associated with chronic kidney disease. Early detection of renal dysfunction enables implementation of strategies to prevent progression. International guidelines recommend review at 6-8 weeks postpartum to identify persistent hypertension and abnormal renal function, but evidence for the efficacy of this review is limited.
All women attending a specialist fetal-maternal medicine clinic for hypertensive disorders of pregnancy (pre-eclampsia, chronic hypertension, gestational hypertension) were invited for a 6-8 weeks postpartum review of their blood pressure and renal function in order to establish the prevalence and independent predictors of renal dysfunction. Renal dysfunction was defined as low estimated Glomerular Filtration Rate (eGFR < 60 ml/min/1.73 m) or proteinuria (24-h protein excretion > 150 mg or urinary albumin-to-creatinine ratio > 3 mg/mmol). All women attending a specialist clinic for hypertensive disorders were invited for a 6-8 weeks postpartum review of their blood pressure and renal function. Demographics, pregnancy and renal outcomes were prospectively collected.
Between 2013 and 2019, 740 of 1050 (70.4%) women who had a pregnancy complicated by a hypertensive disorder attended their 6-8 weeks postpartum visit. Renal dysfunction was present in 32% of the total cohort and in 46% and 22% of women with and without pre-eclampsia, respectively. Multivariate logistic regression demonstrated that independent predictors were pre-eclampsia, chronic hypertension, highest measured antenatal serum creatinine, highest measured antenatal 24-h urinary protein, and blood pressure ≥ 140/90 mmHg at the postnatal visit.
Renal dysfunction was present in one in three women with hypertensive disorders of pregnancy at 6-8 weeks postpartum. This includes women with gestational hypertension and chronic hypertension without superimposed pre-eclampsia, and thus these women should also be offered postnatal review.
妊娠高血压疾病与慢性肾脏病有关。早期发现肾功能障碍有助于实施预防疾病进展的策略。国际指南建议在产后 6-8 周进行复查，以识别持续性高血压和异常肾功能，但该复查的疗效证据有限。
所有因妊娠高血压疾病（子痫前期、慢性高血压、妊娠期高血压）就诊于专科胎儿-母体医学门诊的女性均被邀请在产后 6-8 周复查血压和肾功能，以确定肾功能障碍的患病率和独立预测因素。肾功能障碍定义为肾小球滤过率估计值（eGFR＜60ml/min/1.73m）低或蛋白尿（24 小时尿蛋白排泄＞150mg 或尿白蛋白/肌酐比值＞3mg/mmol）。所有因妊娠高血压疾病就诊于专科门诊的女性均被邀请在产后 6-8 周复查血压和肾功能。前瞻性收集人口统计学、妊娠和肾脏结局数据。
在 2013 年至 2019 年间，1050 名患有妊娠高血压疾病的女性中有 740 名（70.4%）参加了产后 6-8 周的复查。总队列中肾功能障碍的发生率为 32%，子痫前期组、非子痫前期组分别为 46%和 22%。多变量逻辑回归显示，独立预测因素为子痫前期、慢性高血压、产前最高血清肌酐、产前最高 24 小时尿蛋白和产后血压≥140/90mmHg。
妊娠高血压疾病女性在产后 6-8 周时，肾功能障碍的发生率为三分之一。这包括妊娠期高血压和无子痫前期合并症的慢性高血压女性，因此这些女性也应接受产后复查。
