Tsikouras Panagiotis, Nikolettos Konstantinos, Kotanidou Sonia, Kritsotaki Nektaria, Oikonomou Efthymios, Bothou Anastasia, Andreou Sotiris, Nalmpanti Theopi, Chalkia Kyriaki, Spanakis Vlasios, Tsikouras Nikolaos, Pagkaki Christina, Iatrakis George, Damaskos Christos, Garmpis Nikolaos, Machairiotis Nikolaos, Nikolettos Nikolaos
Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
Department of Midwifery, School of Health Sciences, University of West Attica (UNIWA), Egaleo Park Campus-28, Ag. Spyridonos Street, 12243 Egaleo, Greece.
J Clin Med. 2025 Jan 29;14(3):892. doi: 10.3390/jcm14030892.
Pre-eclampsia (PE) is a complex, advancing condition marked either by the recent emergence of hypertension and proteinuria or by the recent onset of hypertension accompanied by notable end-organ impairment, which may occur with or without proteinuria. PE usually appears in the postpartum phase or after the 20th week of gestation, though it might appear sooner in cases of molar pregnancy. This disorder is a serious multisystem condition during pregnancy that can lead to serious, life-threatening complications for both the mother and the fetus if it is not diagnosed and managed promptly. These changes result from widespread and intense vasoconstriction caused by renin, angiotensin II (Ang II), aldosterone, and catecholamines. The renin-angiotensin-aldosterone system (RAAS) and its sequence of signaling reactions demonstrate its crucial role in regulating blood pressure and electrolyte balance that diverges in PE from that observed in healthy pregnancies. However, it is widely recognized that the above description is incomplete for pre-eclampsia and further relationships should be analyzed. The purpose of this article is to review and synthesize alterations in renal function and the RAAS during normal pregnancy and pre-eclampsia. We aim to provide clinical gynecologists with a comprehensive understanding of how pregnancy-specific adaptations can impact renal function and the RAAS, as well as the deviations observed in pre-eclampsia. This information is essential to enhance clinical awareness, improve the accuracy of diagnosis, and support evidence-based decision-making in the management of pregnant patients, especially those complicated by pre-eclampsia.
子痫前期（PE）是一种复杂的进行性疾病，其特征为近期出现高血压和蛋白尿，或近期发生高血压并伴有明显的终末器官损害，可伴有或不伴有蛋白尿。PE通常出现在产后阶段或妊娠20周后，不过在葡萄胎妊娠的情况下可能出现得更早。这种疾病是妊娠期一种严重的多系统疾病，如果不及时诊断和处理，可能会给母亲和胎儿带来严重的、危及生命的并发症。这些变化是由肾素、血管紧张素II（Ang II）、醛固酮和儿茶酚胺引起的广泛而强烈的血管收缩所致。肾素-血管紧张素-醛固酮系统（RAAS）及其信号反应序列表明其在调节血压和电解质平衡方面的关键作用，在PE中与正常妊娠时观察到的情况有所不同。然而，人们普遍认识到，上述对子痫前期的描述并不完整，应进一步分析其相关关系。本文的目的是回顾和综合正常妊娠和子痫前期期间肾功能及RAAS的变化。我们旨在让临床妇科医生全面了解妊娠特异性适应性变化如何影响肾功能和RAAS，以及子痫前期中观察到的偏差。这些信息对于提高临床意识、提高诊断准确性以及支持对妊娠患者，尤其是合并子痫前期患者的循证管理决策至关重要。
