Chronic Kidney Disease as a Long-term Consequence of Preeclampsia and Hypertensive Disorders in Pregnancy

2016 ◽  
Vol 70 (3) ◽  
pp. 148-152
Author(s):  
Biljana Gerasimovska Kitanovska ◽  
Vesna Gerasimovska
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Literature Search ◽  
Later Life ◽  
Potential Association ◽  
Hypertensive Disorders In Pregnancy ◽  
In Pregnancy

Abstract Introduction. Preeclampsia is a condition characterized by hypertension, proteinuria after 20th week of gestation, dysfunction of other maternal organs or uteroplacentary dysfunction and is associated with short-term renal damage. Recent studies report on potential association of preeclampsia with chronic kidney disease in later life. The aim of this study was to determine this potential association by literature review and our results. Methods. A Pubmed (Medline) literature search on the association of preeclampsia and subsequent chronic kidney disease was carried out. Our study was conducted at the Department of Nephrology of the University Clinical Centre Skopje in 2010 and included women who consulted the Clinic due to hypertension or impaired renal function and who had either preeclampsia or hypertensive disorders in pregnancy. Thirty patients with decreased glomerular filtration that occurred 1-28 years after pregnancy with hypertensive disorder were included in the study. Results. Literature search yielded 227 abstracts, of which 19 papers were selected, and they referred only to chronic kidney disease in the period after delivery in patients with preeclampsia. Various risks for emergence of chronic kidney disease in later life were reported in recent literature, varying from 1.2 to 14 for preeclampsia and in patients with superimposed preeclampsia, the risk was 45 times higher. In our study, risk of reduction in glomerular filtration rate was highest in the first 5 years (OR 3.6, 95% CI 1.06-22.5). Delivery before 27 weeks of gestation insignificantly increased the risk of reduced glomerular filtration in the later period (OR 1.33 95% CI 0.2-8.5). Preeclampsia is not a direct risk factor for chronic kidney disease, however, proteinuria over 0.3 g/24h in the group of patients with hypertension or preeclampsia in pregnancy, increased the risk of reduced glomerular filtration rate by 28 times (OR 28.5, 95% CI 2.7-30.9). Conclusions. Patients with preeclampsia need careful monitoring in postpartal and long-term period, not only for cardiovascular but for chronic kidney disease.

scholarly journals Effect of cyclosporin and tacrolimus on kidney function in liver recipients

2018 ◽  
Vol 4 (3) ◽  
pp. 37-42
Author(s):  
Elena Kosmacheva ◽  
Anna Babich
Keyword(s):  
Chronic Kidney Disease ◽  
Liver Transplantation ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Kidney Function ◽  
Filtration Rate ◽  
Calcineurin Inhibitors

Introduction. Chronic renal failure is a significant issue regarding treatment of patients after liver transplantation. One of the factors determining the impaired renal function after liver transplantation is a long-term immunosuppressive therapy based on calcineurin inhibitors. The objective of the study was to evaluate the dynamics of renal function, depending on the use of various calcineurin inhibitors in the long-term postoperative period in liver recipients in real clinical practice. Materials and methods. A retrospective analysis of the renal function in patients operated in the State Public Health Budget Institution “Scientific Research Institute – S.V. Ochapovsky Regional Clinic Hospital № 1”, Krasnodar Region, was carried out. This article describes dynamics of creatinine level and glomerular filtration rate (GFR) in patients before liver transplant, as well as 6 months, 1, 2 and 3 years after surgery. GFR was calculated using the CKD-EPI formula (Chronic Kidney Disease Epidemiology Collaboration). Statistical processing of the results was carried out using the Statistica 10 software package. Results and discussion. Before transplantation, the level of creatinine in the blood plasma was 82.9±19.8 mmol/l, 6 months later a20.4% increase in creatinine was registered (p=0.004), 12, 24 and 36 months later – it increased by 24.8% (p=0.00001), 24.4% (p=0.0004), and 26.0% (p=0.0005), respectively. Both cyclosporine and tacrolimus caused an increase in the level of creatinine. Baseline GFR was 83.4±25.9, the reduction in GFR occurred in comparison with the baseline by 14.2% (p=0.0005), 18.8% (p=0.00001), 20.2% (p=0.00003), 22.6% % (p=0.00006) 6, 12, 24 and 36 months later, respectively. The degree of the decrease in GFR against the background of tacrolimus therapy did not differ significantly from that in case of cyclosporine. Verification of chronic kidney disease and the administration of statins were recorded in isolated cases. Conclusions. In liver recipients, the level of creatinine rises and GFR decreases. Reduction of kidney function occurs against the background of both inhibitors of calcineurin, in connection with which it is necessary to increase the doctors’ alertness for early detection of a decrease in glomerular filtration rate with further verification of chronic kidney disease.

scholarly journals Renal function: glomerular filtration rate and renal concentration capacity in mild primary hyperparathyroidism

2016 ◽  
Vol 62 (5) ◽  
pp. 71-72
Author(s):  
Svetlana S. Mirnaya ◽  
Natalya G. Mokrysheva
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Urine Osmolality ◽  
Mild Form ◽  
Disease Stages

Introduction. Patients with primary hyperparathyroidism (pHPT) run an increased risk of death, and in some studies cardiovascular diseases were inversely related to glomerular filtration rate (GFR) and urine osmolality.Aim: to evaluate the renal filtration function and concentration capacity in patients with mild primary hyperparathyroidism.Materials and methods. The study included 100 patients with pHPT (median age 57 [52;61]), including 33 with mild form (median age 54 [45;60]). Changes in GFR and osmolality index were evaluated in 29 patients after surgery for pHPT. Follow-up period was up to 24 months.Osmolality index was calculated as urine osmolality to blood osmolality ratio. Renal concentration capacity impairment was diagnosed with osmolality index less than 2. Glomerular filtration rate was calculated by Modification of Diet in Renal Disease Study (MDRD) formula. Chronic kidney disease stage was estimated accordingly to current recommendations.Results. Osmolality index in patients with mild pHPT was low with median 1.65 [1.4; 2.43]. We found a high prevalence of renal concentration capacity impairment in patients with mild pHPT, that was 70%. Mean GFR was 90.9 [73.3; 95.6] ml/min/1,73 m2. Prevalence of chronic kidney disease stages 3-4 was 6% in patients with mild pHPT. Changes in renal concentration capacity in long-term period after surgery for pHPT were characterized by increase of osmolality index, also in patients with mild form (initially 1.75 [1.4; 2.14], after surgery 2.38 [1.84; 2.54]), changing Me was +12.4% in 6-24 months (p=0.012). Changes in renal function in long-term period after surgery for pHPT were characterized by decrease of GFR within the limits of chronic kidney disease stages 1-2, also in patients with mild form.Conclusions. Renal concentration capacity impairment is common in mild pHPT and is restorated after surgery for pHPT. The findings of this study add cause for measurement of urine osmolality or osmolality index in all patients with pHPT. Our results confirm the requirement of estimating GFR in pHPT patients not only while active disease, but also in remission after surgery for pHPT.

scholarly journals Soluble Fas affects erythropoiesis in vitro and acts as a potential predictor of erythropoiesis-stimulating agent therapy in patients with chronic kidney disease

2020 ◽  
Vol 318 (4) ◽  
pp. F861-F869
Author(s):  
Daniela Mendes Chiloff ◽  
Danilo Candido de Almeida ◽  
Maria A. Dalboni ◽  
Maria Eugênia Canziani ◽  
Sunil K. George ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Dependent Manner ◽  
Potential Predictor ◽  
Soluble Fas ◽  
Esa Therapy

Serum soluble Fas (sFas) levels are associated with erythropoietin (Epo) hyporesponsiveness in patients with chronic kidney disease (CKD). Whether sFas could predict the need for erythropoiesis-stimulating agent (ESA) usage and its influence in erythropoiesis remain unclear. We evaluated the relation between sFas and ESA therapy in patients with CKD with anemia and its effect on erythropoiesis in vitro. First, we performed a retrospective cohort study with 77 anemic patients with nondialysis CKD. We performed in vitro experiments to investigate whether sFas could interfere with the behavior of hematopoietic stem cells (HSCs). HSCs were isolated from umbilical cord blood and incubated with recombinant sFas protein in a dose-dependent manner. Serum sFas positively correlated with Epo levels ( r = 0.30, P = 0.001) but negatively with hemoglobin ( r = −0.55, P < 0.001) and glomerular filtration rate ( r = −0.58, P < 0.001) in patients with CKD at baseline. Elevated sFas serum levels (4,316 ± 897 vs. 2,776 ± 749, P < 0.001) with lower estimated glomerular filtration rate (26.2 ± 10.1 vs. 33.5 ± 14.3, P = 0.01) and reduced hemoglobin concentration (11.1 ± 0.9 vs. 12.5 ± 1.2, P < 0.001) were identified in patients who required ESA therapy compared with patients with non-ESA. Afterward, we detected that the sFas level was slight correlated with a necessity of ESA therapy in patients with nondialysis CKD and anemia. In vitro assays demonstrated that the erythroid progenitor cell frequency negatively correlated with sFas concentration ( r = −0.72, P < 0.001). There was decreased erythroid colony formation in vitro when CD34+ HSCs were incubated with a higher concentration of sFas protein (1.56 ± 0.29, 4.33 ± 0.53, P < 0.001). Our findings suggest that sFas is a potential predictor for ESA therapy in patients with nondialysis CKD and that elevated sFas could affect erythropoiesis in vitro.

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