Abnormal increases in urinary albumin excretion during pregnancy in IDDM women with pre-existing microalbuminuria.
We compared urinary albumin excretion during and after pregnancy in 30 insulin-dependent diabetic (IDDM) women with normoalbuminuria and in 12 IDDM women with microalbuminuria (> 15 micrograms.min-1) prior to conception. There was a 6.7-fold increase in the urinary albumin excretion up until the third trimester in the women with pre-existing microalbuminuria, compared with a 3.8-fold increase in the normoalbuminuric women. In both groups of patients the urinary albumin excretion reached a peak during the third trimester with 492 +/- 404 micrograms.min-1 in the microalbuminuric women vs 43 +/- 36 micrograms.min-1 in the normoalbuminuric women (p < 0.0005). Two women from each of the groups developed eclampsia with diastolic blood pressure over 90 mm Hg, mild or moderate oedema and macroproteinuria. Four of the pregnant women with pre-existing microalbuminuria showed a transient nephrotic syndrome (33.3%) with protein excretion over 3 g in 24-h urine samples during the third trimester. In contrast, this was not observed in any of the normoalbuminuric women (p < 0.05). Within 12 weeks after delivery the urinary albumin excretion rates dropped to the pre-conception values in both patient groups. Renal function remained normal during pregnancy in both of the groups, with a physiological increase in creatinine clearance up until the third trimester (26% increase in the normoalbuminuric women vs 22% in the microalbuminuric women). In conclusion, the effect of pregnancy on the urinary albumin excretion in diabetic women with pre-existing microalbuminuria is an exaggeration of the increase of albuminuria in diabetic women with normoalbuminuria; normalization occurs within 12 weeks after delivery in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)
Biesenbach
G
G
II Department of Medicine, General Hospital, Linz, Austria.
Zazgornik
J
J
Stöger
H
H
Grafinger
P
P
Hubmann
R
R
Kaiser
W
W
Janko
O
O
Stuby
U
U
D000328:Adult; D000419:Albuminuria; D001724:Birth Weight; D001794:Blood Pressure; D001798:Blood Proteins / Q000032:analysis; D003404:Creatinine / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology / Q000652:urine*; D005260:Female; D005313:Fetal Death; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D007234:Infant, Premature; D049590:Postpartum Period / Q000652:urine; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000503:physiopathology / Q000652:urine*; D011507:Proteinuria
D001798:Blood Proteins; D003404:Creatinine; D006442:Glycated Hemoglobin