Renal function and lipid metabolism in pregnant renal transplant recipients.
OBJECTIVE
To estimate renal function and lipid metabolism in pregnant renal transplant recipients.


METHODS
The study covered 64 women during the third trimester of pregnancy including 33 renal transplant recipients (the study group) and 31 healthy women (the control group). Serum concentrations of uric acid, urea, creatinine, electrolytes, total protein, albumin, acid-base balance and blood cell count were examined to assess renal function. Moreover, the levels of the following lipid metabolism parameters were estimated: (1) total lipids (TL), (2) total LDL fraction (TLDL), (3) total cholesterol (TCh), (4) free cholesterol (fCh), (5) free/total cholesterol (fCh/TCh) ratio, (6) phospholipids (PhL), (7) total cholesterol/phospholipids (fCh/PhL) ratio, (8) triglycerides (TG), (9) HDL-cholesterol (HDL-Ch), (10) LDL-cholesterol (LDL-Ch) and (11) LDL-Ch/HDL-Ch ratio. 'The effect of immunosuppressants (cyclosporine, prednisone and azathioprine) on serum lipid levels was estimated in the study group. The mean maternal age, gestational age and BMI did not differ in both groups.


RESULTS
Pregnant renal transplant recipients presented mild renal insufficiency during the third trimester resulting in the increase in serum level of uric acid (P<0.001), urea (P<0.001), creatinine (P<0.001), and Cl- (P<0.001). Proteinuria (1.19+/-1.9 g/24 h) leading to hypoproteinemia (P<0.001) and hypoalbuminemia (P<0.05) confirmed renal function impairment in the study group. Additionally, the diagnosis of renal insufficiency was supported by mild acidosis reflected by a drop in pH (P<0.001). standard HCO3- (P<0.001) and base excess (P<0.001). The women with renal grafts presented vital lipid metabolism disturbances illustrated by the elevated levels of: (1) TL by 72% (P<0.001), (2) TLDL by 21% (P<0.001), (3) TCh by 16% (P<0.001), (4) fCh by 34% (P<0.001), (5) fCh/TCh ratio by 21% (P<0.001), (6) PhL by 28% (P<0.001), (7) TG by 53% (P<0.001), (8) LDL-Ch by 13% (P<0.05) and (9) LDL-Ch/HDL-Ch ratio by 23% (P<0.001). No difference in HDL-Ch level between the two groups was found. Hyperlipidemia in pregnant kidney recipients was associated with immunosuppressive treatment and depended on cyclosporine treatment regimen. Treatment with azathioprine and prednisone was associated with elevated serum levels of examined lipids.


CONCLUSIONS
Serum lipid abnormalities are significantly influenced by the administered dosages of immunosuppressants.
Czajkowski
Krzysztof
K
The 2nd Department of Obstetrics and Gynecology, Warsaw Medical University, ul. Karowa 2 00-315 Warsaw, Poland.
Wójcicka-Bentyn
Janina
J
Sieńko
Jacek
J
Grymowicz
Monika
M
Smolarczyk
Roman
R
Malinowska-Polubiec
Aneta
A
Romejko
Ewa
E
D000138:Acidosis; D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage / Q000009:adverse effects; D002712:Chlorides / Q000097:blood; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D007668:Kidney / Q000503:physiopathology*; D016030:Kidney Transplantation / Q000502:physiology*; D008055:Lipids / Q000097:blood*; D010743:Phospholipids / Q000097:blood; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D011507:Proteinuria; D014280:Triglycerides / Q000097:blood; D014508:Urea / Q000097:blood; D014527:Uric Acid / Q000097:blood
D002712:Chlorides; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D007166:Immunosuppressive Agents; D008055:Lipids; D010743:Phospholipids; D014280:Triglycerides; D014527:Uric Acid; D016572:Cyclosporine; D014508:Urea; D002784:Cholesterol; D003404:Creatinine; D001379:Azathioprine; D011241:Prednisone