title: Superimposed preeclampsia in women with chronic kidney disease.
abstract: OBJECTIVE
  To evaluate whether pregnant women with chronic kidney disease (CKD) adapt poorly to increases in renal blood flow. This can exacerbate renal function and impair perinatal outcome, as there is a major interplay between CKD and preeclampsia (PE).
  
  
  METHODS
  We analyzed the outcomes of 90 pregnant women with preexisting CKD. The estimated glomerular filtration rate (eGFR) was measured along with the levels of angiogenic factors, soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor, which might act in the pathophysiology of PE.
  
  
  RESULTS
  In pregnancies with CKD, PE and preterm delivery were increased and the increased blood pressure worsened the perinatal outcomes much more than the increased proteinuria. All pregnancies with severe renal insufficiency were delivered preterm because of impaired renal function. The eGFR was correlated significantly with 24-hour creatinine clearance (r = 0.830). Significant differences in sFlt-1 and placental growth factor levels were found between severe PE without any complications and severe superimposed PE (p < 0.05), and between women with and without declining renal function in superimposed PE (p < 0.01).
  
  
  CONCLUSIONS
  Pregnancies with CKD have a high risk of obstetrical complications. The eGFR might serve for evaluating renal function during pregnancy. Angiogenic factors might be potential markers for a differential diagnosis between PE and worsening renal function.
authors: Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. masuyama@cc.okayama-u.ac.jp
authors: Hisashi
authors: H
authors: Masuyama
authors: Etsuko
authors: E
authors: Nobumoto
authors: Naoki
authors: N
authors: Okimoto
authors: Seiji
authors: S
authors: Inoue
authors: Tomonori
authors: T
authors: Segawa
authors: Yuji
authors: Y
authors: Hiramatsu
mesh_terms: D000328:Adult; D001034:Apgar Score; D015415:Biomarkers / Q000097:blood; D001724:Birth Weight; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007231:Infant, Newborn; D000072483:Placenta Growth Factor; D011225:Pre-Eclampsia / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology*; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood; D047928:Premature Birth / Q000503:physiopathology*; D011507:Proteinuria / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood
chemical_list: D015415:Biomarkers; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; D003404:Creatinine; D040281:Vascular Endothelial Growth Factor Receptor-1