title: Podocyturia predates proteinuria and clinical features of preeclampsia: longitudinal prospective study.
abstract: Podocyturia, the shedding of live podocytes, is present at delivery in women with preeclampsia. The aim of this study was to test whether podocyturia is present earlier in pregnancy and predicts for preeclampsia. We also aimed to compare test characteristics of podocyturia with those of angiogenic factors previously implicated in the pathogenesis of this disorder. We prospectively enrolled 315 women who provided blood and urine samples at the end of the second trimesters of their pregnancies (median, 27 gestational weeks) and within 24 hours of their deliveries (median, 39.5 gestational weeks). Blood samples were analyzed for angiogenic markers, including placental growth factor, the soluble receptor fms-like tyrosine kinase receptor-1 for vascular endothelial growth factor, and endoglin. The urine sediments were analyzed for podocytes, identified by staining for podocin after culturing the urinary sediments for 24 hours. This analysis included all women who developed preeclampsia (n=15), gestational hypertension (n=15), and a subsample of women who remained normotensive throughout pregnancy (n=44), matched for maternal age and number of previous pregnancies to those who developed preeclampsia. At the second trimester collection, all women who developed preeclampsia had podocyturia, compared with none of those who remained normotensive or were diagnosed with gestational hypertension. Podocyturia in the second trimester had a significantly greater sensitivity and specificity for the subsequent diagnosis of preeclampsia than any single angiogenic marker or a combination thereof. Screening for podocyturia at the end of the second trimester may allow for accurate identification of pregnant women at risk for preeclampsia.
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: Iasmina M
authors.initials: IM
authors.lastname: Craici
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Wagner
authors.forename: Kent R
authors.initials: KR
authors.lastname: Bailey
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Fitz-Gibbon
authors.forename: Christina M
authors.initials: CM
authors.lastname: Wood-Wentz
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Turner
authors.forename: Suzanne R
authors.initials: SR
authors.lastname: Hayman
authors.forename: Wendy M
authors.initials: WM
authors.lastname: White
authors.forename: Brian C
authors.initials: BC
authors.lastname: Brost
authors.forename: Carl H
authors.initials: CH
authors.lastname: Rose
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Grande
authors.forename: Vesna D
authors.initials: VD
authors.lastname: Garovic
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D000072483:Placenta Growth Factor; D050199:Podocytes / Q000473:pathology*; D011225:Pre-Eclampsia / Q000097:blood / Q000503:physiopathology / Q000652:urine*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood; D011262:Pregnancy Trimester, Second; D011379:Prognosis; D011446:Prospective Studies; D011507:Proteinuria / Q000209:etiology* / Q000652:urine; D015203:Reproducibility of Results; D016482:Urinalysis; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood
chemical_list: D015415:Biomarkers; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; D040281:Vascular Endothelial Growth Factor Receptor-1
keywords: high-risk pregnancy; podocyturia; preeclampsia; pregnancy hypertension; proteinuria