title: Is It Possible to Differentiate Chronic Kidney Disease and Preeclampsia by means of New and Old Biomarkers? A Prospective Study.
abstract: OBJECTIVE
  Chronic kidney disease (CKD) and preeclampsia (PE) may both present with hypertension and proteinuria in pregnancy. Our objective is to test the possibility of distinguishing CKD from PE by means of uteroplacental flows and maternal circulating sFlt-1/PlGF ratio.
  
  
  METHODS
  Prospective analysis.
  
  
  METHODS
  Seventy-six patients (35 CKD, 24 PE, and 17 other hypertensive disorders), with at least one sFlt-1/PlGF and Doppler evaluation after the 20th gestational week.
  
  
  METHODS
  Maternal sFlt-1-PlGF were determined by immunoassays. Abnormal uterine artery Doppler was defined as resistance index ≥ 0.58. Umbilical Doppler was defined with gestational-age-adjusted Pulsatility Index. Clinical diagnosis was considered as reference. Performance of Doppler study was assessed by sensitivity analysis; sFlt-1/PlGF cut-off values were determined by ROC curves.
  
  
  RESULTS
  The lowest sFlt-1/PlGF ratio (8.29) was detected in CKD, the highest in PE (317.32) (P < 0.001). Uteroplacental flows were mostly preserved in CKD patients in contrast to PE (P < 0.001). ROC analysis suggested two cut-points: sFlt-1/PlGF ≥ 32.81 (sensitivity 82.93%; specificity 91.43%) and sFlt-1/PlGF ≥ 78.75 (sensitivity 62.89%, specificity 97.14%). Specificity reached 100% at sFlt-1/PlGF ≥ 142.21 (sensitivity: 48.8%). Early-preterm delivery was associated with higher sFlt-1/PlGF ratio and abnormal uteroplacental flows relative to late-preterm and term deliveries.
  
  
  CONCLUSIONS
  sFlt-1/PlGF ratio and uteroplacental flows significantly correlated with PE or CKD and preterm delivery.
authors.affiliation: Department of Surgical Sciences, O.I.R.M-Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, 10126 Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rolfo
authors.affiliation: Department of Surgical Sciences, O.I.R.M-Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, 10126 Turin, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Attini
authors.affiliation: Department of Surgical Sciences, O.I.R.M-Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, 10126 Turin, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Tavassoli
authors.affiliation: SS Nephrology, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy.
authors.forename: Federica Vigotti
authors.initials: FV
authors.lastname: Neve
authors.affiliation: Chemical-Clinical and Microbiological Analysis Laboratory, Giovanni Bosco Hospital, 10154 Turin, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Nigra
authors.affiliation: Chemical-Clinical and Microbiological Analysis Laboratory, Giovanni Bosco Hospital, 10154 Turin, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cicilano
authors.affiliation: Department of Surgical Sciences, O.I.R.M-Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, 10126 Turin, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Nuzzo
authors.affiliation: Department of Surgical Sciences, O.I.R.M-Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, 10126 Turin, Italy.
authors.forename: Domenica
authors.initials: D
authors.lastname: Giuffrida
authors.affiliation: Department of Surgical Sciences, O.I.R.M-Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, 10126 Turin, Italy.
authors.forename: Marilisa
authors.initials: M
authors.lastname: Biolcati
authors.affiliation: Service of Biostatistics, Department of Hematology, Niguarda Ca' Granda Hospital, 20162 Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Nichelatti
authors.affiliation: Department of Surgical Sciences, O.I.R.M-Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, 10126 Turin, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Gaglioti
authors.affiliation: Department of Surgical Sciences, O.I.R.M-Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, 10126 Turin, Italy.
authors.forename: Tullia
authors.initials: T
authors.lastname: Todros
authors.affiliation: SS Nephrology, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy.
authors.forename: Giorgina Barbara
authors.initials: GB
authors.lastname: Piccoli
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D000072483:Placenta Growth Factor; D011225:Pre-Eclampsia / Q000097:blood* / Q000000981:diagnostic imaging; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood*; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000000981:diagnostic imaging; D014463:Ultrasonography; D055988:Uterine Artery / Q000000981:diagnostic imaging; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood*
chemical_list: D015415:Biomarkers; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1