title: Can preeclampsia be considered a renal compartment syndrome? A hypothesis and analysis of the literature.
abstract: The morbidity and mortality associated with preeclampsia is staggering. The physiology of the Page kidney, a condition in which increased intrarenal pressure causes hypertension, appears to provide a unifying framework to explain the complex pathophysiology. Page kidney hypertension is renin-mediated acutely and ischemia-mediated chronically. Renal venous outflow obstruction also causes a Page kidney phenomenon, providing a hypothesis for the increased vulnerability of a subset of women who have what we are hypothesizing is a "renal compartment syndrome" due to inadequate ipsilateral collateral renal venous circulation consistent with well-known variation in normal venous anatomy. Dynamic changes in renal venous anatomy and physiology in pregnancy appear to correlate with disease onset, severity, and recurrence. Since maternal recumbent position is well known to affect renal perfusion and since chronic outflow obstruction makes women vulnerable to the ischemic/inflammatory sequelae, heightened awareness of renal compartment syndrome physiology is critical. The anatomic and physiologic insights provide immediate strategies to predict and prevent preeclampsia with straightforward, low-cost interventions that make renewed global advocacy for pregnant women a realistic goal.
authors.affiliation: Department of Pediatrics, Division of Cardiology, Seattle Children's Hospital, Seattle, WA; General Pediatrics, Allegro Pediatrics, Bellevue, WA. Electronic address: David.Reuter@seattlechildrens.org.
authors.forename: David G
authors.initials: DG
authors.lastname: Reuter
authors.affiliation: Department of Pediatrics, Division of Cardiology, Seattle Children's Hospital, Seattle, WA.
authors.forename: Yuk
authors.initials: Y
authors.lastname: Law
authors.affiliation: Division of Cardiology, University of Washington School of Medicine, Seattle, WA.
authors.forename: Wayne C
authors.initials: WC
authors.lastname: Levy
authors.affiliation: Department of Pediatrics, Division of Cardiology, Seattle Children's Hospital, Seattle, WA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Seslar
authors.affiliation: Division of Vascular Surgery, University of Washington School of Medicine, Seattle, WA.
authors.forename: R Eugene
authors.initials: RE
authors.lastname: Zierler
authors.affiliation: Department of Radiology, Seattle Children's Hospital, Seattle, WA.
authors.forename: Mark
authors.initials: M
authors.lastname: Ferguson
authors.affiliation: General Pediatrics, Allegro Pediatrics, Bellevue, WA.
authors.forename: James
authors.initials: J
authors.lastname: Chattra
authors.affiliation: Department of Pediatrics, Division of Cardiology, Seattle Children's Hospital, Seattle, WA.
authors.forename: Tim
authors.initials: T
authors.lastname: McQuinn
authors.affiliation: Division of General Pediatrics, University of Washington School of Medicine, Seattle, WA.
authors.forename: Lenna L
authors.initials: LL
authors.lastname: Liu
authors.affiliation: Science Department, The Northwest School, Seattle, WA.
authors.forename: Mark
authors.initials: M
authors.lastname: Terry
authors.affiliation: PATH, Maternal Innovation Portfolio, Seattle, WA.
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Coffey
authors.affiliation: Division of Obstetrics, University of Washington School of Medicine, Seattle, WA.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Dimer
authors.affiliation: Department of Nephrology, Seattle Children's Hospital, Seattle, WA.
authors.forename: Coral
authors.initials: C
authors.lastname: Hanevold
authors.affiliation: Department of Nephrology, Seattle Children's Hospital, Seattle, WA.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Flynn
authors.affiliation: Department of Nephrology, Seattle Children's Hospital, Seattle, WA.
authors.forename: F Bruder
authors.initials: FB
authors.lastname: Stapleton
mesh_terms: D063405:Anatomic Variation; D003097:Collateral Circulation; D003161:Compartment Syndromes / Q000503:physiopathology*; D019332:Endothelin-1 / Q000097:blood / Q000378:metabolism; D005260:Female; D006801:Humans; D007511:Ischemia / Q000503:physiopathology; D007668:Kidney / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology*; D009765:Obesity / Q000150:complications / Q000503:physiopathology; D011225:Pre-Eclampsia / Q000503:physiopathology* / Q000517:prevention & control; D011247:Pregnancy; D012079:Renal Circulation; D012082:Renal Veins / Q000033:anatomy & histology* / Q000503:physiopathology; D012083:Renin / Q000378:metabolism*; D012084:Renin-Angiotensin System; D012307:Risk Factors; D013564:Sympathetic Nervous System / Q000503:physiopathology
chemical_list: D019332:Endothelin-1; D012083:Renin
keywords: Gestational hypertension; hypertension; obesity-related hypertension; renal ischemia