High-Normal Estimated Glomerular Filtration Rate in Early-Onset Preeclamptic Women 10 Years Postpartum.
Women with a history of preeclampsia have a 5- to 12-fold increased risk to develop end-stage kidney disease. Previous observations in small cohorts suggest that former preeclamptic (fPE) women have subtle abnormalities in renal hemodynamics and renal function, which might predispose them to renal failure in later life. In this study, we analyzed renal function in a cross-sectional cohort consisting of former early-onset preeclamptic (fPE, n=339) and former healthy pregnant women (fHP, n=332), overall with a mean age of 39 years at 10 years postpartum. Estimated glomerular filtration rate (eGFR), assessed by the modification of diet in renal disease (MDRD) and chronic kidney disease-epidemiology (CKD-epi) equations, and urinary protein:creatinine ratios were assessed 10 years postpartum. Median MDRD and CKD-epi eGFR did not significantly differ between fHP and fPE groups, whereas a comparison of distribution of eGFR revealed a shift toward a high-normal MDRD eGFR in the fPE group (χ2, P=0.02) with the same trend for CKD-epi eGFR (χ2, P=0.18). The odds ratio for fPE women having MDRD eGFR >110 mL/min per 1.73 m2was 1.6 (1.1-2.4). In addition, the median urinary protein:creatinine ratio was slightly higher in fPE (8.5 versus 7.1 mg/mmol; P<0.01) and correlated positively with both MDRD and CKD-epi eGFR in fPE women. No increased incidence of CKD in fPE women was observed. In conclusion, we demonstrate subtle changes in renal function in former early-onset preeclamptic women 10 years postpartum, characterized by a high-normal eGFR and a slightly higher protein excretion. Whether these subtle differences predispose to or predict long-term renal function loss in fPE women remains to be investigated.



URL: http://www.trialregister.nl. Unique identifier: NTR2668.
From the Department of Obstetrics, Wilhelmina Children's Hospital Birth Center (N.D.P., A.F., A.T.L.) and Department of Nephrology and Hypertension (J.A.J., M.C.V.), University Medical Center Utrecht, The Netherlands; Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (J.T.D.); Department of Nephrology, University Medical Center Groningen, The Netherlands (G.N.); and Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands (A.H.E.M.M.). n.d.paauw-2@umcutrecht.nl.
Nina D
ND
Paauw
From the Department of Obstetrics, Wilhelmina Children's Hospital Birth Center (N.D.P., A.F., A.T.L.) and Department of Nephrology and Hypertension (J.A.J., M.C.V.), University Medical Center Utrecht, The Netherlands; Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (J.T.D.); Department of Nephrology, University Medical Center Groningen, The Netherlands (G.N.); and Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands (A.H.E.M.M.).
Jaap A
JA
Joles
From the Department of Obstetrics, Wilhelmina Children's Hospital Birth Center (N.D.P., A.F., A.T.L.) and Department of Nephrology and Hypertension (J.A.J., M.C.V.), University Medical Center Utrecht, The Netherlands; Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (J.T.D.); Department of Nephrology, University Medical Center Groningen, The Netherlands (G.N.); and Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands (A.H.E.M.M.).
José T
JT
Drost
From the Department of Obstetrics, Wilhelmina Children's Hospital Birth Center (N.D.P., A.F., A.T.L.) and Department of Nephrology and Hypertension (J.A.J., M.C.V.), University Medical Center Utrecht, The Netherlands; Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (J.T.D.); Department of Nephrology, University Medical Center Groningen, The Netherlands (G.N.); and Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands (A.H.E.M.M.).
Marianne C
MC
Verhaar
From the Department of Obstetrics, Wilhelmina Children's Hospital Birth Center (N.D.P., A.F., A.T.L.) and Department of Nephrology and Hypertension (J.A.J., M.C.V.), University Medical Center Utrecht, The Netherlands; Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (J.T.D.); Department of Nephrology, University Medical Center Groningen, The Netherlands (G.N.); and Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands (A.H.E.M.M.).
Arie
A
Franx
From the Department of Obstetrics, Wilhelmina Children's Hospital Birth Center (N.D.P., A.F., A.T.L.) and Department of Nephrology and Hypertension (J.A.J., M.C.V.), University Medical Center Utrecht, The Netherlands; Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (J.T.D.); Department of Nephrology, University Medical Center Groningen, The Netherlands (G.N.); and Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands (A.H.E.M.M.).
Gerjan
G
Navis
From the Department of Obstetrics, Wilhelmina Children's Hospital Birth Center (N.D.P., A.F., A.T.L.) and Department of Nephrology and Hypertension (J.A.J., M.C.V.), University Medical Center Utrecht, The Netherlands; Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (J.T.D.); Department of Nephrology, University Medical Center Groningen, The Netherlands (G.N.); and Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands (A.H.E.M.M.).
Angela H E M
AH
Maas
From the Department of Obstetrics, Wilhelmina Children's Hospital Birth Center (N.D.P., A.F., A.T.L.) and Department of Nephrology and Hypertension (J.A.J., M.C.V.), University Medical Center Utrecht, The Netherlands; Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (J.T.D.); Department of Nephrology, University Medical Center Groningen, The Netherlands (G.N.); and Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands (A.H.E.M.M.).
A Titia
AT
Lely
D000328:Adult; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005865:Gestational Age; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D049590:Postpartum Period; D011225:Pre-Eclampsia / Q000503:physiopathology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
glomerular filtration rate; hemodynamics; kidney; preeclampsia; proteinuria