Preeclampsia and Kidney Disease: Deciphering Cause and Effect
- PDF / 657,728 Bytes
- 11 Pages / 595.276 x 790.866 pts Page_size
- 64 Downloads / 225 Views
PREECLAMPSIA (VD GAROVIC, SECTION EDITOR)
Preeclampsia and Kidney Disease: Deciphering Cause and Effect Andrea Kattah 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Preeclampsia and chronic kidney disease have a complex, bidirectional relationship. Women with kidney disease, with even mild reductions in glomerular filtrate rate, have an increased risk of developing preeclampsia. Preeclampsia, in turn, has been implicated in the subsequent development of albuminuria, chronic kidney disease, and end-stage kidney disease. We will discuss observational evidence and mechanisms linking the two disease processes. Recent Findings Preeclampsia is characterized by an imbalance in angiogenic factors that causes systemic endothelial dysfunction. Chronic kidney disease may predispose to the development of preeclampsia due to comorbid conditions, such as hypertension, but is also associated with impaired glycocalyx integrity and alterations in the complement and renin-angiotensinaldosterone systems. Preeclampsia may lead to kidney disease by causing acute kidney injury, endothelial damage, and podocyte loss. Summary Preeclampsia may be an important sex-specific risk factor for chronic kidney disease. Understanding how chronic kidney disease increases the risk of preeclampsia from a mechanistic standpoint may open the door to future biomarkers and therapeutics for all women. Keywords Preeclampsia . Hypertensive disorders of pregnancy . Chronic kidney disease . End-stage kidney disease
Introduction There have been significant advances in our understanding of the pathogenesis of preeclampsia over the last two decades. Preeclampsia is a systemic disorder characterized by endothelial dysfunction that impacts multiple organ systems, including the kidney, where the most common presentation is newonset proteinuria. The impact of preeclampsia on kidney histology has been well documented, with postpartum biopsies demonstrating classic pathologic features, including glomerular endotheliosis and vascular injury [1, 2]. While proteinuria typically resolves within months of delivery, there is an expanding body of evidence suggesting that there is a future risk of kidney disease after preeclampsia. Preeclampsia has been associated with an increased risk of albuminuria [3, 4], This article is part of the Topical Collection on Preeclampsia * Andrea Kattah [email protected] 1
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
chronic kidney disease (CKD) [5], and end-stage kidney disease (ESKD) [5–8]. As women tend to be older and have more comorbidities at the time conception in the more recent era [9], the incidence of preeclampsia has been increasing [10], which makes preeclampsia a potentially important sex-specific risk factor for CKD. Confounding the “cause and effect” relationship of preeclampsia and kidney disease is the fact that kidney disease itself is a significant risk factor for preeclampsia. Kidney donation [11•], stage 1 CKD [12], and a previous ep
Data Loading...
