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Renal Evaluation in Women with Preeclampsia

Background/Aims: Preeclampsia (PE) is a cause of glomerulopathy worldwide. Urinary retinol-binding protein (RBP) is a marker of proximal tubular dysfunction, albuminuria is an endothelial injury marker, urine protein:creatinine ratio (PCR) may have a predictive value for renal disease later in life, and, recently, podocyturia has been proposed as a sensitive tool in pregnancy, but it needs to be tested. The aim of this study was to evaluate renal involvement in PE and healthy pregnancy. Methods: Case-control study with 39 pregnant women assessed after 20 weeks of gestation (25 in the control group, CG, and 14 in the PE group) by performing urinary tests. Results: Mean (±SD) age and gestational age of the CG were 26.9 ± 6.4 years and 37.1 ± 5.0 weeks, and of the PE group 26.4 ± 6.9 years and 30.6 ± 5.6 weeks, respectively (p = 0.001). Mean (±SD) urinary RBP (p = 0.017), albuminuria (p = 0.002), and urinary albumin concentration (UAC) ratio (p = 0.006) of the CG were 0.4 ± 0.7 mg/l, 7.3 ± 6.9 mg/l, and 8.2 ± 6.7 mg/g and of the PE group 2.0 ± 4.4 mg/l, 2,267.4 ± 2,130.8 mg/l (p = 0.002), and 3,778.9 ± 4,296.6 mg/g (p = 0.006), respectively. Mean (±SD) urine PCR in the PE group was 6.7 ± 6.1 g/g (p < 0.001). No statistical differences were found between podocyturia in the CG and PE group (p = 0.258). Conclusions: Urinary RBP, PCR, albuminuria, and UAC ratio were elevated in the PE group in comparison to the CG. Podocyturia did not predict PE.

Pregnancy as an early stress test for cardiovascular and kidney disease diagnosis

OBJECTIVES Pregnancy is a cardiometabolic and renal stress test for women, primarily when associated with hypertension syndrome, which can have deleterious effects in the long term. We undertook this study to make a long-term evaluation on these women. STUDY DESIGN A retrospective cohort study was conducted to investigate voluntary women who had pregnancy-induced hypertension syndrome versus normal pregnancy. MAIN OUTCOME MEASURES We evaluated a total of 85 women, divided in case (n = 25) and control (n = 60) groups, by clinical, anthropometric and epidemiological profiles, general, metabolic and renal tests, and risk stratification for cardiovascular disease (CVD) and chronic kidney disease (CKD). RESULTS The case group showed a higher incidence of hypertension (P = .003), shorter period between its diagnosis and end of pregnancy (P < .001) and lower age at diagnosis (P = .033); higher weight (P < .001), body mass index (BMI) (P < .001), waist-to-height ratio (p = .001) and abdominal circumference (P < .001); higher fat percentage (P = .004) and weight to lose (P < .001) as measured by bioimpedance; lower estimate glomerular filtration rate (eGFR) by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation (P = .021), greater difference between estimated vascular age and real age (P = .008) according to Framingham Risk Score (2008) and higher frequency of metabolic syndrome (P < .001). CONCLUSIONS Women who had pregnancy-induced hypertension syndrome were found with a higher incidence of obesity, metabolic syndrome and hypertension, earlier onset of hypertension, higher estimated vascular age and lower eGFR. These findings reinforce the importance of investigating the history of hypertension syndrome in pregnancy, which should be considered an indicator to be followed long term after childbirth.

PP019 The role of renal markers in women with and without preeclampsia: Evaluation of urinary excretion of podocytes and proteins

INTRODUCTION Preeclampsia (PE) is an important cause of glomerulopathy. Assessment of renal markers during pregnancy may have a predictive value for glomerular disease later in life. The early detection of PE may prevent the complications of this syndrome. OBJECTIVES Assess the glomerular involvement in PE and in normal pregnancy by evaluating renal markers such as podocyturia and proteinuria. METHODS Case-control study with 39 pregnant women after 20 weeks of gestation (control group - CG with n=25 and PE with n=14), we assessed podocyturia (cytospin method) and proteinuria (albuminuria, urine protein:creatinine - PCR, urinary retinol protein - RBP and albumin/creatinine ratio - ACR). (Grant FAPESP 08/56338-1) RESULTS: Mean±standard deviation of age and mean gestational age of CG were 26.9±6.4years and 37.1±5.0weeks and of PE, 26.4±6.9 and 30.6±5.6, respectively (p=0.001). No statistical differences were found between podocyturia in CG and PE although it was more frequent in this last group (p=0.258). Podocyte cells and parietal epithelial cells were detected in the slides. Mean±standard deviation of urinary RBP (p=0.017), albuminuria (p=0.002) and UAC ratio (p=0.006) of CG were 0.4±0.7mg/L, 7.3±6.9mg/L and 8.2±6.7mg/g and of PE, 2.0±4.4mg/L, 2267.4±2130.8mg/L (p=0.002) and 3778.9±4296.6mg/g (p=0.006), respectively. Mean value±standard deviation of urine PCR in PE was 6.7±6.1g/g (p=< 0.001). CONCLUSION Urinary RBP, PCR, albuminuria and UAC ratio were elevated in PE in comparison to CG indicating its glomerular involvement but there was no correlation between those renal parameters and podocyturia. RPC and UAC ratios were good predictors of PE, but not podocyturia. Either podocyte cells as parietal epithelial cells were detected in the urine, these findings may indicate a non-invasive marker for renal disease activity but more studies are required to determine its role in PE.

236. Pregnancy in renal transplant patients: renal function markers and maternal-fetal outcomes

Introduction Progressive proteinuria and glomerulosclerosis characterize chronic allograft nephropathy. Podocytes are fundamental cells for maintaining the functionality of glomerular filtration barrier. Failure to achieve this task due to reduced podocyte number and results in progressive glomerular dysfunction, causing proteinuria and glomerulosclerosis and ultimately leading to end-stage kidney disease. Assessment of podocyturia and its correlation with other renal parameters could help with the diagnosis and definition of prognosis of the glomerulopathies, thus contributing to risk reduction. Objective To evaluate podocyturia and others renal parameters as functional markers in pregnant women with kidney grafts. Methods In this cross-sectional and prospective study, 43 pregnant women with kidney grafts had their Mid-stream urine samples collected to determine proteinuria, including retinol-binding protein (enzyme immunoassay using monoclonalantibodies), albumin/creatinine ratio (immunoturbidimetry), protein/creatinine ratio (the alkaline picrate colorimetric method), and podocyturia (indirect immunofluorescence). Results 43 women who got pregnant after renal transplantation were included. Podocyturia was not significantly correlated with other renal function markers. A gradual increase was observed in the following parameters during pregnancy and puerperium: serum creatinine levels (P  Conclusion Proteinuria, urinary protein/creatinine ratio, and retinol-binding protein levels were elevated in patients with preeclampsia. Proteinuria (or more specifically, urinary protein/creatinine ratio) and albumin/creatinine ratio has also used as a marker of CKD progression. We observed that urinary podocyte excretion occurs in pregnant women with kidney transplant. Using these markers to assess renal function during pregnancy may be clinically useful for early diagnosis and follow-up of glomerular injury, eventually preeclampsia. It may be also associated to its severity or activity.

Podocitúria em gestantes hipertensas crônicas pode predizer dano renal

PURPOSE To evaluate the presence of podocyturia in chronic hypertensive pregnant women in the third trimester of pregnancy and its possible association with renal disease. METHODS This was an observational study of a convenience sample of 38 chronic hypertensive pregnant women. The podocytes were labeled by the indirect immunofluorescence technique with anti-podocin and diamidino-phenylindole (DAPI). The count was made on 30 random fields analyzed and corrected according to urinary creatinine (podocytes/mg creatinine). The patients were assigned to two groups: NG (normal glomerular function), up to 100 podocytes, and GP (probable glomerulopathy), more than 100 podocytes. Urinary creatinine was measured by the alkaline picrate method. The variables analyzed were body mass index, gestational age, and systolic and diastolic blood pressure at the time of sample collection. Data were analyzed using the SPSS - version 16.0 (IBM - USA). Statistical analysis was performed by the χ2 test, and significant differences were considered when p<0.05. RESULTS The median podocyte count was 20.3 (0.0-98.1) for group GN, and 176.9 (109.1-490.6) for GP. The mean body mass index was 30.2 kg/m2 (SD=5.6), mean gestational age was 35.1 weeks (SD=2.5), median systolic blood pressure was 130.0 mmHg (100.0-160.0) and median diastolic blood pressure was 80.0 mmHg (60.0-110.0). There was no significant correlation between podocyturia and body mass index (p=0.305), gestational age (p=0.392), systolic blood pressure (p=0.540) or diastolic blood pressure (p=0.540). CONCLUSIONS In this study, there was no podocyturia pattern consistent with the presence of active renal disease, although some of the women studied (15.8%) exhibited a significant loss. We believe that it is premature to recommend the inclusion of the determination of podocyturia in routine prenatal clinical practice in chronically hypertensive pregnant women.

PP148. Is there podocyturia in pregnant women with chronic hypertension? (Preliminary results).

later age of her reproductive cycle has be a phenomenon around the world. Epidemiology data show frequent increase of clinical complications in direct proportion in advanced age motherhood, hypertensive disturbances being more prevalent. Objectives: Analyse the prevalence of hypertensive syndromes in pre-determined age groups at Hospital Guilherme Alvaro in Santos, Sao Paulo, Brazil showing the different segments in each one. Methods: From data collected in the outpatient department of Hospital Guilherme Alvaro of High Risk Pre-natal between 04/06/2008 and 30/05/2011, a prevalence transversal study was carried out where data were obtained from 628 patients aged between 16 and 46 years. Procedures of homogeny analysts were set out, always collecting data such as age and disorder for high risk gestation. According to age, patients were divided into groups: precocious (up to 19 years old), middle age (between 20 and 34) and late pregnancies (over 35). Results: In the precocious pregnancies, clinical illnesses/ no hypertension (31%) were observed in first place, 25% (8) twin pregnancy in second place, 19% (6) showed hypertensive disturbances. Concerning pregnancies between 20 and 34 years old, 36% (144 patients) showed hypertensive syndromes, 23% (92 patients) showed endocrine disturbances, 22% (90 patients) showed clinical illnesses/no hypertension, and 9% twin pregnancy. Regarding late pregnancies, the most frequent disturbance was isolated hypertensive syndromes: 44% (88 patients) in first place, only endocrine disturbances, 24% (47 patients) in second place followed by association between hypertensive syndromes and endocrinopathy with 13% (26 patients). Conclusion: About precocious pregnancies, greater prevalence showed clinical illnesses/no hypertension, whereas middle age and late pregnancies showed greater hypertensive syndrome prevalence, results, which are compatible with other studies, have been observed that due to advance of age, hypertensive syndromes aremore frequent. For late pregnancies, the prevalence of clinical illnesses/no hypertension was a lower percentage regarding the other two groups: precocious pregnancies (31% = 10 women), middle age pregnancies (22% = 90 women), and late pregnancies (2% = 7 women). Considering the fact that the occurrence of pregnancy is more and more late in life, it can be concluded that the professionals must be prepared to attend pregnancies on women with hypertensive disturbances and their eventual complications.

P119 Clinical and epidemiological profile of pregnant women with chronic hypertension

relationship between systolic blood pressure (SBP) and plasma levels of sE-selectin, sVCAM-1 and sFlt-1. Moreover, high SBP and diastolic BP and plasma levels of sE-selectin, sVCAM-1 and sFlt1 were negatively associated with newborn weight and gestational age at delivery. Women with elevated levels of sE-selectin (>63 ng/mL), sVCAM-1 (>752 ng/mL) and sFlt-1 (>15204 pg/mL), showed high risk (RR 2.05, 1.69 and 3.07, respectively) for preterm delivery, very preterm delivery (RR 1.9, 1.21, and 2.66, respectively), or fetal weigh under 1500 g (RR 2.33, 1.10 and 1.94, respectively) compared with women with low levels. Conclusions: High serum levels of endothelial dysfunction markers are associated with poor newborn outcomes such as growth restriction and pre-term delivery. Severe pre-eclampsia characterized by hypertension and high maternal circulating levels of sVCAM-1 and sFlt-1 is associated with decreased NO synthesis in the fetal endothelium. Supported by FONDECYT 11070035, DIUC-UDEC 205.072.032-1.0, 205.072.031-1.0 and CE is granted by FONDECYT 1100684, DI-UBB 0965091/RS

P120 Profile of pregnant Brazilian patients in a glomerulopathies outpatient clinic

relationship between systolic blood pressure (SBP) and plasma levels of sE-selectin, sVCAM-1 and sFlt-1. Moreover, high SBP and diastolic BP and plasma levels of sE-selectin, sVCAM-1 and sFlt1 were negatively associated with newborn weight and gestational age at delivery. Women with elevated levels of sE-selectin (>63 ng/mL), sVCAM-1 (>752 ng/mL) and sFlt-1 (>15204 pg/mL), showed high risk (RR 2.05, 1.69 and 3.07, respectively) for preterm delivery, very preterm delivery (RR 1.9, 1.21, and 2.66, respectively), or fetal weigh under 1500 g (RR 2.33, 1.10 and 1.94, respectively) compared with women with low levels. Conclusions: High serum levels of endothelial dysfunction markers are associated with poor newborn outcomes such as growth restriction and pre-term delivery. Severe pre-eclampsia characterized by hypertension and high maternal circulating levels of sVCAM-1 and sFlt-1 is associated with decreased NO synthesis in the fetal endothelium. Supported by FONDECYT 11070035, DIUC-UDEC 205.072.032-1.0, 205.072.031-1.0 and CE is granted by FONDECYT 1100684, DI-UBB 0965091/RS

P47 Importance of renal function evaluation during pregnancy performed by obstetricians/gynecologists and residents

and 0.4g/24h for PE and 2.9mg/dl and 4.8g/24h for PG. Podocyte cells were observed in all three groups, but there were only significant numbers in PG and PE. In PE group it was found almost three times the quantity detected in PG. Conclusions: Urinary podocyte excretion occurs in PE and PG besides other renal abnormalities; furthermore, it may contribute to the development of glomerulosclerosis. The detection of podocyturia in PE could be useful for preventing, diagnosing and following up the glomerular injury and it may also be correlated to its severity or activity, although additional studies are necessary to confirm these points. Apoio FAPESP 08/56338-1