Background Any hypertensive disorder of pregnancy can evolve into preeclampsia which represents a complex medical condition with high mortality and morbidity for both the mother and the fetus, which can experience intrauterine fetal growth retardation, hypoxia and placental abruption. It is not known whether, in a macroscopic and low-risk manner, renal maladaptation to pregnancy is capable of determining a hypertensive problem in patients without a priori renal problem and without predisposing risk factors. There are no studies yet that can determine why some patients develop hypertension and preeclampsia. The severity of the possible consequences and the high incidence of hypertension in pregnancy is the reason why we wanted to investigate the correlation of renal maladaptation to pregnancy and the onset of preeclampsia. Objective of the study To verify, in patients considered to be at low obstetric risk and with a single pregnancy, whether the creatinine value in the first trimester of pregnancy can be predictive of the development of gestational hypertension and/or preeclampsia in the second and third trimester, compared to a control group. Materials and methods The study includes 259 women, of whom 210 cases and 49 controls. Patients who developed hypertensive disorders (gestational hypertension, preeclampsia and eclampsia) during pregnancy were selected, both in the pregnancy under examination and who had hypertensive problems and/or episodes of preeclampsia in previous pregnancies. This is a retrospective observational study conducted over two years at the Gynecological and Obstetrics Clinic of the University of Padua. For each of the patients, renal parameters were analysed, such as levels of creatinine, uric acid, diuresis, proteinuria and albuminuria, from the time of the rise in blood pressure to the date of delivery and in the post-pregnancy period. This is to evaluate the creatinine delta. In addition to the haematochemical and urinary parameters just described, anthropometric parameters of the mother during pregnancy, of the fetus and of the newborn baby were examined, to monitor a hypothetical IUGR linked to preeclampsia. A comparison of all the parameters taken into consideration between cases and controls was performed. Results All the renal parameters taken into consideration in the study (creatinemia, uric acid, 24-hour diuresis, 24-hour proteinuria and albuminuria) were increased in cases compared to controls. Each parameter was evaluated in the I, II, and III trimester and in the post-partum period, taking into account the patient's age and pre-pregnancy BMI and the possible presence of diabetes. Multivariate analysis of serum creatinine, uric acid and 24-hour diuresis revealed no significant differences taking into account the patients' age, prepregnancy BMI and diabetes. Unlike 24h proteinuria for which the multivariate analysis indicated that a greater age was associated with a lower level of proteinuria (p=0.02) and for albuminuria whose analysis indicated that a greater age was associated with a lower albuminuria level (p=0.0006). In this study, thanks to the results obtained, we demonstrate that the increase in creatininemia is associated with the development of hypertensive disorders in pregnancy, such as gestational hypertension and preeclampsia, in single pregnancies. Conclusions This study underlines, thanks to the results obtained, that it would be appropriate to include creatinine levels in the first trimester exams in order to preventively diagnose hypertensive disorders in pregnancy. Further research should explore the possibility of identifying blood and/or urinary markers indicative of early renal damage to be associated with creatinine. Furthermore, it would be advisable to have patients who have had gestational hypertension or preeclampsia monitored by a nephrology specialist.
Ogni disordine ipertensivo della gravidanza può evolvere in preeclampsia che rappresenta una condizione medica complessa con elevata mortalità e morbilità sia per la madre che per il feto, il quale può andare incontro a ritardo di crescita fetale intrauterina, ipossia e distacco di placenta. Il maladattamento renale alla gravidanza non è noto se sia in grado di determinare una problematica ipertensiva in pazienti senza una patologia renale a priori e senza fattori di rischio predisponenti. Non sono ancora presenti studi che sono in grado di determinare perché alcune pazienti sviluppano l’ipertensione e la preeclampsia. La gravità delle possibili conseguenze e l’alta incidenza dell’ipertensione in gravidanza è il motivo per il quale abbiamo voluto indagare sulla correlazione del maladattamento renale alla gravidanza e l’insorgenza della preeclampsia. Obiettivo dello studio Verificare, in pazienti considerate a basso rischio ostetrico e con gravidanza singola, se il valore di creatinemia nel I trimestre di gravidanza possa essere predittivo di sviluppo di ipertensione gestazionale e/o preeclampsia nel II e III trimestre, rispetto ad un gruppo di controllo. Materiali e MetodiLo studio include 259 donne, delle quali 210 casi e 49 controlli. Sono state selezionate pazienti che hanno sviluppato nel corso della gravidanza disturbi ipertensivi (ipertensione gestazionale, preeclampsia ed eclampsia), sia nella gravidanza presa in esame sia coloro che hanno avuto problemi ipertensivi e/o episodi di preeclampsia nelle gravidanze precedenti. Si tratta di uno studio osservazionale retrospettivo condotto nell’arco di due anni presso la Clinica Ginecologica e Ostetrica dell’Università degli studi di Padova. Per ognuna delle pazienti sono stati analizzati i parametri renali, come livelli di creatinemia, acido urico, diuresi, proteinuria e albuminuria, dal momento del rialzo pressorio, alla data del parto e nel post-gravidanza. Questo per valutare il delta della creatinina. Oltre ai parametri ematochimici e urinari appena descritti sono stati presi in esami parametri antropometrici della madre durante la gravidanza, del feto e del bambino appena nato, per monitorare un ipotetico IUGR legato alla preeclampsia. Tutti i parametri renali presi in considerazione nello studio (creatinemia, acido urico, diuresi 24h, proteinuria 24h e albuminuria) risultano aumentati nei casi, rispetto ai controlli. Ogni parametro è stato valutato nel I, II, e III trimestre e nel post-partum, tenendo conto dell’età e del BMI pregravidico della paziente e dell’eventuale presenza di diabete. L’analisi multivariata di creatinina sierica, dell’acido urico e della diuresi delle 24h non ha rilevato differenze significative tenendo conto dell’età delle pazienti, del BMI pregravidico e del diabete. A differenza della proteinuria 24h per la quale l’analisi multivariata ha indicato che un’età maggiore era associata un minor livello di proteinuria (p=0.02) e per l’albuminuria la cui analisi ha indicato che un’età maggiore era associata un minor livello di albuminuria (p=0.0006). In questo studio, grazie ai risultati ottenuti, noi dimostriamo che il rialzo del valore della creatininemia è associato allo sviluppo dei disturbi ipertensivi in gravidanza, quale ipertensione gestazionale e preeclampsia, nelle gravidanze singole. Questo studio sottolinea, grazie ai risultati ottenuti, che sarebbe opportuno inserire negli esami del I trimestre i livelli di creatinemia allo scopo di diagnosticare preventivamente i disturbi ipertensivi nella gravidanza. Ulteriori ricerche dovrebbero esplorare la possibilità di individuare marcatori ematici e/o urinari indici di danno renale precoce da associare alla creatinemia. Sarebbe consigliato far monitorare le pazienti che hanno avuto ipertensione gestazionale o preeclampsia da uno specialista in ambito nefrologico.
Ruolo dell’adattamento funzionale renale nella patogenesi dei disturbi ipertensivi in gravidanza.
VELASCO CARANDENTE, CAMILLA
2022/2023
Abstract
Background Any hypertensive disorder of pregnancy can evolve into preeclampsia which represents a complex medical condition with high mortality and morbidity for both the mother and the fetus, which can experience intrauterine fetal growth retardation, hypoxia and placental abruption. It is not known whether, in a macroscopic and low-risk manner, renal maladaptation to pregnancy is capable of determining a hypertensive problem in patients without a priori renal problem and without predisposing risk factors. There are no studies yet that can determine why some patients develop hypertension and preeclampsia. The severity of the possible consequences and the high incidence of hypertension in pregnancy is the reason why we wanted to investigate the correlation of renal maladaptation to pregnancy and the onset of preeclampsia. Objective of the study To verify, in patients considered to be at low obstetric risk and with a single pregnancy, whether the creatinine value in the first trimester of pregnancy can be predictive of the development of gestational hypertension and/or preeclampsia in the second and third trimester, compared to a control group. Materials and methods The study includes 259 women, of whom 210 cases and 49 controls. Patients who developed hypertensive disorders (gestational hypertension, preeclampsia and eclampsia) during pregnancy were selected, both in the pregnancy under examination and who had hypertensive problems and/or episodes of preeclampsia in previous pregnancies. This is a retrospective observational study conducted over two years at the Gynecological and Obstetrics Clinic of the University of Padua. For each of the patients, renal parameters were analysed, such as levels of creatinine, uric acid, diuresis, proteinuria and albuminuria, from the time of the rise in blood pressure to the date of delivery and in the post-pregnancy period. This is to evaluate the creatinine delta. In addition to the haematochemical and urinary parameters just described, anthropometric parameters of the mother during pregnancy, of the fetus and of the newborn baby were examined, to monitor a hypothetical IUGR linked to preeclampsia. A comparison of all the parameters taken into consideration between cases and controls was performed. Results All the renal parameters taken into consideration in the study (creatinemia, uric acid, 24-hour diuresis, 24-hour proteinuria and albuminuria) were increased in cases compared to controls. Each parameter was evaluated in the I, II, and III trimester and in the post-partum period, taking into account the patient's age and pre-pregnancy BMI and the possible presence of diabetes. Multivariate analysis of serum creatinine, uric acid and 24-hour diuresis revealed no significant differences taking into account the patients' age, prepregnancy BMI and diabetes. Unlike 24h proteinuria for which the multivariate analysis indicated that a greater age was associated with a lower level of proteinuria (p=0.02) and for albuminuria whose analysis indicated that a greater age was associated with a lower albuminuria level (p=0.0006). In this study, thanks to the results obtained, we demonstrate that the increase in creatininemia is associated with the development of hypertensive disorders in pregnancy, such as gestational hypertension and preeclampsia, in single pregnancies. Conclusions This study underlines, thanks to the results obtained, that it would be appropriate to include creatinine levels in the first trimester exams in order to preventively diagnose hypertensive disorders in pregnancy. Further research should explore the possibility of identifying blood and/or urinary markers indicative of early renal damage to be associated with creatinine. Furthermore, it would be advisable to have patients who have had gestational hypertension or preeclampsia monitored by a nephrology specialist.| File | Dimensione | Formato | |
|---|---|---|---|
|
VELASCO CARANDENTE_CAMILLA.pdf
accesso riservato
Dimensione
574.6 kB
Formato
Adobe PDF
|
574.6 kB | Adobe PDF |
The text of this website © Università degli studi di Padova. Full Text are published under a non-exclusive license. Metadata are under a CC0 License
https://hdl.handle.net/20.500.12608/60856