OBJECTIVE: Pregnant women with acute pyelonephritis develop acute respiratory distress syndrome (ARDS) more frequently than non-pregnant women. The reasons for this remain unknown. The complement system is a complex set of self-assembling proteins that have been implicated in the pathophysiology of ARDS and sepsis. The purpose of this study was to determine if activation of the complement system occurs in pregnant women with acute pyelonephritis. METHODS: A cross-sectional study was conducted to determine the plasma concentrations of C3a, C4a and C5a (i.e., complement split products) in pregnant patients with acute pyelonephritis (n=38) and normal pregnant women (n=38). The complement split products C3a, C4a and C5a were measured using ELISA. Data were analyzed using non-parametric statistics. RESULTS: 1) The median plasma concentration of C5a in pregnant patients with acute pyelonephritis was significantly higher than that in normal pregnant women (p<0.001); 2) there was no statistical difference in the median plasma concentration of C3a and C4a between the two groups (p>0.05); and 3) concentrations of C3a, C4a and C5a were not different among patients with acute pyelonephritis with and without bacteremia. CONCLUSIONS: 1) Pyelonephritis in pregnant women is associated with an increased plasma concentration of C5a, but not C3a and C4a; and 2) an excess of C5a can predispose pregnant women to develop ARDS and multi-organ failure in pyelonephritis. This finding may have clinical implications since blocking C5a improves ARDS in experimental sepsis.
OBJECTIVE: Pregnant women with acute pyelonephritis develop acute respiratory distress syndrome (ARDS) more frequently than non-pregnant women. The reasons for this remain unknown. The complement system is a complex set of self-assembling proteins that have been implicated in the pathophysiology of ARDS and sepsis. The purpose of this study was to determine if activation of the complement system occurs in pregnant women with acute pyelonephritis. METHODS: A cross-sectional study was conducted to determine the plasma concentrations of C3a, C4a and C5a (i.e., complement split products) in pregnant patients with acute pyelonephritis (n=38) and normal pregnant women (n=38). The complement split products C3a, C4a and C5a were measured using ELISA. Data were analyzed using non-parametric statistics. RESULTS: 1) The median plasma concentration of C5a in pregnant patients with acute pyelonephritis was significantly higher than that in normal pregnant women (p<0.001); 2) there was no statistical difference in the median plasma concentration of C3a and C4a between the two groups (p>0.05); and 3) concentrations of C3a, C4a and C5a were not different among patients with acute pyelonephritis with and without bacteremia. CONCLUSIONS: 1) Pyelonephritis in pregnant women is associated with an increased plasma concentration of C5a, but not C3a and C4a; and 2) an excess of C5a can predispose pregnant women to develop ARDS and multi-organ failure in pyelonephritis. This finding may have clinical implications since blocking C5a improves ARDS in experimental sepsis.
Authors: S Okusawa; K B Yancey; J W van der Meer; S Endres; G Lonnemann; K Hefter; M M Frank; J F Burke; C A Dinarello; J A Gelfand Journal: J Exp Med Date: 1988-07-01 Impact factor: 14.307
Authors: Shali Mazaki-Tovi; Edi Vaisbuch; Roberto Romero; Juan Pedro Kusanovic; Tinnakorn Chaiworapongsa; Sun Kwon Kim; Giovanna Ogge; Bo Hyun Yoon; Zhong Dong; Juan M Gonzalez; Maria Teresa Gervasi; Sonia S Hassan Journal: Am J Reprod Immunol Date: 2010-02-18 Impact factor: 3.886
Authors: Francesca Gotsch; Roberto Romero; Jimmy Espinoza; Juan Pedro Kusanovic; Shali Mazaki-Tovi; Offer Erez; Nandor Gabor Than; Samuel Edwin; Moshe Mazor; Bo Hyan Yoon; Sonia S Hassan Journal: J Matern Fetal Neonatal Med Date: 2007-10
Authors: Shali Mazaki-Tovi; Edi Vaisbuch; Roberto Romero; Juan Pedro Kusanovic; Tinnakorn Chaiworapongsa; Sun Kwon Kim; Chia-Ling Nhan-Chang; Ricardo Gomez; Bo H Yoon; Lami Yeo; Pooja Mittal; Giovanna Ogge; Juan M Gonzalez; Sonia S Hassan Journal: Am J Reprod Immunol Date: 2010-01-19 Impact factor: 3.886