Lei Han1, Zhiling Yang1, Kailong Li2, Jiaqun Zou3, Hongmei Li1, Jian Han1, Lijuan Zhou1, Xiaojie Liu1, Xin Zhang1, Yingru Zheng1, Lili Yu1, Li Li1. 1. Department of Obstetrics and Gynecology, Research Institute of Surgery, Daping Hospital, Third Military Medical University Chongqing 400042, P. R. China. 2. Department of Nephrology, Research Institute of Surgery, Daping Hospital, Third Military Medical University Chongqing 400042, P. R. China. 3. Department of General Surgery, Research Institute of Surgery, Daping Hospital, Third Military Medical University Chongqing 400042, P. R. China.
Abstract
BACKGROUND: Preeclampsia (PE) and eclampsia remain leading causes of maternal and fetal mortality worldwide. The kidney is considered the first and most severely affected organ in women with PE/eclampsia. In this study, we analyzed new morphologic features of kidney biopsies and clinical findings in patients with PE or eclampsia at our hospital. METHODS: Eight patients with PE/eclampsia underwent renal biopsies during the antepartum (3/8) or postpartum (5/8) period. Maternal clinical findings, major serological indices, neonatal outcomes, and renal histopathologic and immunofluorescent characteristics were reviewed for each case. RESULTS: Most patients had abnormal serum cholesterol (8/8), triglyceride (6/8), albumin (7/8), and uric acid (5/8). The ratio of blood urea nitrogen (BUN) to serum creatinine (SCr) was elevated in all patients. Five of eight newborns survived. Various degrees of morphologic change were present in the renal glomeruli, and were associated with proteinuria. All patients had deposition of complement factor 4 (C4) in the renal glomeruli and seven had deposition of immunoglobulin M (IgM). CONCLUSION: Endotheliosis, vacuolation of podocytes, proliferation of mesangial cells, and protein casts in the tubule lumens were found in the kidneys of women with PE/eclampsia. Immune depositions of C4 and IgM are major contributors to renal lesions in preeclamptic patients, whose neonates can generally survive. Eclampsia can occur without increased blood pressure.
BACKGROUND: Preeclampsia (PE) and eclampsia remain leading causes of maternal and fetal mortality worldwide. The kidney is considered the first and most severely affected organ in women with PE/eclampsia. In this study, we analyzed new morphologic features of kidney biopsies and clinical findings in patients with PE or eclampsia at our hospital. METHODS: Eight patients with PE/eclampsia underwent renal biopsies during the antepartum (3/8) or postpartum (5/8) period. Maternal clinical findings, major serological indices, neonatal outcomes, and renal histopathologic and immunofluorescent characteristics were reviewed for each case. RESULTS: Most patients had abnormal serum cholesterol (8/8), triglyceride (6/8), albumin (7/8), and uric acid (5/8). The ratio of blood ureanitrogen (BUN) to serum creatinine (SCr) was elevated in all patients. Five of eight newborns survived. Various degrees of morphologic change were present in the renal glomeruli, and were associated with proteinuria. All patients had deposition of complement factor 4 (C4) in the renal glomeruli and seven had deposition of immunoglobulin M (IgM). CONCLUSION: Endotheliosis, vacuolation of podocytes, proliferation of mesangial cells, and protein casts in the tubule lumens were found in the kidneys of women with PE/eclampsia. Immune depositions of C4 and IgM are major contributors to renal lesions in preeclamptic patients, whose neonates can generally survive. Eclampsia can occur without increased blood pressure.
Authors: Anne Cathrine Staff; Samantha J Benton; Peter von Dadelszen; James M Roberts; Robert N Taylor; Robert W Powers; D Stephen Charnock-Jones; Christopher W G Redman Journal: Hypertension Date: 2013-03-04 Impact factor: 10.190
Authors: Meredith A Brisco; Steven G Coca; Jennifer Chen; Anjali Tiku Owens; Brian D McCauley; Stephen E Kimmel; Jeffrey M Testani Journal: Circ Heart Fail Date: 2013-01-16 Impact factor: 8.790