13 The renin-angiotensin-aldosterone system and superimposed pre-eclampsia in women with chronic kidney disease and chronic hypertension: Chronic hypertension

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• 作者：Daniele Cristovao Escouto^a ; Lesia Kurlak^b ; Carolyn Gill^c ; Hiten Mistren^b ; Lucy Chappel^c ; Kate Bramham^c
• 刊名：Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：6
• 期：3
• 页码：143
• 全文大小：38 K

文摘

Systemic renin–angiotensin–aldosterone system (RAAS) activity is augmented in non-pregnant women with chronic kidney disease (CKD) and chronic hypertension (CHT), but its activity in pregnancy and superimposed pre-eclampsia is poorly understood.

Objectives

(i) To compare longitudinal changes in plasma renin and angiotensinogen concentrations in pregnant women with CKD and CHT with healthy controls.

(ii) To compare differences in plasma renin and angiotensinogen concentrations in pregnant women with CKD and CHT with and without superimposed pre-eclampsia and women with pre-eclampsia without pre-existing disease.

Methods

Plasma renin activity and angiotensinogen were quantified in samples from women with CKD or CHT, women with pre-eclampsia without pre-existing disease and healthy controls recruited to a longitudinal prospective cohort study at two London Academic Health Centers. Demographics and pregnancy outcomes were extracted from patient records. RAAS component concentrations were compared across gestational ages using repeated measures analysis.

Results

One hundred and ninety-five women were recruited (CKD = 80; Primary CHT = 31; Pre-eclampsia without pre-existing disease = 19; Healthy controls = 65). Eighteen women with CKD (22.5%) and 10 women (32.3%) with primary CHT developed superimposed pre-eclampsia. Plasma renin activity was lower in women with CKD or CHT with compared to healthy controls at all gestational time points (p < 0.006). Women with CKD or CHT who later developed superimposed pre-eclampsia tended to have lower plasma renin activity adjusted for gestation age at sampling than women with CKD or CHT without superimposed pre-eclampsia. There were no differences in plasma angiotensinogen between groups. Women with superimposed pre-eclampsia had lower plasma renin activity compared to women with CKD or CHT without superimposed pre-eclampsia (p 0.003) or healthy controls (p < 0.001) with no differences in plasma angiotensinogen concentrations. There were no differences in plasma renin or angiotensinogen concentrations between women with superimposed pre-eclampsia and those with pre-eclampsia without pre-existing disease.

Conclusion

Women with CKD or CHT have suppressed plasma renin activity during pregnancy compared with healthy controls. After diagnosis of superimposed pre-eclampsia women with CKD or CHT have lower plasma renin than women without superimposed pre-eclampsia, but there are no differences between women with pre-eclampsia and superimposed pre-eclampsia, suggestive of a common pathophysiological pathway.