8 Contribution of podocyturia and kidney biomarkers to the evaluation of renal disorders in pregnant women with kidney graft: Preliminary results: Biomarkers, prediction of preeclampsia

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• 作者：Jussara Leiko Sato ; Thais Alquezar Facca ; LucianA Zicardi Nicastro ; Amelia Rodrigues Pereira ; Sonia Nishida ; Larissa Fatima Santos ; Marina Cristelli ; Gianna Mastroianni Kirsztajn ; Nelson Sass
• 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：181-182
• 全文大小：47 K

文摘

End stage renal disease usually disrupts normal gonadal function and leads to infertility. After successful renal transplantation, fertility improves within months and pregnancy occurs in approximately 12% of childbearing age women. Progressive proteinuria and glomerulosclerosis characterize chronic allograft nephropathy. Injury of parietal epithelial cells in glomeruli, the podocytes, is the initiating cause of many renal diseases, leading to proteinuria with possible progression to glomerulosclerosis. Podocytes must completely cover the filtration surface area with foot processes to maintain the glomerular filtration barrier. Failure to achieve this task due to reduced podocyte number, size, or function, or increased glomerular volume (quantitated by “podometric” methodology), 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. As during gestation there is a physiological increase in the glomerular filtration rate and reduction of serum creatinine, even mild elevations of the later can indicate renal function deficit.

Objective

To evaluate podocyturia and other renal parameters as functional markers in pregnant women.

Methods

50 pregnant women with kidney grafts had their urine samples evaluated by indirect immunofluorescence for detection of podocyturia, as well as for dosages of albuminuria and retinol binding protein (urRBP).

Results

The mean age of the women was 28 years; 17 did not exhibit urinary podocytes and 22 had podocyturia in the 3rd trimester. Serum creatinine levels in the 3rd trimester and post childbirth were both increased compared to the 1st and 2nd trimesters (p < 0.001). Proteinuria levels were higher when compared to other moments (p < 0.001); 25 women had microalbuminuria and 30 macroalbuminuria; 35 had elevated urRBP. 35 pregnant women developed pre-eclampsia and high rate of pre-term delivery (50%).

Conclusion

Levels of urinary podocyte, blood pressure and proteinuria were associated with worsening of kidney function during pregnancy. The proteinuria level in the 3rd trimester was higher when compared to the 1st and 2nd trimesters. There was a significantly greater excretion (P < 0,001) of ur RBP in the 3rd trimester. We observed that urinary podocyte excretion occurs in pregnant women with kidney transplant almost synchronously with higher systolic and diastolic blood pressure and higher mean levels of proteinuria. The detection of podocyturia in these women could be useful for early diagnosis and follow-up of glomerular injury, and eventually of preeclampsia. It may also be associated to its severity or activity, although additional studies are necessary to confirm these aspects.

GRANT FAPESP 20140213-7.