Urinary congophilia in women with pre-eclampsia and chronic kidney disease

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• 作者：Dr Fergus McCarthy ; PhD^a ; ^{fergus.mccarthy@kcl.ac.uk" class="auth_mail" title="E-mail the corresponding author} ; Adedamola Adetoba ; BSc^a ; Carolyn Gill ; PhD^a ; Kate Bramham ; PhD^a ; Maria Bertolaccini ; PhD^a ; Prof Guillermina Girardi ; PhD^a ; Prof Lucilla Poston ; PhD^a ; Prof Lucy Chappell ; PhD^a
• 刊名：The Lancet
• 出版年：2016
• 出版时间：25 February 2016
• 年：2016
• 卷：387
• 期：supp_S1
• 页码：S72
• 全文大小：58 K

文摘

Pre-eclampsia remains a major cause of fetal and maternal morbidity. Researchers have reported that urinary congophilia could be a useful test in the diagnosis and prediction of the disorder. Congophilia is thought to indicate the presence of amyloid protein, an aggregate of misfolded proteins implicated through placental endoplasmic reticulum stress in pre-eclampsia. We aimed to determine whether congophilia is a specific diagnostic test for pre-eclampsia and superimposed pre-eclampsia.

Methods

We analysed samples from women with pre-eclampsia (n=23), gestational hypertension (10), chronic kidney disease (28), chronic hypertension (14), chronic kidney disease with superimposed pre-eclampsia (5), chronic hypertension with superimposed pre-eclampsia (12), and healthy pregnant controls (31). Samples from healthy non-pregnant controls (n=10) and non-pregnant women with systemic lupus erythematosus either with (25) or without lupus nephritis (14) were analysed. Urinary congophilia was quantified by measurement of congo red retention (CRR) and compared between groups.

Findings

A significant increase in congophilia was detected in urine from women with pre-eclampsia (median CRR 47%, IQR 22–68) compared with healthy pregnant controls (16, 13–21; p=0·002), women with gestational hypertension (20, 13–27; p=0·008), or women with chronic hypertension (17, 12–28; p=0·01). Congophilia was also present in pregnant women with chronic kidney disease and was not significantly different from those with pre-eclampsia or women with chronic kidney disease and superimposed pre-eclampsia. Non-pregnant women with lupus nephritis had significantly higher congophilia retention than did non-pregnant controls (38%, 17–73 vs 9, 7–11; p<0·0001) and non-pregnant women with systemic lupus erythematosus but no lupus nephritis (13, 11–17; p=0·001).

Interpretation

This study confirms the presence of urinary congophilia, as assessed by CRR, in women with pre-eclampsia but demonstrates that it is similarly present in other conditions associated with renal impairment in pregnant and non-pregnant women.

Funding

This work was supported by funding from Tommy's Charity UK, an Academy of Medical Sciences UK Starter Grant for Clinical Lecturers, and the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London. FPM is funded by a NIHR Clinical Academic Fellowship.