Elsevier

Obstetrics & Gynecology

Volume 96, Issue 6, December 2000, Pages 945-949
Obstetrics & Gynecology

Renal disease in women with severe preeclampsia or gestational proteinuria

https://doi.org/10.1016/S0029-7844(00)01055-3Get rights and content

Abstract

Objective: To identify women with severe preeclampsia or severe gestational proteinuria at high risk of having underlying renal disease.

Methods: Between 1980 and 1999, 86 Japanese women who had severe hypertension, severe proteinuria, or both during pregnancy had postpartum needle biopsies of their kidneys. Diagnoses before biopsies were severe preeclampsia in 74 women and severe gestational proteinuria in 12. We compared clinical characteristics, such as antepartum hematuria and postpartum proteinuria, and maternal and neonatal outcomes with regard to presence of renal disease.

Results: Nineteen of 86 women (22.1%, 95% confidence interval [CI] 13.9%, 32.3%) were diagnosed with underlying renal disease. Immunoglobulin A nephropathy was present in 12. Women with renal disease had a significantly earlier onset of proteinuria than those without (median 11 versus 32 weeks’ gestation, P < .001). Eighteen of 19 women with renal disease had proteinuria, hypertension, or both before 30 weeks’ gestation. Ten of 12 women with severe gestational proteinuria (83.3%, 95% CI 51.6%, 97.9%) had underlying renal disease. Eight of the 19 women had antepartum hematuria, and seven had elevated serum immunoglobulin A levels. In women with severe preeclampsia, onset before 30 weeks’ gestation was the best predictor of underlying renal disease (odds ratio 34.1, 95% CI 3.8, 304.5). Women with renal disease had lower rates of severe hypertension (nine of 19 versus 59 of 67, P < .01) and small-for-gestational-age infants (four of 19 versus 34 of 67, P < .05) than those without renal disease.

Conclusion: Women who had gestational proteinuria or preeclampsia before 30 weeks’ gestation were more likely to have had underlying renal disease.

Section snippets

Materials and methods

Preeclampsia was diagnosed according to the criteria established by the National High Blood Pressure Education Program Working Group.8 Proteinuria was defined as excretion exceeding 300 mg in a 24-hour urine collection, measured by the pyrogallol red method,9 or in some outpatients, a concentration of 30 mg/dL (1+ on dipstick) or more in a random urine specimen that is usually correlative.8 Severe preeclampsia was defined as sustained hypertension exceeding 160 mmHg systolic or 110 mmHg

Results

One woman had transient macrohematuria after biopsy. No others had any complications. Nineteen of 86 women (22.1%, 95% CI 13.9%, 32.3%) had underlying renal disease. Histologic diagnoses of renal diseases were IgA nephropathy (n = 12), non-IgA nephropathy (n = 3), minimal change (n = 2), interstitial nephritis (n = 1), and benign nephrosclerosis (n = 1). Twelve of 19 women (63.2%) with renal disease and 50 of 67 (74.6%) without were nulliparous (statistically not significant). Nine of the 19

Discussion

Our rate of underlying renal disease was 22.1%, a figure compatible with some studies5, 11 but lower than others.3, 6, 7 That discrepancy should not be because of characteristics of our patient population because the rate was lowered to 12.1% after the subjects were restricted to those with severe preeclampsia. Therefore, extremely high rates of underlying renal disease (65.0% in early-onset preeclampsia3 and 71.7%6) seem to appear in a selected population, perhaps relating to the referral

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