ACADEMIC AND RESEARCH PEER-REVIEWED MEDICAL JOURNALISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
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Renal Dysfunction in Pre-eclampsia Patients: Prediction and Differential Diagnosis. Part 1

DOI:10.31550/1727-2378-2020-19-6-23-29
For citation: Bezhenar V.F., Smirnov A.V., Temirbulatov R.R., Gabelova K.A., Shapkaits V.A., Nesterov I.M. Renal Dysfunction in Pre-eclampsia Patients: Prediction and Differential Diagnosis. Part 1. Doctor.Ru. 2020; 19(6): 23–29. (in Russian) DOI: 10.31550/1727-2378-2020-19-6-23-29
23 July 14:49

Study Objective: To assess the prognostic value, sensitivity, and specificity of biomarkers of acute renal injury (ARI) and angiogenic factors in the development of pre-eclampsia (PE), and determine their significance, in the pathogenesis of early and late PE, for differential diagnosis between PE and isolated renal dysfunction.

Study Design: This was a comparative, group, prospective study.

Materials and Methods: One hundred and twenty-two pregnant women, 46 (37.7%) of whom had chronic kidney disease (CKD), were included in phase one of the study. The aim of phase two was to identify a diagnostic criterion for differentiating CKD from PE. PE was diagnosed in 36 out of 122 patients. In phase three another 16 pregnant women with CKD entered the study. Based on the distinguishing diagnostic criterion and the outcomes of pregnancy, the 138 patients were divided into three groups, with 14 women being moved from the comparison group to the main group. Group I (main) consisted of 66 (47.8%) patients who developed hypertensive disorders during pregnancy, 30 (21.7%) of whom were included in subgroup 1 (CKD) and 36 (26.1%) in subgroup 2 (no CKD). Group II (comparison) was made up of 32 patients with CKD who did not have hypertensive disorders. Group III (control) comprised 40 women who had a normal pregnancy and no prior history of reproductive disorders.

All participants underwent clinical and laboratory examinations and had their levels of sFlt-1, PlGF, S-endoglin, cystatin C, KIM-1, podocalyxin, and α1- and β2-microglobulin measured.

Study Results: Analysis of the ROC curve showed that the threshold concentration of sFlt-1 for distinguishing PE from CKD is 7,715 pg/ml (sensitivity 97%, specificity 96%), for PlGF it is 88.15 pg/ml (sensitivity 90%, specificity 100%), and the threshold value for the sFlt-1/PlGF ratio is 150.25 (sensitivity 100%, specificity 100%). The sFlt-1/PlGF ratio is the most sensitive and specific marker with the highest accuracy (94%) and prognostic value in the case of a negative result (95.4%).

Conclusion: The sFlt-1/PlGF ratio equal to or greater than 150.25 can be viewed as a distinguishing diagnostic criterion for PE in patients with hypertension and clinically significant proteinuria. The authors suppose that using the distinguishing diagnostic criterion identified in the study and measuring the above-mentioned markers in urine and peripheral blood may be effective both in diagnosing existing PE and in predicting this condition.

Contributions: Dr. V.F. Bezhenar and Dr. A.V. Smirnov designed the study and approved the final version of the manuscript submitted for publication. Dr. R.R. Temirbulatov and Dr. K.A. Gabelova collected clinical material, followed up patients during pregnancy, and did statistical analysis of study data. Dr. V.A. Shapkaits and Dr. I.M. Nesterov collected clinical material and described the study groups.

Conflict of interest: The authors declare that they do not have any conflict of interests.

 

V.F. Bezhenar (Corresponding author) — Academician I.P. Pavlov First St. Petersburg State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Federation Ministry of Health; 6-8 Lev Tolstoy St., St. Petersburg, Russian Federation 197022. E-mail: bez-vitaly@yandex.ru

A.V. Smirnov — Academician I.P. Pavlov First St. Petersburg State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Federation Ministry of Health; 6-8 Lev Tolstoy St., St. Petersburg, Russian Federation 197022. E-mail: smirnov@nephrolog.ru

R.R. Temirbulatov — Academician I.P. Pavlov First St. Petersburg State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Federation Ministry of Health; 6-8 Lev Tolstoy St., St. Petersburg, Russian Federation 197022. E-mail: rinattmr@gmail.com

K.A. Gabelova — Academician I.P. Pavlov First St. Petersburg State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Federation Ministry of Health; 6-8 Lev Tolstoy St., St. Petersburg, Russian Federation 197022. E-mail: kgabelova@mail.ru

V.A. Shapkaits — Academician I.P. Pavlov First St. Petersburg State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Federation Ministry of Health; 6-8 Lev Tolstoy St., St. Petersburg, Russian Federation 197022. Maternity Hospital No. 16 (a Government-funded Healthcare Institution of St. Petersburg); 54A Malaya Balkanskaya St., St. Petersburg, Russian Federation 192283. E-mail: shapkaitz@mail.ru

I.M. Nesterov — Academician I.P. Pavlov First St. Petersburg State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Federation Ministry of Health; 6-8 Lev Tolstoy St., St. Petersburg, Russian Federation 197022. E-mail: ignester@yandex.ru

Доктор.ру

Part 2 of this article will be published in Doctor.Ru Gynecology. 2020, V. 19, No. 8. 

Table 1
Clinical characteristics of women examined in the study

t1_1-1.jpgt1_1-2.jpg 
Fig. 1. ROC curve: angiogenic factors (2nd trimester of pregnancy)

r1_1.jpg 

Fig. 2. ROC curve: markers of acute renal injury (2nd trimester of pregnancy)

r1_2.jpg 

Table 2

Concentrations of predictive biomarkers of pre-eclampsia: Logistic regression analysis

t1_2.jpg 

Received: 16.03.2020

Accepted: 04.06.2020


23 July 14:49
LITERATURE
  1. Ailamazyan E.K., Mozgovaya E.V. Pre-eclampsia: theory and practice M.: MEDpress-Inform; 2008. 272 p. (in Russian)
  2. Medvedev B.I., Syundyukova E.G., Sashenkov S.L. Ways to prevent pre-eclampsia. Modern problems of science and education. 2017; 2. (in Russian)
  3. Serov V.N., Sukhikh G.T., eds. Obstetrics and gynecology: clinical guidelines. M.: GEOTAR-Media; 2015. 1024 p. (in Russian). URL: http://www.science-education.ru/ ru/article/view?id=26296 (accessed March 8, 2020).
  4. Proletov Ya.Yu., Saganova E.S., Smirnov A.V. Biomarkers in the diagnosis of acute renal injury. Paper I. Nephrology; 2014; 18(4): 25–35. (in Russian)
  5. Temirbulatov R.R., Bezhenar V.F., Smirnov A.V. Differential diagnosis of pre-eclampsia in patients with chronic kidney disease. Nephrology. 2019; 23(1): 45–50. (in Russian)
  6. Sidorova I.S. Solved and unsolved problems of pre-eclampsia in Russia. Russian Bulletin of Obstetrician-Gynecologist. 2015; 15(2): 4–9. (in Russian) DOI: 10.17116/rosakush20151524-9
  7. Adamyan L.V., Artymuk N.V., Bashmakova N.V., Belokrinitskaya T.E., Belomestnov S.R., Brotishchev I.V. et al. Hypertensive disorders during pregnancy, labor, and postpartum. Pre-eclampsia. Eclampsia. Clinical guidelines (a treatment protocol). M.; 2016. 72 p. (in Russian)
  8. Gunnarsson R., Åkerström B., Hansson S.R., Gram M. Recombinant alpha-1-microglobulin: a potential treatment for preeclampsia. Drug Discov. Today. 2017; 22(4): 736–43. DOI: 10.1016/j.drudis.2016.12.005

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