[Long-term outcome of renal function in women with preeclampia and pregestational diabetes]

Pre-eclampsia (PE) is an important cause of acute renal failure and an important risk marker for subsequent chronic kidney disease. In normal pregnancy, there are marked changes in the renin-angiotensin system (RAS) including considerably elevated angiotensin II (ang II) levels. However, vascular resistance decreases markedly during normal pregnancy, suggesting that pregnant individuals are less sensitive to ang II than non-pregnant individuals. In contrast, during PE decreased circulating components of the RAS with enhanced sensitivity of ang II infusion have been reported. Patients with a history of PE have an increased risk of microalbuminuria with a prevalence similar to subjects with type 1 diabetes mellitus. Women with gestational or chronic hypertension were at a high risk of end-stage renal disease (ESRD) vs. normotensive ones, but the risk is much greater for women who had PE or eclampsia than those who had gestational hypertension only. A previous episode of PE should suggest long-term follow-up, especially with respect to hypertension and microalbuminuria within 6-8 weeks of delivery, and should require a nephrological consult if these disorders do not resolve. Pregestational diabetes was also associated with long-term increased risk of ESRD and death. Lastly, women who have PE and give birth to offspring with low birth weight and short gestation have a substantially increased risk for having a later kidney biopsy. For all these reasons, short and long-term evaluation of kidney function should be suggested in women with previous complicated pregnancy.