Urinary abnormalities and renal function in pregnant women with chronic hypertension

Silva Junior, Guilherme Santos da; Moreira, Silvia Regina; Nishida, Sonia K.; Sass, Nelson; Kirsztajn, Gianna Mastroianni

doi:10.5935/0101-2800.20160028

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Brazilian Journal of Nephrology

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Sumário

Original Article, Chronic Kidney Disease • J. Bras. Nefrol. 38 (02) • Apr-Jun 2016 • https://doi.org/10.5935/0101-2800.20160028 copy

Urinary abnormalities and renal function in pregnant women with chronic hypertension

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Renal involvement in pregnant women with chronic hypertension is not widely known.

Objectives:

1- To describe the epidemiological profile of pregnant women with chronic hypertension; 2- To evaluate urinary abnormalities (by urinalysis), renal function (serum creatinine and cystatin C, and estimated glomerular filtration rate (eGFR); 3- To evaluate the pregnancy outcome in chronic hypertension.

Methods:

103 pregnant women with chronic hypertension (blood pressure over 140/90 mmHg, detected previously to pregnancy or until the 20th week) were submitted to clinical and laboratorial evaluation.

Results:

Pregnant women were 21-45 (mean: 34) years-old. Protein/creatinine ratio in random urine was elevated in 5.2% (0.0-6.4g/g), serum creatinine in 19.6% and cystatin C in 14.7% of them. It was observed that characteristics of pregnant patients and their newborns (vs. frequencies of the cases with CKD-EPI cystatin C < 60 ml/min/1.73 m²⁾ were: 20.5% (33.3%) of preterm birth < 37 weeks, 17.5% (22.2%) of birth weight < 2500g and 17.5% (22.2%) of small for gestational age; superimposed preeclampsia-eclampsia occurred in 24.7% (22.2%) of the cases.

Conclusions:

Renal abnormalities were detected by proteinuria, determinations of serum creatinine and cystatin C in 5.2, 19.6 and 14.7% of the cases. The results suggest that the formulas CKD-EPI and MDRD can have applicability in assessing renal function in pregnant women. It was also shown a high frequency of preterm birth or with < 2500g at birth or small for gestational age, as well as of superimposed preeclampsia-eclampsia (24.7%) in pregnant women with chronic hypertension.

Keywords:
creatinine; cystatin C; glomerular filtration rate; high-risk; hypertension; pregnancy; proteinuria

Characteristics		Values
Diagnosed with high BP during current gestation		14.9%
Time since diagnosed with high BP (years)	≤ 5a	60.4%
	> 5a and ≤ 10a	23.7%
	> 10a	15.9%
	total	100.0%
Prior nephropathy		78%
Drug therapy for high BP before gestation		79.6%
Number of antihypertensive drugs taken before pregnancy^* * Four cases were not able to provide information;	one	66.6%
	two	29.5%
	Three or more	3.9%
	total	100.0%
Pre-gestational BMI (kg/m²^* * Four cases were not able to provide information;	< 25	24.2%
	25 to 29.9	29.3%
	> or = 30	46.5%
	total	100%
Family history of hypertension n/n total (%)		97/100 (97%)
Family history of preeclampsia-eclampsia n/n total (%)		7/97 (72%)
Systolic BP ≥ 140 mmHg^ Checked once in only one appointment.		24.3%
Diastolic BP ≥ 90 mmHg^* * Four cases were not able to provide information;		28.2%

		Chronic Hypertension		Controls		p
Serum creatinine	normal	82	80.4%	22	100.0%	0.023^b b Fisher's exact test or extension.
	altered	20	19.6%	-	-
	total	102	100%	22	100%
Serum cystatin C	normal	87	85.3%	22	100.0%	0.071^b b Fisher's exact test or extension.
	altered	15	14.7%	-	-
	total	102	100%	22	100%
Urine I: pH	normal	93	95.9%	19	86.4%	0.117^b b Fisher's exact test or extension.
	altered	4	4.1%	3	13.6%
	total	97	100%	22	100%
Density	normal	94	96.9%	20	90.9%	0.230^b b Fisher's exact test or extension.
	altered	3	3.1%	2	9.1%
	total	97	100%	22	100%
Glucose	normal	94	96.9%	22	100.0%	> 0.999^b b Fisher's exact test or extension.
	altered	3	3.1%	-	-
	total	97	100%	22	100%
Leukocytes	normal	38	39.2%	12	54.5%	0.187^a a Pearson's chi-square test,
	altered	59	60.8%	10	45.5%
	total	97	100%	22	100%
Red blood cells	normal	81	83.5%	21	95.5%	0.192^b b Fisher's exact test or extension.
	altered	16	16.5%	1	4.5%
	total	97	100%	22	100%
Erythrocyte dysmorphism	ausente	93	95.9%	22	100.0%	> 0.999^b b Fisher's exact test or extension.
	presente	4	4.1%	-	-
	total	97	100%	22	100%
Urine protein to creatinine ratio	normal	92	94.8%	22	100.0%	0.583^b b Fisher's exact test or extension.
	altered	5	5.2%	-	-
	total	97	100%	22	100%

Characteristics		Values
Type of delivery	normal n (%)	27	32.9%
	Cesarean section	55	67.1%
	Total	82	100.0%
Gestational diabetes	yes n (%)	10	12.0%
	no	73	88.0%
	Total	83	100.0%
Overlapping PIH	yes n (%)	21	24.7%
	no	64	75.3%
	Total	85	100.0%

Characteristics			Values
Gestational age (weeks)	n		83
	mean		37.1
	median		38.0
	minimum-maximum		26.0-41.9
	standard deviation		3.0
Categorization by gestational age	Full-term birth n (%)	66		79.5%
	Preterm birth	17		20.5%
	Total	83		100.0%
Weight (grams)	n		80
	mean		2863.3
	median		2922.5
	minimum-maximum		500.0-4165.0
	standard deviation		696.0
Weight at birth (category1)^* * Data from 80 pregnant individuals.	adequate weight n (%)	34		42.5%
	insufficient weight	32		40%
	low weight	9		11.2%
	very low weight	2		2.5%
	extremely low weight	3		3.8%
Weight at birth (category 2)^* * Data from 80 pregnant individuals.	< 2500g n (%)	14		17.5%
	> or = a 2500g	66		82.5%
Categorization by weight vs. gestational weight^* * Data from 80 pregnant individuals.	SGA n (%)	14		17.5%
	AGA	63		78.8%
	LGA	3		3.7%
	Total	80		100.0%

Ethnicity n (%)	n = 21
Black	1 (4.8)
White	4 (19.0)
Brown	16 (76.2)
Age (years)
Mean and standard deviation	35 ± 4.86
Age > 35 years n (%)	12 (571)
Pre-gestational BMI (kg/m²) n (%)	n = 19
< 25	2 (10.5)
25 to 29.9	8 (42.1)
≥ 30	9 (474)
Nulliparous n (%)	3 (14.2)
Smoking n (%)	2 (10.0)
Time with high BP n (%)	n = 20
≤ 10 years	15 (75.0)
> 10 years	5 (25.0)
History of PIH n (%)	5 (23.8)
Familial PIH n (%)	1 (5.0)
Preterm birth in current pregnancy n (%)	10 (52.6)
Low birth weight (< 2499 g) n (%)	6 (35.2)
SGA in current pregnancy n (%)	4 (23.5)
Serum creatinine > 0.6 mg/dL n (%)	4 (19.0)
Serum cystatin C (> 1.15 mg/L) n (%)	3 (15.0)
High UPC > 0.3 n (%)	2 (10.0)

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[1] Correspondence to: Guilherme Santos da Silva Júnior. Universidade Federal de São Paulo. Rua Botucatu, nº 740, 2.º Andar, Vila Clementino, São Paulo, SP, Brasil. CEP: 04023-900. E-mail: guilhermessjr@bol.com.br