English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Plus monthly

Global: Zendy Tools annual

Global: Zendy Tools monthly

Global: Zendy Free Plan

Claudia Ferrier, Department of Nephrology, Royal Melbourne Hospital, Grattan Street, Parkville, Vic. 3050 (Australia) Dear Sir, Pregnant women with primary renal disease, impaired renal function and hypertension are at higher risk for the development of fetal and maternal complications [1]. However, pregnancy outcome in normotensive women with preserved renal function is less clear. It has been postulated that the vascular changes in the renal biopsy may be useful in predicting pregnancyrelated complications [2]. Preeclampsia and intrauterine growth retardation, two major complications of pregnancy, are associated with an increased resistance index in the uteroplacental circulation [3]. It may be speculated that preexisting renal vascular changes may be related to the increased vascular resistance in uteroplacental circulation during pregnancy. To test this hypothesis, we analysed the relationship between vascular changes in the renal biopsy and uterine artery resistance index in 20 normotensive pregnant women with primary kidney disease and normal renal function. All women had a renal biopsy performed within the 12 months prior to pregnancy. The vascular changes were semiquan-titatively classified as normal, mild, moderate and severe. Each blood vessel was evaluated for the presence or absence of intimal thickening, medial thickening, medial hyalinosis and intimal hyalinosis by an independent investigator. A blood vessel was regarded as normal when none of the above abnormalities was present. Vessel changes were considered mild when 1 out of 4 of the abovementioned abnormalities was present; moderate when 2 out of 4 abnormalities were present and severe when 3 out of 4 abnormalities or severe intimal thickening were present. The score used was 1 for normal, 2 for mild, 3 for moderate und 4 for severe. Uterine artery resistance index was derived from uterine artery waveform obtained by Color Doppler ultrasound between 19 and 24 weeks’ gestation [3]. The resistance index was calculated on the placen-tal side of the uterus from the peak systolic (A) and late diastolic (B) flow velocities and expressed as (A-B)⁄A [4]. Of the women studied, 2 had normal renal vessels (10%), 11 had mild changes (55%), 5 had moderate changes (25%) and 2 severe changes (10%). Among the 13 women who had no or mild renal vascular changes only 1 developed preeclampsia (7%), while 5 out of 7 (71%) with moderate or severe vascular changes developed preeclampsia and/or intrauterine growth retardation (p < 0.05; by χ2 test). The semiquantitatively classified renal vascular changes correlated with the uterine artery resistance index obtained from the placental side of the uterus (r=0.54; p < 0.05; by Spearman’s correlation) (fig. 1).

Renal Vascular Changes and Uterine Artery Resistance in Pregnant Women with Renal Disease