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[Predictors of renal dysfunction and its correction in women with preeclampsia and alimentary obesity]
Insights
Alimentary obesity and preeclampsia often cause kidney dysfunction. Differentiated therapy improved renal function in 81.2% of women, compared to 54.8% with usual intensive therapy.
Area of Science:
- Obstetrics and Gynecology
- Nephrology
- Critical Care Medicine
Context:
- Alimentary obesity (AO) is a significant risk factor for preeclampsia (PE).
- Diagnosing renal dysfunction in PE patients with AO presents challenges.
- Early identification of kidney issues is crucial for managing PE.
Purpose:
- To enable early detection of renal dysfunction in pregnant women with PE and AO.
- To establish principles for pathogenetic therapy in these patients.
- To compare the effectiveness of standard intensive therapy versus differentiated therapy for renal function.
Summary:
- A randomized controlled study involved 63 pregnant women with moderate PE and AO.
- One group received standard intensive therapy (IT), while the other received differentiated therapy targeting renal function improvement.
- Differentiated therapy, incorporating solute free water clearance and colloid oncotic pressure monitoring, showed superior results.
Impact:
- Baseline renal dysfunction was present in 87.3% of women with PE and AO.
- Differentiated therapy corrected renal dysfunction in 81.2% of patients, versus 54.8% with standard IT.
- The Rehberg-Tareev method proved effective for GFR determination, while Cockcroft-Gault and 6-v MDRD were less suitable.
Unlabelled:
Alimentary obesity (AO) is considered as an independent risk factor for preeclampsia (PE). Diagnosis of renal dysfunction in the development of PE is difficult.
Objective:
Early detection of renal dysfunction in women with PE and AO and substantiation of principles of pathogenetic therapy.
Design:
A randomized controlled study of 63 pregnant women.
Patients And Methods:
Average age--27.4 ± 1.6 years. First group--31 women with PE of moderate severity and AO who received usual intensive therapy (IT). Second group--32 women with PE of moderate severity and AO who received differentiated therapy for improvement of renal function. During the IT we accounted solute free water clearance (FWC) and colloid oncotic pressure (COP). If FWC was less than 0.45 ml /min, and the COP--less than 18 mm Hg, we started 6% HES administering 130/4 (6.5 ml/kg/day with a rate of 350 ml/h). After that we administered magnesium sulfate (0.75 ml/kg/day, with a rate of 2.8 ml/hr). We evaluated osmotic renal function and tubular function according to β2- microglobulin concentration of urine, glomerular filtration rate (GFR ) according to Rehberg Tareev method and Cockroft-Gault formula and the Modification of Diet in Renal Disease Study (6-v MDRD).
Results:
Baseline renal dysfunction was observed in 87.3% of women with PE and AO. Determination of GFR is effective according to Rehberg-Tareev. Cockroft-Gault formula and 6-v MDRD unsuitable in case of PE and AO. Common IT corrected renal dysfunction in 54.8% of women and differentiated IT in 81.2% of women with PE and AO. Intensive therapy did not lead to the recovery of kidney function in 45.2% in the first group and 18.8% in the second group.
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