Tuesday, June 15, 2010
Renal outcomes after preeclampsia
Recently, I had to look up this topic after one of my patients posed this question. In the largest study that I could find on this topic (Vikse et al, NEJM, Aug 2008), outcomes data on 570,433 women from national registries of Norway were reviewed. The relative risk of ESRD among women with history of preeclampsia was 3.2 to 6.7 compared to women without history of preeclampsia, with risk being higher in women who had preeclampsia in more than one pregnancy or if preeclampsia resulted in low birth weight or preterm infant. This translates into an absolute risk of less than 1% after a mean time of 17 years after first pregnancy. The main limitation of this study is that it is based on administrative database and is not a prospective study. There is a systematic review and metanalysis on this topic in the current issue of AJKD (McDonald et al, AJKD, June 2010). In this review, data from 7 cohort studies involving 273 patients with preeclampsia and 333 patients with uncomplicated pregnancies were analyzed. It was found that, after a mean of 7.1 years postpartum, 31% of women with history of preeclampsia had microalbuminuria compared to 7% of controls.