Preeclampsia Raises Risk of Serious Kidney Disease
WEDNESDAY Aug. 20, 2008 -- Women who've experienced the pregnancy complication known as preeclampsia face a much greater risk of end-stage renal disease, new research suggests.
In fact, says the report in the Aug. 21 issue of the New England Journal of Medicine, the rate of end-stage renal disease (ESRD) was between 3.2 and 15.5 times greater for women who had preeclampsia in pregnancy.
"If you have had preeclampsia, you should be aware that you are at increased risk for renal and cardiovascular disease, and you should try to reduce that risk," said study author Dr. Bjorn Vikse, a researcher at the University of Bergen in Norway.
Preeclampsia is a complication of pregnancy characterized by high blood pressure, protein in the urine, and swelling, as well as more serious problems, according to the National Institutes of Health. Symptoms resolve when the baby is born.
"Historically, the thought was that after delivery, everything was fine. But preeclampsia isn't benign, and it may initiate a cascade of damage that takes years to develop into clinically relevant renal disease," said Dr. Robert Provenzano, chief of nephrology at St. John Hospital and Medical Center in Detroit.
"The take-home message from this study is that any young woman who has had any variant of preeclampsia and eclampsia needs to be monitored for ongoing or recurrent kidney disease, high blood pressure and diabetes," Provenzano said.
The current study looked at data from the Norwegian Medical Birth Registry, which has information on all births in Norway since 1967. This study included 570,433 women who gave birth between 1967 and 1991, and data from up to three pregnancies was included.
End-stage renal disease developed in 477 women, an average of 17 years after delivery.
In women who'd been pregnant one or more times, those who experienced preeclampsia during the first pregnancy had a 4.7 times greater risk of developing ESRD. For women who'd been pregnant two or more times, preeclampsia during the first pregnancy resulted in a 3.2 times higher risk of ESRD. Women who'd been pregnant three or more times, and who'd had preeclampsia during two or three of those pregnancies had the highest risk -- 15.5 times that of women who'd never had preeclampsia.
Additionally, the study found that when the baby was born early or had a low birth weight, the mother was more likely to develop ESRD later in life.
Vikse said the increased risk of ESRD may be a result of damage that occurs during a pregnancy with preeclampsia, or it may be that risk factors for both, such as increased body-mass index and elevated blood pressure, may have already been present before the pregnancy and contributed to the preeclampsia and later kidney disease.
The one bright spot in the study was that the overall risk of ESRD is quite low. In an accompanying editorial, authors from Massachusetts General Hospital wrote, "Indeed, the likelihood that chronic renal failure did not develop, even among women with three previous episodes of preeclampsia, was greater than 99 percent."
But that doesn't mean you should just forget that you've had preeclampsia, advised Provenzano. "It's critical that doctors and patients understand that there is now a linkage between preeclampsia and ESRD. For women who've had preeclampsia, this is a reason to increase your sensitivity to healthy living and not add to your risk. Keep your weight down, avoid smoking, and avoid drinking too much. Also, check for diabetes and blood pressure at least once a year," he recommended.
Posted: August 2008
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