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This Article Full Text Full Text (PDF) All Versions of this Article: 286/3/F496    most recent 00194.2003v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by Hladunewich, M. A. Articles by Myers, B. D. Search for Related Content PubMed PubMed Citation Articles by Hladunewich, M. A. Articles by Myers, B. D.

The dynamics of glomerular filtration in the puerperium

¹Division of Nephrology, Department of Medicine, and ²Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California 94305; and ³Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139

Submitted 21 May 2003 ; accepted in final form 31 October 2003

We evaluated the glomerular filtration rate (GFR) during the second postpartum week in 22 healthy women who had completed an uncomplicated pregnancy. We used physiological techniques to measure GFR, renal plasma flow, and oncotic pressure and computed a value for the two-kidney ultrafiltration coefficient (K_f). We compared these findings with those in pregnant women previously studied on the first postpartum day as well as nongravid women of reproductive age. Healthy female transplant donors of reproductive age permitted the morphometric analysis of glomeruli and computation of the single-nephron K_f. The aforementioned physiological and morphometric measurements were utilized to estimate transcapillary hydraulic pressure (P) from a mathematical model of glomerular ultrafiltration. We conclude that postpartum day 1 is associated with marked glomerular hyperfiltration (+41%). A theoretical analysis of GFR determinants suggests that depression of glomerular capillary oncotic pressure, the force opposing the formation of filtrate, is the predominant determinant of early elevation of postpartum GFR. A reversal of the gestational hypervolemia and hemodilution, still evident on postpartum day 1, eventuates by postpartum week 2. An elevation of oncotic pressure in the plasma that flows axially along the glomerular capillaries to supernormal levels ensues; however, GFR remains modestly elevated (+20%) above nongravid levels. An analysis of filtration dynamics at this time suggests that a significant increase in P by up to 16%, an 50% increase in K_f, or a combination of smaller increments in both must be invoked to account for the persistent hyperfiltration.

pregnancy; glomerular hemodynamics; ultrafiltration coefficient; transcapillary hydraulic pressure gradient

This article has been cited by other articles:

				M. A. Hladunewich, B. D. Myers, G. C. Derby, K. L. Blouch, M. L. Druzin, W. M. Deen, D. M. Naimark, and R. A. Lafayette Course of preeclamptic glomerular injury after delivery Am J Physiol Renal Physiol, March 1, 2008; 294(3): F614 - F620. [Abstract] [Full Text] [PDF]