Submitted on October 9, 2007
Accepted on January 6, 2008
Course of Pre-Eclamptic Glomerular Injury Following Delivery
Michelle A. Hladunewich1*, Bryan D. Myers2, Geraldine C. Derby2, Kristina L. Blouch2, Maurice L. Druzin3, William M. Deen4, David M Naimark1, and Richard A Lafayette2
1 Medicine/Nephrology, University of Toronto, Toronto, Canada
2 Medicine/Nephrology, Stanford University, Stanford, California, United States
3 Obstetrics and Gynecology, Stanford University, Stanford, California, United States
4 Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States
* To whom correspondence should be addressed. E-mail: michelle.hladunewich{at}sunnybrook.ca.
We evaluated the early postpartum recovery of the glomerular function over 4 weeks in 57 women with pre-eclampsia. We used physiologic techniques to measure glomerular filtration rate (GFR), renal plasma flow and oncotic pressure (
A), and computed a value for the 2-kidney ultrafiltration coefficient (Kf ). Compared to healthy, postpartum controls, GFR was depressed by 40% on postpartum Day 1, but by only 19% and 8% in the second and fourth postpartum weeks, respectively. Hypofiltration was attributable solely to depression, at corresponding postpartum times, of Kf by 55, 30 and 18%, respectively. Improvement in the glomerular filtration capacity was accompanied by recovery of hypertension to near-normal levels and significant improvement in albuminuria. We conclude that the functional manifestations of the glomerular endothelial injury of pre-eclampsia largely resolve within the first postpartum month.
