الفهرس 
Hypertensive Disorders in Pregnancy (HDPs)Only 14 pages are availabe for public view
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Abstract
SUMMARY AND CONCLUSION
P
reeclampsia is a multisystem disorder that has substantial adverse effects for pregnant women and their fetuses, and it is a major cause of maternal morbidity and mortality worldwide, that complicates 4.6 % of pregnancies globally and can reach up to 10 % of pregnancies in the developing world, mainly due to the lack of health care facilities.
Preeclampsia affects kidney function during pregnancy causing pregnancy-related (AKI) in approximately 2% of women with severe preeclampsia and also increases the risk of future chronic kidney disease (CKD) and cardiovascular disease.
Proteinuria after preeclampsia significantly resolves within three months after delivery. However in some cases, up to 14 % will have persistent proteinuria twelve weeks after delivery, which requires prompt close follow-up and appropriate referral, for underlying renal disease.
Because of the health hazards of persistent proteinuria after preeclampsia, its prediction and detection is an important step in the follow-up of kidney functions in women with preeclampsia especially after 3 months of delivery as it is the time for early diagnosis of CKD according to KIDIGO, 2012.
Despite the importance of follow-up of kidney functions after preeclampsia the actual postpartum follow-up rates are poor, so there is a need for reliable, simple markers that can predict the effect of severe preeclampsia / HELLP syndrome and future kidney disease.
Our study was conducted at Ain Shams University maternity hospital thorough the period between April 2019 and January 2021 to assess the prognostic value of HE4 for persistent proteinuria in women with serve preeclampsia and/or HELLP syndrome.
Out of 167 women assessed for eligibility for participation in the study, 17 women did not meet the inclusion criteria, 40 women declined to participate in the study, and 23 women were lost to follow up leaving only 87 women who completed the study.
All participants’ women are followed up till improvement or discharge from the hospital and there was no statistically significant difference in the level of laboratory from day 1 to day 3 except statistically significant increase in the serum creatinine at day 3 than day 1 and 2 and also statistically significant decrease in eGFR and serum uric acid in day 3 than day 1 and 2.
Regarding the measured outcomes, the median (IQR) eGFR by (CKD-EPI) equation (ml/min/1.73m2) after 3 months of delivery was 116.64 (99.25 − 120.81) ml/min/1.73m2 (range: 64.75 – 140.76). Based on KIDIGO (2012) clinical practice guidelines, eGFR is classified as: 76 women (87.3%) category 1, and 11 women (12.6 %) category 2.
Based on KIDIGO (2012) clinical practice guidelines, protein: creatinine ratio (PCR) categorized as category A1 (16 women = 18.3%), category A2 (53 women =60.9 %), and category A3 (18 women =20.6%).
Regarding the measured outcomes after 3 months of delivery, there were 19 women with persistent proteinuria, while there were 68 women without persistent proteinuria.
The outcome of persistent proteinuria after 3 months of delivery was affected significantly by HE4 biomarker (picomol/l), the median (IQR) HE4 (picomol/l) in the study group with persistent proteinuria was 139 (122 – 152), (range 65 – 186 picomol/l), height (the mean height (cm) in the study group with persistent proteinuria is 161.26 ± 4.19 cm), BMI (the mean BMI in the study group with persistent proteinuria is 81.21 ± 11.39 kg/m2), and dipstick albuminuria +++ at admission.
After adjustment for age, BMI, height, dipstick albuminuria+++ at admission day, 3 months postpartum SBP>120 mmHge, 12 weeks postpartum DBP>85 mmHge, 12 weeks postpartum serum creatinine >0.7 mg/dl, 12 weeks postpartum eGFR by MDRD ≤ 96.7 (mL/min/1.73m2), and 12 weeks postpartum serum uric acid >4.6 mg/dl, revealed that HE4 was the most significant predictor with 71 folds increased risk of the occurrence of persistent proteinuria after 3 months of delivery.
Regarding the complications of severe preeclampsia such as; decreased urine output rate (UOP), intrauterine fetal death (IUFD),visual disturbance, severe headache, right upper quadrant or epigastric pain, platelets less than 100000/microL, and ICU admission, they were not significantly different between the group with persistent proteinuria and the group without persistent proteinuria.
In conclusion, assessment of the serum level of human epididymis protein 4 (HE4) at admission of women with severe preeclampsia/HELLP syndrome has a good prognostic value for the persistence of proteinuria after 3 months of delivery, that help in early detection of women who are at high risk of developing chronic kidney diseases.