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Angiogenic Factors and Renal Disease in Pregnancy

机译：妊娠中的血管生成因子和肾脏疾病

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Background. Preeclampsia is difficult to diagnose in patients with underlying renal disease and proteinuria. Prior studies show that there is an angiogenic factor imbalance with elevated levels of antiangiogenic proteins soluble fms-like tyrosine kinase 1 (sFlt1) and soluble endoglin (sEng) and reduced levels of the proangiogenic protein, placental growth factor (PlGF) in women with preeclampsia. These angiogenic biomarkers may be useful in distinguishing preeclampsia from other conditions of pregnancy, which may present with overlapping clinical characteristics.Cases. Case 1: A multiparous woman at 18 weeks gestation with nephrotic syndrome presented with hypertensive emergency and worsening renal insufficiency. She underwent induction of labor for severe preeclampsia. Her sFlt1 and sEng levels were at the 97 percentile while her PlGF level was undetectable (less than the 1st percentile). Case 2: A nulliparous woman with lupus nephritis at 22 weeks gestation presented with fetal demise and heart failure. Three weeks previously, the patient had developed thrombocytopenia and hypertensive urgency. She underwent dilation and evacuation. Her angiogenic profile was consistent with severe preeclampsia.Conclusion. Angiogenic factors may provide evidence to support a diagnosis of preeclampsia in patients with preexisting renal disease and proteinuria, conditions in which the classical definition of hypertension and proteinuria cannot be used.
机译：背景。患有先天性肾脏疾病和蛋白尿的患者难以诊断先兆子痫。先前的研究表明，先兆子痫妇女的抗血管生成蛋白，可溶性fms样酪氨酸激酶1（sFlt1）和可溶性内皮糖蛋白（sEng）水平升高，血管生成蛋白，胎盘生长因子（PlGF）水平降低，从而导致血管生成因子失衡。 。这些血管生成生物标志物可能有助于将先兆子痫与其他妊娠状况区分开，其他状况可能具有重叠的临床特征。病例1：妊娠18周时，多胎妇女肾病综合征，伴有高血压急症，肾功能不全加重。她因严重先兆子痫而引产。她的sFlt1和sEng水平为97％，而其PlGF水平却无法检测到（小于1％）。病例2：妊娠22周时患有狼疮肾炎的未产妇，伴有胎儿死亡和心力衰竭。三周前，患者出现了血小板减少症和高血压急症。她经历了扩张和疏散。她的血管生成特征与严重子痫前期一致。血管生成因子可能为支持患有既往肾脏疾病和蛋白尿的患者先兆子痫的诊断提供证据，而在这些情况下，高血压和蛋白尿的经典定义无法使用。

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