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Ren J, Zhao C, Fan Z, Wang Y, Sheng H, Hua S. The interval between the onset of increased blood pressure and proteinuria in preeclampsia and the contributing factors. Arch Gynecol Obstet 2024; 310:757-767. [PMID: 38133812 DOI: 10.1007/s00404-023-07284-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/28/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE New-onset proteinuria, as a pivotal sign of representative renal lesions in preeclampsia, is still the most common diagnostic tool for this condition and has been proven to be related to a significantly abnormal sFlt-1/VEGF ratio in circulation. At the same time, blood pressure control plays a vital role in the occurrence and evolution of proteinuria. Therefore, it is particularly helpful to investigate their interval, not only for performing urinalysis for protein more accurately but also for evaluating blood pressure as well as the aggravation of illness, as the related research is limited. METHODS This retrospective study included 515 preeclampsia patients and 358 normotensive pregnant women who labored in the Second Hospital of Tianjin Medical University from January 2016 to January 2020. First, we described the onset circumstance of high blood pressure and proteinuria as well as the interval among the case group and the subgroups. Then, we determined whether there were significant differences in the basic information, laboratory test results, and newborns between the case and normal groups. Finally, multifactor ANOVA was used to determine the factors influencing the interval. RESULTS 1. The two most common complications in preeclampsia were proteinuria (88.35%) and placental dysfunction (5.05%). Moreover, 72.04% of preeclampsia cases were diagnosed by abnormal blood pressure together with new-onset proteinuria. 2. The average interval between high blood pressure and proteinuria was 22 gestational days (from 0 to 106 days), and this interval was not significantly different between mild and severe PE (26 days vs. 21 days, P > 0.05) but significantly differed between early-onset and late-onset PE (9 days vs. 28 days, P < 0.05). 3. The number of prenatal visits, serum creatinine in the early trimester, gestational time and diastolic blood pressure value when increased blood pressure was initially detected may influence the interval between the onset of increased blood pressure and proteinuria. CONCLUSION New-onset proteinuria was still the main parameter for identifying preeclampsia. The interval between increased blood pressure and proteinuria was probably related to the imbalance in the sFlt-1/VEGF ratio; therefore, we should pay attention to monitor proteinuria during the prenatal visits, especially for patients with a lower frequency of prenatal visits, higher serum creatinine in the early trimester, earlier onset and higher diastolic blood pressure at the initial onset of increased blood pressure.
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Affiliation(s)
- Jie Ren
- Obstetrics Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Tianjin, 300211, China
| | - Caiyun Zhao
- Obstetrics Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Tianjin, 300211, China
| | - Zhuoran Fan
- Obstetrics Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Tianjin, 300211, China
| | - Yanli Wang
- Obstetrics Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Tianjin, 300211, China
| | - Hongna Sheng
- Obstetrics Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Tianjin, 300211, China
| | - Shaofang Hua
- Obstetrics Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Tianjin, 300211, China.
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Zhang Z, Wang FZ, Li ZX, Song XR. Telmisartan Attenuates the Growth of Epithelium-like Cells and Glomerular Injury in Spontaneously Hypertensive Rats. Curr Med Sci 2021; 41:498-504. [PMID: 34129200 DOI: 10.1007/s11596-021-2368-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
The abnormal growth of epithelium-like cells has been noticed in spontaneously hypertensive rats (SHRs) with hypertensive nephropathy. However, the characteristics of abnormal epithelium-like cells and their pathogenesis in hypertensive nephropathy are not fully understood. In the present study, we investigated the correlation of epithelium-like cells with glomerular injury, and the effects of early drug intervention with telmisartan, an anti-hypertensive drug, on the growth of epithelium-like cells. The results showed that the epithelium-like cells were obviously observed lining along the luminal surface of Bowman's capsule in glomeruli, significantly resulting in the atrophy of the glomerular tuft. Some of the epithelium-like cells strongly expressed proliferating cell nuclear antigen (PCNA) and vimentin, indicating active cellular proliferation. The incidence of epithelium-like cells varied from 13.6% to 54.4% of glomeruli in 48-week-old SHRs, and from 5.1% to 18.0% of glomeruli in age-matched Wistar-Kyoto (WKY) rats (P<0.01). The linear regression analysis further confirmed an obvious correlation between the incidence of epithelium-like cells and the glomerular injury. Moreover, early intervention with telmisartan could dramatically attenuate the progression of epithelium-like cells growth. However, no significant effect of telmisartan on the established epithelium-like cells was observed. Taken together, we demonstrated the involvement of abnormal epithelium-like cells growth in glomerular injury during hypertensive nephropathy in SHRs, and firstly showed the positive effects of the anti-hypertensive drug on the progression of epithelium-like cells growth.
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Affiliation(s)
- Zhi Zhang
- College of Biological Engineering, Sichuan University of Science & Engineering, Zigong, 643000, China.
| | - Fa-Zhan Wang
- State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu, 610041, China
| | - Zai-Xin Li
- College of Biological Engineering, Sichuan University of Science & Engineering, Zigong, 643000, China
| | - Xiang-Rong Song
- State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu, 610041, China
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van Aanhold CCL, Bos M, Mirabito Colafella KM, van der Hoorn MLP, Wolterbeek R, Bruijn JA, Bloemenkamp KWM, van den Meiracker AH, Danser AHJ, Baelde HJ. Thrombomodulin is upregulated in the kidneys of women with pre-eclampsia. Sci Rep 2021; 11:5692. [PMID: 33707524 PMCID: PMC7952396 DOI: 10.1038/s41598-021-85040-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/23/2021] [Indexed: 02/07/2023] Open
Abstract
The endothelial glycoprotein thrombomodulin regulates coagulation, vascular inflammation and apoptosis. In the kidney, thrombomodulin protects the glomerular filtration barrier by eliciting crosstalk between the glomerular endothelium and podocytes. Several glomerular pathologies are characterized by a loss of glomerular thrombomodulin. In women with pre-eclampsia, serum levels of soluble thrombomodulin are increased, possibly reflecting a loss from the glomerular endothelium. We set out to investigate whether thrombomodulin expression is decreased in the kidneys of women with pre-eclampsia and rats exposed to an angiogenesis inhibitor. Thrombomodulin expression was examined using immunohistochemistry and qPCR in renal autopsy tissues collected from 11 pre-eclamptic women, 22 pregnant controls and 11 hypertensive non-pregnant women. Further, kidneys from rats treated with increasing doses of sunitinib or sunitinib in combination with endothelin receptor antagonists were studied. Glomerular thrombomodulin protein levels were increased in the kidneys of women with pre-eclampsia. In parallel, in rats exposed to sunitinib, glomerular thrombomodulin was upregulated in a dose-dependent manner, and the upregulation of glomerular thrombomodulin preceded the onset of histopathological changes. Selective ETAR blockade, but not dual ETA/BR blockade, normalised the sunitinib-induced increase in thrombomodulin expression and albuminuria. We propose that glomerular thrombomodulin expression increases at an early stage of renal damage induced by antiangiogenic conditions. The upregulation of this nephroprotective protein in glomerular endothelial cells might serve as a mechanism to protect the glomerular filtration barrier in pre-eclampsia.
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Affiliation(s)
- Cleo C L van Aanhold
- Department of Pathology, Leiden University Medical Center, L1Q, Room P0-107, 2300 RC, Leiden, The Netherlands.
| | - Manon Bos
- Department of Pathology, Leiden University Medical Center, L1Q, Room P0-107, 2300 RC, Leiden, The Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Katrina M Mirabito Colafella
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
| | | | - Ron Wolterbeek
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan A Bruijn
- Department of Pathology, Leiden University Medical Center, L1Q, Room P0-107, 2300 RC, Leiden, The Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Birth Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - A H Jan Danser
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hans J Baelde
- Department of Pathology, Leiden University Medical Center, L1Q, Room P0-107, 2300 RC, Leiden, The Netherlands
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Bąchor R, Gąszczyk D, Panek-Laszczyńska K, Konieczny A, Witkiewicz W, Stefanowicz P, Szewczuk Z. Detection of Podocin in Human Urine Sediment Samples by Charge Derivatization and LC-MS-MRM Method. Int J Mol Sci 2020; 21:ijms21093225. [PMID: 32370166 PMCID: PMC7247335 DOI: 10.3390/ijms21093225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 12/14/2022] Open
Abstract
Detection of podocytes in urine might serve as a useful diagnostic tool in both primary and secondary glomerular diseases. The utility of podocyturia has been confirmed for both pre-eclampsia and glomerulonephritis. Here, we present a new and sensitive method for qualitative LC-MS-multiple-reaction-monitoring (MRM) analysis of podocin, serving as a podocyturia biomarker in urine sediments. The following podocin tryptic peptides with the 169LQTLEIPFHEIVTK182, 213AVQFLVQTTMK223, 240SIAQDAK246, and 292MIAAEAEK299 sequences were applied as a model. The selective chemical derivatization of the ε amino group of C-terminal lysine residue in tryptic peptides, by 2,4,6-triphenylpyrylium salt (TPP) as a fixed charge tag, was employed to increase the ionization efficiency, in routine ESI-MS analysis. Additionally, the generation of a reporter ion, in the form of a protonated 2,4,6-triphenylpyridinium cation, makes the derivatized peptide analysis in the MRM mode unambiguous. Identification of derivatized and non-derivatized peptides were performed, and the obtained results suggest that the peptide with the 292MIAAEAEK299 sequence may serve as a marker of podocyturia.
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Affiliation(s)
- Remigiusz Bąchor
- Faculty of Chemistry, University of Wroclaw, 50-383 Wroclaw, Poland; (D.G.); (P.S.); (Z.S.)
- Correspondence: ; Tel.: +48-71-375-7218; Fax: +48-71-328-2348
| | - Dorota Gąszczyk
- Faculty of Chemistry, University of Wroclaw, 50-383 Wroclaw, Poland; (D.G.); (P.S.); (Z.S.)
| | - Karolina Panek-Laszczyńska
- 1st Department and Clinic of Gynecology and Obstetrics, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Andrzej Konieczny
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Wojciech Witkiewicz
- Research and Development Center, Regional Specialized Hospital, 51-124 Wroclaw, Poland;
| | - Piotr Stefanowicz
- Faculty of Chemistry, University of Wroclaw, 50-383 Wroclaw, Poland; (D.G.); (P.S.); (Z.S.)
| | - Zbigniew Szewczuk
- Faculty of Chemistry, University of Wroclaw, 50-383 Wroclaw, Poland; (D.G.); (P.S.); (Z.S.)
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Müller-Deile J, Schiffer M. Podocytes from the diagnostic and therapeutic point of view. Pflugers Arch 2017; 469:1007-1015. [PMID: 28508947 DOI: 10.1007/s00424-017-1993-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/04/2017] [Indexed: 01/23/2023]
Abstract
The central role of podocytes in glomerular diseases makes this cell type an interesting diagnostic tool as well as a therapeutic target. In this review, we discuss the current literature on the use of podocytes and podocyte-specific markers as non-invasive diagnostic tools in different glomerulopathies. Furthermore, we highlight the direct effects of drugs currently used to treat primary glomerular diseases and describe their direct cellular effects on podocytes. A new therapeutic potential is seen in drugs targeting the podocytic actin cytoskeleton which is essential for podocyte foot process structure and function. Incubation of cultured human podocyte cell lines with sera from patients with active glomerular diseases is currently also used to identify novel circulating factors with pathophysiological relevance for the glomerular filtration barrier. In addition, treatment of detached urinary podocytes from patients with substances that restore their cytoskeleton might serve as a novel personalized tool to estimate their potential for podocyte recovery ex vivo.
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Affiliation(s)
- Janina Müller-Deile
- Department of Nephrology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Mario Schiffer
- Department of Nephrology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Boeldt DS, Bird IM. Vascular adaptation in pregnancy and endothelial dysfunction in preeclampsia. J Endocrinol 2017; 232:R27-R44. [PMID: 27729465 PMCID: PMC5115955 DOI: 10.1530/joe-16-0340] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/11/2016] [Indexed: 12/27/2022]
Abstract
Maternal vascular adaptation to pregnancy is critically important to expand the capacity for blood flow through the uteroplacental unit to meet the needs of the developing fetus. Failure of the maternal vasculature to properly adapt can result in hypertensive disorders of pregnancy such as preeclampsia (PE). Herein, we review the endocrinology of maternal adaptation to pregnancy and contrast this with that of PE. Our focus is specifically on those hormones that directly influence endothelial cell function and dysfunction, as endothelial cell dysfunction is a hallmark of PE. A variety of growth factors and cytokines are present in normal vascular adaptation to pregnancy. However, they have also been shown to be circulating at abnormal levels in PE pregnancies. Many of these factors promote endothelial dysfunction when present at abnormal levels by acutely inhibiting key Ca2+ signaling events and chronically promoting the breakdown of endothelial cell-cell contacts. Increasingly, our understanding of how the contributions of the placenta, immune cells, and the endothelium itself promote the endocrine milieu of PE is becoming clearer. We then describe in detail how the complex endocrine environment of PE affects endothelial cell function, why this has contributed to the difficulty in fully understanding and treating this disorder, and how a focus on signaling convergence points of many hormones may be a more successful treatment strategy.
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Affiliation(s)
- D S Boeldt
- Department of Ob/GynPerinatal Research Laboratories, University Wisconsin - Madison, Madison, Wisconsin, USA
| | - I M Bird
- Department of Ob/GynPerinatal Research Laboratories, University Wisconsin - Madison, Madison, Wisconsin, USA
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Rätsep MT, Paolozza A, Hickman AF, Maser B, Kay VR, Mohammad S, Pudwell J, Smith GN, Brien D, Stroman PW, Adams MA, Reynolds JN, Croy BA, Forkert ND. Brain Structural and Vascular Anatomy Is Altered in Offspring of Pre-Eclamptic Pregnancies: A Pilot Study. AJNR Am J Neuroradiol 2015; 37:939-45. [PMID: 26721772 DOI: 10.3174/ajnr.a4640] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/05/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Pre-eclampsia is a serious clinical gestational disorder occurring in 3%-5% of all human pregnancies and characterized by endothelial dysfunction and vascular complications. Offspring born of pre-eclamptic pregnancies are reported to exhibit deficits in cognitive function, higher incidence of depression, and increased susceptibility to stroke. However, no brain imaging reports exist on these offspring. We aimed to assess brain structural and vascular anatomy in 7- to 10-year-old offspring of pre-eclamptic pregnancies compared with matched controls. MATERIALS AND METHODS Offspring of pre-eclamptic pregnancies and matched controls (n = 10 per group) were recruited from an established longitudinal cohort examining the effects of pre-eclampsia. Children underwent MR imaging to identify brain structural and vascular anatomic differences. Maternal plasma samples collected at birth were assayed for angiogenic factors by enzyme-linked immunosorbent assay. RESULTS Offspring of pre-eclamptic pregnancies exhibited enlarged brain regional volumes of the cerebellum, temporal lobe, brain stem, and right and left amygdalae. These offspring displayed reduced cerebral vessel radii in the occipital and parietal lobes. Enzyme-linked immunosorbent assay analysis revealed underexpression of the placental growth factor among the maternal plasma samples from women who experienced pre-eclampsia. CONCLUSIONS This study is the first to report brain structural and vascular anatomic alterations in the population of offspring of pre-eclamptic pregnancies. Brain structural alterations shared similarities with those seen in autism. Vascular alterations may have preceded these structural alterations. This pilot study requires further validation with a larger population to provide stronger estimates of brain structural and vascular outcomes among the offspring of pre-eclamptic pregnancies.
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Affiliation(s)
- M T Rätsep
- From the Department of Biomedical and Molecular Sciences (M.T.R., A.F.H., B.M., V.R.K., S.M., G.N.S., J.N.R., B.A.C.)
| | - A Paolozza
- Centre for Neuroscience Studies (A.P., D.B., P.W.S., M.A.A., J.N.R.), Queen's University, Kingston, Ontario, Canada
| | - A F Hickman
- From the Department of Biomedical and Molecular Sciences (M.T.R., A.F.H., B.M., V.R.K., S.M., G.N.S., J.N.R., B.A.C.)
| | - B Maser
- From the Department of Biomedical and Molecular Sciences (M.T.R., A.F.H., B.M., V.R.K., S.M., G.N.S., J.N.R., B.A.C.)
| | - V R Kay
- From the Department of Biomedical and Molecular Sciences (M.T.R., A.F.H., B.M., V.R.K., S.M., G.N.S., J.N.R., B.A.C.)
| | - S Mohammad
- From the Department of Biomedical and Molecular Sciences (M.T.R., A.F.H., B.M., V.R.K., S.M., G.N.S., J.N.R., B.A.C.)
| | - J Pudwell
- Department of Obstetrics and Gynecology (J.P., G.N.S.), Kingston General Hospital, Kingston, Ontario, Canada
| | - G N Smith
- From the Department of Biomedical and Molecular Sciences (M.T.R., A.F.H., B.M., V.R.K., S.M., G.N.S., J.N.R., B.A.C.) Department of Obstetrics and Gynecology (J.P., G.N.S.), Kingston General Hospital, Kingston, Ontario, Canada
| | - D Brien
- Centre for Neuroscience Studies (A.P., D.B., P.W.S., M.A.A., J.N.R.), Queen's University, Kingston, Ontario, Canada
| | - P W Stroman
- Centre for Neuroscience Studies (A.P., D.B., P.W.S., M.A.A., J.N.R.), Queen's University, Kingston, Ontario, Canada
| | - M A Adams
- Centre for Neuroscience Studies (A.P., D.B., P.W.S., M.A.A., J.N.R.), Queen's University, Kingston, Ontario, Canada
| | - J N Reynolds
- From the Department of Biomedical and Molecular Sciences (M.T.R., A.F.H., B.M., V.R.K., S.M., G.N.S., J.N.R., B.A.C.) Centre for Neuroscience Studies (A.P., D.B., P.W.S., M.A.A., J.N.R.), Queen's University, Kingston, Ontario, Canada
| | - B A Croy
- From the Department of Biomedical and Molecular Sciences (M.T.R., A.F.H., B.M., V.R.K., S.M., G.N.S., J.N.R., B.A.C.)
| | - N D Forkert
- Department of Radiology and Hotchkiss Brain Institute (N.D.F.), University of Calgary, Calgary, Alberta, Canada
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