From the Guidelines
Preeclampsia can damage multiple kidney structures, primarily affecting the glomeruli, which are the filtering units of the kidney, leading to proteinuria and potentially acute tubular necrosis in severe cases. The main structures damaged include the glomerular endothelial cells, which develop swelling (endotheliosis), the podocytes that form the filtration barrier, and the basement membrane. These changes occur due to the release of anti-angiogenic factors like sFlt-1 and endoglin from the placenta, which disrupt the normal balance of vascular growth factors, as discussed in the context of hypertensive disorders of pregnancy 1. The resulting endothelial dysfunction, inflammation, and oxidative stress contribute to widespread kidney damage. Key kidney structures that can be affected include:
- Glomeruli: the filtering units of the kidney, where endothelial cells, podocytes, and the basement membrane can be damaged
- Renal arterioles: which may experience vasospasm and narrowing, reducing blood flow to the kidneys
- Tubular structures: which can be affected by acute tubular necrosis in severe cases of preeclampsia In most cases, these kidney changes resolve after delivery, but some women may experience persistent kidney dysfunction, especially if they had severe preeclampsia or pre-existing kidney disease, highlighting the importance of close monitoring and management of blood pressure during pregnancy, as outlined in guidelines for the management of arterial hypertension 1.
From the Research
Kidney Structures Damaged by Preeclampsia
The kidney structures that can be damaged by preeclampsia include:
- Glomerular endotheliosis: This is one of the main features of kidney involvement in preeclampsia, as noted in the study by 2.
- Podocytes: Preeclampsia is associated with kidney dysfunction due to deficiency in podocyte-specific vascular endothelial growth factor (VEGF), as discussed in 2.
- Filtration barrier: The imbalance in angiogenic factors in preeclampsia can cause damage to the filtration barrier, leading to proteinuria and kidney dysfunction, as explained in 2.
- Thrombotic microangiopathy (TMA): TMA is another feature of kidney involvement in preeclampsia, which can induce clotting and vessel occlusion, as mentioned in 2.
- Renal vessels: Preeclampsia can cause endothelial damage and vessel occlusion, leading to acute kidney injury and chronic kidney disease, as discussed in 3.
Long-term Kidney Effects
Preeclampsia can have long-term effects on the kidney, including:
- Increased risk of chronic hypertension: Individuals with preeclampsia have a higher risk of developing chronic hypertension, as found in the study by 4.
- Reduced estimated glomerular filtration rate (eGFR): Preeclampsia is associated with a higher risk of reduced eGFR, as noted in 4.
- Albuminuria: Preeclampsia can increase the risk of albuminuria, as discussed in 4 and 5.
- End-stage kidney disease: Preeclampsia significantly increases the risk of end-stage kidney disease, as found in the meta-analysis by 5.