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Glomerular Ultrafiltration in Normal and Preeclamptic Pregnancy

Paul Moran^*, Peter H. Baylis, Marshall D. Lindheimer and John M. Davison^*

Departments of *Obstetrics and Gynecology and Medicine, University of Newcastle upon Tyne, England; and Departments of Medicine, Obstetrics and Gynecology and Clinical Pharmacology, University of Chicago, Illinois.

Correspondence to Dr. John M. Davison, University of Newcastle, OB/GYN, 4th Floor Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, England. Phone: 191-282-4132; Fax: 191-222-5066;

ABSTRACT. GFR and renal plasma flow (RPF) decrease in preeclampsia, a serious hypertensive complication of pregnancy. Serial data derived in late pregnancy (LP) and >5 mo postpartum (PP) in 13 healthy controls and 10 preeclamptic women (13 and 5, respectively) returning PP for theoretical analysis of neutral dextran sieving curves (_D), are presented and are used to calculate the key determinants of glomerular ultrafiltration. Normal LP hyperfiltration was associated with increases in RPF and the ultrafiltration coefficient (K_f), as well as in the nondiscriminatory shunt pathway (₀) and the SD of pore size (S). Preeclamptic LP showed the largest ₀ and S values, indicating a loss of size-selectivity, accompanying reduced K_f and RPF, both of which are implicated in the relative hypofiltration. Despite a 100-fold increase in urinary albumin excretion (UAE), LP preeclamptic _D values were reduced for the equivalent neutral dextran (36Å), providing indirect evidence for a loss of glomerular barrier charge-selectivity. All the determinants of GFR and all modeled parameters were comparable across both groups PP, strong evidence that preeclamptic glomerular dysfunction resolves. E-mail: j.m.davison@ncl.ac.uk

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673