Predictors of renal dysfunction and its correction in women with preeclampsia and alimentary obesity

• Published in: Anesteziologiia i reanimatologiia Vol. 60; no. 1; p. 42
• Main Authors: Tumanyan, S S, Tumanyan, S V, Rymashevski, A N
• Format: Journal Article
• Language: Russian
• Published: Russia (Federation) 01-01-2015
• Subjects: Adult; beta 2-Microglobulin - urine; Creatinine - blood; Critical Care - methods; Female; Glomerular Filtration Rate - drug effects; Hemodilution - methods; Hemodynamics - drug effects; Humans; Kidney - drug effects; Kidney - physiopathology; Magnesium Sulfate - administration & dosage; Magnesium Sulfate - therapeutic use; Obesity - complications; Obesity - physiopathology; Pre-Eclampsia - physiopathology; Predictive Value of Tests; Pregnancy; Renal Insufficiency - diagnosis; Renal Insufficiency - etiology; Renal Insufficiency - therapy; Treatment Outcome
• ISSN: 0201-7563

Alimentary obesity (AO) is considered as an independent risk factor for preeclampsia (PE). Diagnosis of renal dysfunction in the development of PE is difficult.
Early detection of renal dysfunction in women with PE and AO and substantiation of principles of pathogenetic therapy.
A randomized controlled study of 63 pregnant women.
Average age--27.4 ± 1.6 years. First group--31 women with PE of moderate severity and AO who received usual intensive therapy (IT). Second group--32 women with PE of moderate severity and AO who received differentiated therapy for improvement of renal function. During the IT we accounted solute free water clearance (FWC) and colloid oncotic pressure (COP). If FWC was less than 0.45 ml /min, and the COP--less than 18 mm Hg, we started 6% HES administering 130/4 (6.5 ml/kg/day with a rate of 350 ml/h). After that we administered magnesium sulfate (0.75 ml/kg/day, with a rate of 2.8 ml/hr). We evaluated osmotic renal function and tubular function according to β2- microglobulin concentration of urine, glomerular filtration rate (GFR ) according to Rehberg Tareev method and Cockroft-Gault formula and the Modification of Diet in Renal Disease Study (6-v MDRD).
Baseline renal dysfunction was observed in 87.3% of women with PE and AO. Determination of GFR is effective according to Rehberg-Tareev. Cockroft-Gault formula and 6-v MDRD unsuitable in case of PE and AO. Common IT corrected renal dysfunction in 54.8% of women and differentiated IT in 81.2% of women with PE and AO. Intensive therapy did not lead to the recovery of kidney function in 45.2% in the first group and 18.8% in the second group.