Ceruloplasmin and antioxidative enzymes in pre-eclampsia

Objective: To evaluate diagnostic value of ceruloplasmin together with other enzymatic and nonenzymatic antioxidants (superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and uric acid) and to evaluate the level of oxidative stress in patients with pre-eclampsia (PE) and compare it with normal pregnancy.

Methods: In this prospective study, antioxidative markers were investigated in two groups of pregnant women: patients with pre-eclampsia (n?=?32) and the healthy pregnant women (n?=?60). The following antioxidative markers and enzymes were evaluated: serum ceruloplasmin levels, uric acid, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px).

Results: Serum levels of ceruloplasmin, uric acid and SOD were significantly higher in the PE group compared to the control group. Serum levels of GSH-Px were not significantly higher in the PE group compared to the control group. Serum ceruloplasmin and serum uric acid have the best diagnostic accuracy for oxidative stress in PE and are more accurate compared to antioxidative enzymes -SOD and specially more accurate than GSH-Px.

Conclusions: Serum ceruloplasmin level may have significant role as the markers of oxidative stress in pre-eclampsia especially when used in combination with uric acid levels.     

The role of cystatin C,neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in the evaluation of kidney function in women with preeclampsia

ObjectiveWe aimed to compare the diagnostic efficiency of cystatin C with traditional kidney markers in preeclampsia and to evaluate the relationship of these markers with neutrophil-lymphocyte and thrombocyte-lymphocyte ratios.Materials and methods14 severe preeclampsia, 48 mild preeclampsia and 79 patients with healthy pregnancy who presented to our obstetrics and gynecology clinic within one year were compared. These three groups were compared in terms of demographic characteristics, physical findings, serum urea, creatinine, cystatin C levels, and neutrophil-lymphocyte and platelet-lymphocyte ratios.ResultsThe mean serum cystatin C, creatinine and uric acid levels were higher in the severe preeclampsia group compared with the mild preeclamptic and healthy pregnancies (p < 0.001). While cystatin C values increased as the week of gestation increased in the mild preeclampsia group, there was no relation with the gestational week in the control group and the severe preeclampsia group. However, the highest cystatin C values were in the severe preeclampsia group, regardless of the week (p < 0.05). The area under the ROC curve was statistically significant for cystatin C, uric acid and creatinine, but of these three values, cystatin C had the highest sensitivity and specificity. Neutrophil-lymphocyte ratio (NLR) was significantly higher in the severe preeclampsia group than healthy pregnancies, but the level was not significant compared to mild preeclampsia. There was no difference between the groups in terms of platelet-lymphocyte ratio.ConclusionIt can be suggested that cystatin C level reflects renal functions better than uric acid and creatinine in preeclampsia. Cystatin C can be used as a prognostic marker in preeclamptic pregnancies, and rising levels may be valuable for predicting severe preeclampsia. Especially with advancing gestational week, the increase in cystatin C level may indicate an association with the development of preeclampsia. NLR levels may be a parameter correlating with severity in severe preeclampsia.     

Serum cystatin C for assessment of glomerular filtration rate in hypertensive disorders of pregnancy.

BACKGROUND: Assessment of renal function is important in the evaluation of the pregnant hypertensive patient. The aim of this study was to evaluate the diagnostic utility of cystatin C as a marker of glomerular filtration rate in hypertensive disorders of pregnancy and to correlate this with serum creatinine and creatinine clearance. METHODS: For our study, 198 women who presented with hypertension during pregnancy were recruited at the antenatal clinic of King Edward VIII Hospital in Durban, South Africa, a tertiary referral centre. Exclusion criteria included women with eclampsia, urinary tract infection and chronic renal disease. Routine dipstick urinalysis (Bayer) was performed by midwives to classify patients suffering from the different forms of hypertensive disorders of pregnancy and venous blood samples for determination of serum cystatin C and serum creatinine were collected. The 24-hour urine creatinine clearance was used as the "gold standard" for evaluation of glomerular filtration rate due to concerns of radiation exposure to pregnant women with the use of radio nucleotide markers. RESULTS: The results of testing the 198 women, 72 of whom had preeclampsia, were analyzed. Serum cystatin C showed a significant correlation with creatinine clearance at the 0.01 level (2-tailed) with an r-value of -0.311. Serum creatinine showed a significant correlation with creatinine clearance at the 0.01 level (2-tailed) with an r-value of -0.486. CONCLUSION: Serum cystatin C seems to reflect glomerular filtration rate reliably in hypertensive pregnant women and avoids the inaccuracy associated with the 24-hour urine collection, which is time consuming and subject to improper collection.     

Angiotensin-Converting Enzyme Insertion/Deletion (ACE I/D) and Angiotensin II Type 1 Receptor (AT1R) Gene Polymorphism and Its Association with Preeclampsia in Chinese Women

Objective: To investigate whether polymorphisms of angiotensin converting enzyme gene (ACE) and angiotensin II receptor type 1 gene (AT1R) are associated with etiology of preeclampsia and renal impact in women with preeclampsia. Methods: DNA was extracted from peripheral blood of 133 patients with preeclampsia and 105 healthy pregnant women. The I/D polymorphism of the ACE gene was assessed by polymerase chain reaction, and the A1166C polymorphism of the AT₁R gene was additionally assessed by DdeI digestion. The level of proteinuria, fasting serum urea, creatinine and uric acid were investigated according to different genotypes of ACE and AT1R genes. Results: The frequency of genotypes of the ACE gene and the AT1R gene was similar in preeclampsia and normal pregnancy. DD and ID genotype predominated in patients with severe proteinuria, as well as increased serum urea and uric acid. Serum creatinine was also increased, but no significant difference was found among three genotypes. The level of proteinuria, serum uric acid, urea, and creatinine did not vary between different AT1R genotypes. Compared with patients without renal dysfunction, the frequency of DD and ID genotypes of ACE gene was much higher in those with renal dysfunction, but AC and CC genotypes of AT1R gene were not. Conclusion: We found no association of the two gene polymorphisms with preeclampsia. However, ACE gene I/D polymorphisms were associated with the severe proteinuria and renal dysfunction seen in preeclampsia. Preeclampsia patients carrying the D allele may be susceptible to renal dysfunction.     

Predictive value of amniotic fluid cystatin C levels for the early identification of fetuses with obstructive uropathies

Objective To compare the diagnostic accuracy of cystatin C with that of creatinine in discriminating renal function in fetuses without ultrasononographic evidence of renal malformations from those with obstructive uropathies.
Design Prospective, observational cohort study.
Setting Prenatal morphologic and functional evaluation of fetal obstructive uropathies throughout pregnancy.
Population A total of 96 healthy pregnant women at different stages of pregnancy, without any pregnancy-related maternal disease. Eighty-one pregnant women without clinical and ultrasonographic evidence of any fetal anomaly, confirmed at birth, were defined as controls; 15 pregnant women with various fetal obstructive uropathies, evidenced by repeated ultrasound examinations and confirmed at birth, were defined as cases.
Methods Creatinine was measured by a kinetic Jaffe picric acid method and cystatin C by a nephelometric immunoassay. Variables were analysed by applying conventional statistical tests; the non-parametric receiver operating curves (ROC) analysis was used to evaluate the diagnostic efficiencies of the biochemical markers.
Main outcome measures Incidence of confirmed, diagnosed, neonatal obstructive uropathy by measuring baseline levels of cystatin C and creatinine in amniotic fluid.
Results Baseline levels of cystatin C in amniotic fluid were significantly higher (   P = 0.0015  ) among cases than in controls with comparable gestational age; no significant difference was found for creatinine levels (   P = n.s.  ). The maximum diagnostic accuracy of serum cystatin C in discriminating controls from fetal uropathies was 96%, while that of creatinine was 62%.
Conclusion Cystatin C may be considered a sensitive biochemical marker for the early identification of fetuses with obstructive uropathies.     

Serum humanin concentrations in women with pre-eclampsia compared to women with uncomplicated pregnancies

Purpose: To compare serum humanin concentrations in pregnant women with and without pre-eclampsia (PE).

Materials and methods: A case-control study where pregnant women (PE group, n?=?37; control group, n?=?34) studied through history parameters (gynecological, obstetrical, personal, and family), physical and sonographic examination parameters [body mass index (BMI), blood pressure obstetrical ultrasound], and biochemical/hormonal assays [creatinine, urea, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), uric acid, platelets, urinary protein, and humanin].

Results: There was no difference in basic characteristics between women with PE and control, except in parity and gravidity. Humanin concentrations were higher in women with PE compared to controls (422.2?±?33.5 vs. 319.1?±?28.1?pg/ml, p?=?0.023). In a binary logistic analysis, humanin was associated with the presence of PE [odds ratio 1.003, 95% confidence interval (CI); 1.000–1.006]. The ability of humanin to discriminate between women with PE and controls was evaluated by receiver operation characteristics (ROC) analysis [area under the curve (AUC) 0.639, 95% CI; 0.510–0.768, p?=?0.045].

Conclusions: Serum humanin concentrations are increased in women with PE, compared to women with uncomplicated pregnancies, suggesting a potential protective role of humanin against the oxidative stress and endothelial dysfunction occurring in PE.     

Serum collectrin levels in patients with early- and late-onset preeclampsia

Aim: The aim of this study is to investigate the maternal levels of collectrin in early-onset preeclampsia (EOPE) and late-onset preeclampsia (LOPE). To assess the correlation between serum collectrin levels and blood pressure in humans.

Material and methods: This cross-sectional study was conducted including 79 pregnant women, 27 with normal pregnancy, 30 with EOPE and 22 with LOPE. Maternal serum levels of collectrin were measured by using enzyme-linked immunosorbent assay kits.

Results: The mean serum collectrin level was significantly lower in women with PE compared with the control group (8.49?±?3.12?ng/ml (EOPE), 9.69?±?3.01?ng/ml (LOPE) versus 11.51?±?4.33?ng/ml) and was found to be the lowest in the EOPE group (8.49?±?3.12?ng/ml). The mean serum urea and uric acid levels were significantly higher in the PE group than the control group. Serum collectrin concentrations did not correlate with maternal age, BMI and serum creatinine levels. However, collectrin concentrations were negatively correlated with systolic blood pressure (r?=??0.284, p?=?.011) and diastolic blood pressure (r?=??0.275, p?=?.014) as well as with maternal serum urea (r?=??0.269, p?=?.017) and uric acid (r?=??0.219, p?=?.049) concentrations.

Conclusion: Maternal serum collectrin levels are significantly lower in patients with preeclampsia than in the control group. There is an inverse correlation between serum collectrin levels and blood pressure.     

The Correlation Between Renal Function and Systolic or Diastolic Blood Pressure in Severe Preeclamptic Women

Objective. To evaluate the correlation between renal function and systolic or diastolic blood pressure in preeclamptic mothers. Methods. In this prospective study from August 1998 to September 2002, 28 women ≥ 28 weeks gestation with severe preeclampsia were selected. Meanwhile, 56 normotensive pregnant women without proteinuria or edema served as the control group. Urine was collected for 24 hours for all subjects. The concentration of uric acid, blood urea nitrogen, creatinine, sodium, calcium, and albumin in the 24-hour urine and blood of both groups were examined. Neonatal outcome also was evaluated. Results. The serum and 24-hour urine concentration of blood urea nitrogen, creatinine, and albumin were significantly higher in severe preeclamptic women. Serum uric acid and urinary albumin/creatinine ratio was significantly higher in severe preeclamptic women compared with that in normotensive mothers and showed positive correlation with systolic or diastolic blood pressure. On the other hand, serum calcium/creatinine ratio was significantly lower in the severe preeclamptic group and negatively correlated to blood pressure. In multiple regressions, systolic or diastolic blood pressure was dependent on serum uric acid, albumin/creatinine, and calcium/creatinine ratios. Fetal birth weight was significantly lower in women with severe preeclampsia and with a lower Apgar score < 7 at 1 minute and 5 minutes and more preterm delivery compared with that in normotensive women. Conclusion. Renal function in women with severe preeclampsia was significantly impaired and highly correlated with systolic or diastolic blood pressure.     

Maternal serum transforming growth factor beta-2 in preeclampsia and eclampsia, a potential biomarker for the assessment of disease severity and fetal outcome

OBJECTIVE: The emerging role of transforming growth factor beta in hypertension, kidney disease, and trophoblast differentiation promoted our interest in evaluating the clinical value of assaying maternal serum TGF-beta2 levels in pregnancies complicated by preeclampsia and eclampsia. We wished to determine these levels in relation to the severity of the disease, the degree of renal involvement, and fetal outcome. METHODS: A prospective study was carried out in 50 pregnant patients with preeclampsia (PE) and eclampsia and these women were compared to 20 pregnant normotensive controls. Preeclamptic patients were subdivided into 20 cases of mild PE, 20 cases of severe PE, and 10 cases of eclampsia. Maternal serum levels of TGF-beta2 were determined in all cases by enzyme immunoassay. Maternal serum creatinine and uric acid were measured, together with an assessment of fetal well being, using the Biophysical Profile Score. RESULTS: Maternal serum TGF-beta2 levels were significantly increased in cases of severe preeclampsia and eclampsia compared to controls. This increase was positively correlated with elevated levels of serum creatinine and uric acid, as well as poor biophysical profile scores (BPS), and low birth weight (LBW). CONCLUSION: Measurement of maternal serum TGF-beta2 levels in preeclampsia may be a useful biomarker for the assessment of the severity of disease and fetal outcome in PE.     

Serum cystatin C reflects glomerular endotheliosis in normal, hypertensive and pre-eclamptic pregnancies

Objective To study the correlation between serum cystatin C levels and renal structural changes in normal, hypertensive and pre-eclamptic pregnancy to evaluate it as a marker of the degree of renal involvement in pre-eclampsia.
Design An observational prospective study.
Setting University Hospital of Lund, Sweden.
Sample Thirty-six women with hypertensive disease in pregnancy and 12 healthy pregnant women in the third trimester recruited from maternal health care centres in the catchment area of the hospital.
Methods Renal biopsy samples were obtained from all participants and the degree of endotheliosis as well as the mean glomerular volume was evaluated by light microscopy in silver methenamin-stained sections. Serum cystatin C levels were measured and correlated to the structural changes.
Main outcome measures Correlation among degree of glomerular endotheliosis, glomerular volume andserum cystatin C.
Results Serum cystatin C levels differed between the different degrees of endotheliosis, showing a highly significant increasing linear trend. They also correlated significantly with glomerular volume (   r = 0.60, P < 0.001  ). Mean serum urate and creatinine levels also increased with the degree of endotheliosis, but not above the reference interval for normal term pregnancy, even in pre-eclamptic women.
Conclusion Serum cystatin C may be used as a marker, not only for impaired renal function, but also for the degree of glomerular endotheliosis and increase in glomerular volume in pregnancy. It may be of value in the monitoring of pregnancies complicated by pre-eclampsia.     

Correlation of maternal serum high-sensitive C-reactive protein levels with biochemical and clinical parameters in preeclampsia

OBJECTIVE: To investigate the relationship between serum high sensitive C-reactive protein (hsCRP) levels and biochemical and clinical parameters in preeclampsia (PE). STUDY DESIGN: This cross-sectional study included 20 women with PE and 20 healthy pregnant women. They were recruited in the third trimester of pregnancy at the Firat University, Firat Medical Center, Department of Obstetric and Gynaecology in Elazig province. The standard biochemical and hematological parameters were measured by an advanced auto analyzer. Venous blood samples were collected at admission to the hospital at least 6h before delivery for measurement of hsCRP by a high sensitive immunonephelometric method. RESULTS: Hemoglobin, serum hsCRP, creatinine, aspartat and alanine transaminase, lactate dehydrogenase, blood urea nitrogen and urine protein excretion were higher, and serum calcium levels were lower in patients with PE compared to control group values. In the preeclampsia group, correlation analysis tests showed a strong positive correlation between serum hsCRP levels and diastolic blood pressures (r=0.9, p=0.05, n=20) and urinary protein excretion (r=0.8, p=0.05, n=20), and a negative correlation between serum hsCRP and weight (r=-0.6, p=0.02, n=20) and length (r=-0.5, p=0.05, n=20) of the newborns. Serum hsCRP levels were also negatively correlated with weights (r=0.5, p=0.02, n=20) and lengths (r=0.5, p=0.05, n=20) of the newborns in the control group. CONCLUSIONS: Serum hsCRP levels increase in women with PE. Elevated serum levels of hsCRP in preeclamptic women are correlated with clinical and biochemical parameters of PE. Determination of serum hsCRP levels may be used as a marker for the severity of PE.     

Ischemia-Modified Albumin (IMA): A Novel Marker for Preeclampsia Independent of Uterine Artery Notching Identified by Doppler Ultrasound

Objective: To determine the predictive value of second trimester serum ischemia-modified albumin (IMA) levels for preeclampsia (PE), small for gestational age (SGA) and gestational diabetes mellitus (GDM). Methods: The study was conducted at a tertiary care hospital between May and August 2014. Healthy pregnant women (n?=?88) who were screened for fetal anomalies with ultrasound at 20–24 weeks of gestation were included in the study. Doppler measurements of the bilateral uterine arteries were performed in all the patients. Serum samples were obtained for an IMA assay. The maternal serum IMA levels were compared in pregnant women who had normal and abnormal uterine artery Doppler findings, including notching, and also in pregnant women who subsequently developed PE, SGA, and GDM during the follow-up period. Results: Uterine artery notching was not significantly predictive for PE, GDM or SGA (p?>?0.05). There was no significant difference between notching of the uterine arteries and serum IMA levels (p?>?0.05). Eight pregnant women (9.1%) subsequently developed PE. Serum IMA levels were significantly elevated in patients with PE compared with patients who did not subsequently develop PE (p?=?0.002). However, serum IMA levels were not significantly different in patients who subsequently developed SGA and GDM compared with women who did not (p?>?0.05). There was no correlation between serum IMA levels and maternal characteristics and laboratory findings. Conclusion: Maternal serum IMA levels at 20–24 weeks’ gestation might be a predictive biomarker for PE, independent of notching of the uterine arteries, maternal characteristics and laboratory findings.     

The Role of Serum Iron Levels in Diagnosing Hypertensive Disorders in Pregnancy

Objective: The clinical use of serum iron in the assessment of 46 patients of mixed parity with hypertensive pregnancies was compared to other laboratory parameters and the possible relationship between maximum serum iron levels and pregnancy outcome was assessed.

Methods: Serum iron concentrations measured in 46 women admitted because of pregnancy-induced hypertensive disorders were related to pregnancy outcome and compared to a control group consisting of 128 normotensive women with uncomplicated pregnancies.

Results: Serum iron levels were significantly higher and birth weights were significantly lower in patients with established preeclampsia (PE) as compared to patients with gestational hypertension (GH) or normotensive control women.

Conclusions: Both serum uric acid as well as serum iron correlate positively with the presence of hypertensive disorders in pregnancy, however, unlike serum uric acid, serum iron was shown (a) to be significantly different between the GH and the PE groups, and (b) to correlate negatively with birth weight.     

Serum cystatin C in pregnant women: reference values, reliable and superior diagnostic accuracy

BACKGROUND: A simple, endogenous, accurate and minimally invasive marker of glomerular filtration rate (GFR) is much desired in clinical nephrology. Cystatin C fulfills all criteria to be a marker for GFR. For early detection of renal impairment in pregnant women, it is necessary to determine serum cystatin C reference values and the correlation with GFR. The present study was therefore undertaken. METHOD: Healthy pregnant women were followed during pregnancy and the postnatal period. Patient demographics included age, height, weight, BMI, parity, total blood count, LFT, urea, creatinine, Na, K, and blood sugar. Serum cystatin C was estimated using particle enhanced nephlo-immunoassay method. All the parameters were recorded at the start of pregnancy and then in each trimester and the postnatal period. Regression analysis correlation coefficient, ANOVA and the Student's t-test were used for analysis using the SPSS statistical package. RESULTS: A total of 197 pregnant women were included. Mean serum cystatin C for all the women was 0.82 +/- 0.184 mg/l. Serum cystatin C levels were high -0.89 +/- 0.12 mg/l in the first trimester, decreased significantly to 0.651 +/- 0.14 mg/l during the second trimester (p = 0.0000 compared to first trimester), and increased again to 0.82 +/- 0.191 mg/l in the third trimester. After delivery the level rose to 0.94 +/- 0.12 mg/l. A strong correlation was found between serum cystatin C and serum creatinine. A strong negative correlation was found between GFR and cystatin C values in the women (r = -0.546, p = 0.000). A linear relationship was found between GFR and cystatin C levels. A significant increase in the GFR was noted with the progression of pregnancy from 128.06 +/- 29.7 ml/min in the first trimester to 155.2 +/- 29.59 ml/min during second trimester (p = 0.006). A decline in the level of cystatin C exactly parallel to the increase in the GFR was noted with the progression of pregnancy. Interestingly cystatin C was found to have a strong negative correlation with gestational age (r = -0.663, p = 0.000). CONCLUSION: Our results indicate that the mean serum cystatin C levels reflect changes in the GFR during the entire pregnancy and also in the postnatal period. Moreover, serum cystatin C levels are independent of age, height, weight, or blood sugar level. Cystatin C can be used for close supervision and early diagnosis of renal impairment in pregnant patients. Cystatin C is a reliable, useful and promising marker of GFR in pregnant women.     

Increased serum heme oxygenase-1 levels as a diagnostic marker of oxidative stress in preeclampsia

Objective: To evaluate the utility of serum biomarkers in the diagnosis of preeclampsia (PE) and also investigate possible correlation with pathogenesis of PE. Methods: Maternal serum concentrations of heme oxygenase-1 (HO1) and N-myc downstream-regulated gene 1 (NDRG1) were measured at 27–34 weeks of gestation in a case–control study of 33 pregnant women diagnosed with PE and in 43 normotensive pregnant women without proteinuria. The Mann–Whitney U test and Spearman's correlation were used for statistical analysis. Results: The median serum HO1 level was found to be significantly higher in the PE group [76.7?ng/ml (23.4–445.7)] than control group [55.9?ng/ml (3.7–354.3)] (p?=?0.006). Positive correlation was found between HO1 levels with presence of PE (r?=?0.316, p?=?0.005). There was no significant difference in NDRG1 values between the two groups (p?=?0.226). Conclusions: Serum HO1 levels were found to be increased in patients with PE compared with normotensive pregnant women.     

Umbilical Blood Flow Correlated to Maternal Hemodynamics in Severe Preeclampsia

Objective: The objective of the study was to compare pro-hepcidin, hemoglobin (Hb) concentration, hematocrit (Hct), C-reactive protein (CRP), IL-6 and iron status parameters in preeclamptic (PE) and healthy pregnant women, and to examine the relationship between serum pro-hepcidin levels and iron parameters of preeclampsia (PE). Methods: In a prospective controlled study, we collected serum from women with normal pregnancy (n?=?37) and from women with PE (n?=?30) at the Department of Obstetrics and Gynecology at Turgut Ozal University between February 2010 and January 2013. Pro-hepcidin, hemoglobin (Hb) concentration, hematocrit (Hct), CRP, IL-6 and iron status parameters were measured in all patients and compared between groups. Results: Levels of serum prohepcidin in PE and control groups were similar and amount 69.4?±?19.7 and 71.9?±?22.1?ng/ml, respectively. The difference was not statistically significant (p: 0.694). On the other hand, the study group had a statistically lower iron binding capacity (IBC), total iron binding capacity, transferin, total protein, albumin levels (p?<?0.05). No significant differences were found among prohepcidin, Hb concentration, Hct, iron, ferritin, IL-6, urea and creatine in both the groups. Conclusion: In pregnancies complicated by PE with normal values of hemoglobin and hematocrit, serum prohepcidin concentrations are similar to those observed in healthy pregnant women. The analysis revealed no significant correlations between prohepcidin level and serum iron, serum ferritin or transferrin in the PE.     

Etiology of third-trimester maternal hyperuricemia in nonpreeclamptic twin gestations

OBJECTIVE: To determine whether the higher maternal serum uric acid levels observed in the third trimester of nonpreeclamptic twin gestations result from increased uric acid production or decreased renal excretion. METHODS: Thirty-four nonpreeclamptic subjects with twin gestations were analyzed, along with 34 singleton controls matched for age, ethnicity, prepregnancy weight, height, and gestational age. For each subject, a serum sample and 24-hour urine specimen were obtained in the third trimester. Serum and urine uric acid and creatinine levels were determined, as well as total 24-hour urine uric acid, uric acid clearance, creatinine clearance, fractional uric acid clearance, and net tubular uric acid absorption. RESULTS: The twin gestation group had significantly higher maternal serum uric acid levels (5.2 +/- 1.2 compared with 4.0 +/- 1.0 mg/dL, P <.001) and maternal serum creatinine levels (0.7 +/- 0.2 compared with 0.5 +/- 0.1 mg/dL, P <.001) than the paired singleton group. This was associated with greater 24-hour urine uric acid excretion (688.7 +/- 167.0 compared with 597.7 +/- 164.2 mg, P =.04) and 24-hour urine creatinine excretion (1268.4 +/- 249.9 compared with 1161.2 +/- 277.1 mg, P =.03) in the twin group. No differences were seen between the groups in uric acid clearance, creatinine clearance, fractional uric acid clearance, filtered uric acid load, or net uric acid absorption. CONCLUSION: The higher maternal serum uric acid levels observed in the third trimester of nonpreeclamptic twin gestations result in part from increased uric acid production, as reflected in the increased daily uric acid excretion.     

Uric Acid in Pregnancy and Preeclampsia: An Alternative Hypothesis

EDITORIAL COMMENT: This hypothesis that the rise in serum uric acid in patients with preeclampsia is secondary to placental damage rather than alteration in renal function will interest readers. A major problem with the hypothesis is acceptance that raised serum uric acid levels are a feature of normal pregnancy although this was the finding in a careful study recently reported in this Journal (Carter J, Child A. Serum uric acid levels in normal pregnancy. Aust NZ J Obstet Gynaecol 1989; 29: 313–431). This hypothesis could be tested by performing uric acid clearance studies in normal pregnancy and in patients with preeclampsia and relating it to creatinine clearance.     

Second Trimester Maternal Serum Cystatin C Levels in Preeclamptic and Normotensive Pregnancies: A Small Case-Control Study

Background/Aims: Cystatin C (CC) is a marker of glomerular filtration rate (GFR) and is elevated in cases of established preeclampsia (PE). It also has widespread presence in extracellular space and high levels in PE might reflect placental ischemia. The aim of this study was to measure CC levels in the second trimester in women who subsequently develop PE and in those who remained normotensive. Methods: Maternal serum taken at time of the anomaly scan from 15 women was analysed for CC and creatinine levels. Six women later developed PE and 9 remained normotensive. Results: Cystatin C levels were significantly higher in women who developed preeclampsia (mean value 0.76 vs. 0.53 mg/L, p =?0.008). However, creatinine levels showed no statistical difference (mean value 76.1 vs. 65.5 umol/L, p?=?0.066). The range of CC was 0.41–0.55 mg/L in normotensive pregnancies and 0.50–1.26 mg/L in pregnancies with PE. Conclusion: This small observational study showed that serum CC is raised as early as the second trimester in women who subsequently develop PE in third trimester. Larger studies are needed to evaluate the potential role of CC as an early marker for the prediction of PE.     

Serum cystatin C in pregnancies with normal and restricted fetal growth

The objective of this study was to investigate circulating levels of cystatin C (an important endogenous marker of renal function) in mothers, fetuses, and neonates from intrauterine growth-restricted (IUGR; characterized by impaired nephrogenesis) and appropriate-for-gestational-age (AGA) pregnancies. Serum cystatin C levels were measured by enzyme immunoassay in 40 parturients and their 20 IUGR (or= 0.376 and P 相似文献