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Responses of the renin-angiotensin-aldosterone system in pregnant chronic kidney disease patients with and without superimposed pre-eclampsia

Kurlak, Lesia O.; Broughton Pipkin, Fiona; Mohaupt, Markus G.; Mistry, Hiten D.


Lesia O. Kurlak

Fiona Broughton Pipkin

Markus G. Mohaupt

Hiten D. Mistry


Background: Women with chronic kidney disease (CKD) are at increased risk of superimposed preeclampsia (SPE). Accurate identification of SPE is challenging. We hypothesised that specific components of the renin-angiotensin-aldosterone-system (RAAS) would discriminate between CKD and SPE. The aim of the study was to establish differences in circulating and intrarenal RAAS in women with CKD with and without SPE and compare these to normotensive controls (NC) and women with pre-eclampsia (PE).

Methods: White European NC women (n=20), women with PE (n=9), normotensive CKD without SPE (n=8) and with SPE (n=11) were recruited in the third trimester. Plasma renin, plasma and urine total angiotensinogen (AGT) concentrations were quantified by ELISA; urinary tetrahydroaldosterone (THaldo) concentration by gas chromatography-mass spectrometry and placental growth factor (PlGF) by immunoassay.

Results: Urinary TH-aldo:creatinine ratios were lower in women with PE or SPE compared to NC or women with CKD (P less than 0.05 for all). The same group differences were observed for plasma active renin and PlGF concentrations (P less than 0.05 for all). Urine total AGT was higher in women with PE compared with NC (P less than 0.05) and urine TH-aldo:urine AGT was lower (P less than 0.05). However, women with SPE had lower urinary AGT concentrations compared with women with PE (P less than 0.05). No differences in plasma total AGT were observed between groups.

Women with SPE have a lower urinary TH-aldo:creatinine ratio, lower plasma active renin and lower PlGF concentrations than women with CKD, comparable to women with PE without pre-existing disease, suggestive of similar pathophysiology. These data suggest disruption of the RAAS pathway in SPE similar to PE. Exploration of the predictive value of RAAS components for adverse pregnancy events in women with CKD is required.


Kurlak, L. O., Broughton Pipkin, F., Mohaupt, M. G., & Mistry, H. D. (2019). Responses of the renin-angiotensin-aldosterone system in pregnant chronic kidney disease patients with and without superimposed pre-eclampsia. Clinical Kidney Journal, 12(6), 847-854.

Journal Article Type Article
Acceptance Date Feb 15, 2019
Online Publication Date Mar 25, 2019
Publication Date Mar 25, 2019
Deposit Date Feb 25, 2019
Publicly Available Date Feb 25, 2019
Journal Clinical Kidney Journal
Print ISSN 2048-8505
Electronic ISSN 2048-8513
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 12
Issue 6
Pages 847-854
Keywords pregnancy, pre-eclampsia, chronic kidney disease, renin-angiotensin; system, Aldosterone, Angiotensinogen
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