Poster Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2015

Retrospective review of postpartum investigation for occult kidney and autoimmune disease in severe pre-eclampsia (#205)

Ganesh Ramanathan 1 , Abishikta Dey 2 , Amanda Mather 2 , Sarah Roxburgh 2 , Stella McGinn 2
  1. Renal Department, The Wollongong Hospital, Wollongong, NSW, Australia
  2. Royal Northshore Hospital, Sydney, NSW, 2065

 Preeclampsia is more common in patients with autoimmune conditions and thrombophilic disorders1. Patients with previous preeclampsia are at a higher risk of developing chronic kidney disease and cardiovascular disease1. However, there is paucity of data to guide follow-up investigations for a medical condition in patients with severe preeclampsia.

In Royal North Shore Hospital, patients with severe preeclampsia are followed up by nephrologists 3 to 5 months post partum. Besides cardiovascular parameters monitoring, patients are tested for lupus serology, anticardiolipin antibodies(ACA), serum creatinine, urinary creatinine clearance, sediment and protein:creatinine ratio in order to screen for underlying medical conditions.

Methods

This is a retrospective cohort study of 97 women with the diagnosis of severe pre-eclampsia who had follow-up investigations in Royal North Shore Hospital from 27/10/2010 to 14/04/2015.

Aim

To assess retrospectively the efficacy and cost-effectiveness of our screening programme for patients with severe preeclampsia.

Results

Our cohort’s mean age was 34.5 years followed up after a median of 5 months post preeclampsia.

At 5 months, 37% patients remained on antihypertensives. 26% and 20% patients were overweight (BMI 25 – 29.9 kg/m2) and obese (BMI ≥ 30 kg/m2) respectively. 43% of patients had elevated fasting cholesterol.

Median estimated GFR was 116 mls/min. 25% had haematuria but otherwise most other patients had no significant proteinuria or urinary casts. Overall, we did not make any new diagnosis of significant renal disease that would have required a renal biopsy or the use of immunosuppression.

ANA was positive in 29/92 (29%) and anti ds-DNA was positive in 2/85 (2%). No new diagnosis of systemic lupus erythematosus was made.

ACA was positive for IgM in 12/84 patients and IgG in 6/75 patients. One new diagnosis of antiphospholipid syndrome was made in a patient with previous miscarriages.

Conclusion

 Our data suggests that patients with severe preeclampsia should have follow up in regards to cardiovascular risk factors but should not prompt extensive investigations to find an occult underlying disease. 

  1. Duckitt K, Harrington D; Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ. 2005;330(7491):565.