Review
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World J Nephrol. Nov 6, 2014; 3(4): 169-181
Published online Nov 6, 2014. doi: 10.5527/wjn.v3.i4.169
Preeclampsia from a renal point of view: Insides into disease models, biomarkers and therapy
Janina Müller-Deile, Mario Schiffer
Janina Müller-Deile, Mario Schiffer, Division of Nephrology and Hypertension, Department of Medicine, Hannover Medical School, 30625 Hannover, Germany
Author contributions: Müller-Deile J and Schiffer M solely contributed to this paper.
Correspondence to: Janina Müller-Deile, MD, Division of Nephrology and Hypertension, Department of Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. schiffer.mario@mh-hannover.de
Telephone: +49-51-15324708 Fax: +49-51-1552366
Received: March 20, 2014
Revised: August 6, 2014
Accepted: September 4, 2014
Published online: November 6, 2014
Abstract

Proteinuria is a frequently detected symptom, found in 20% of pregnancies. A common reason for proteinuria in pregnancy is preeclampsia. To diagnose preeclampsia clinically and to get new insights into the pathophysiology of the disease it is at first essential to be familiar with conditions in normal pregnancy. Animal models and biomarkers can help to learn more about disease conditions and to find new treatment strategies. In this article we review the changes in kidney function during normal pregnancy and the differential diagnosis of proteinuria in pregnancy. We summarize different pathophysiological theories of preeclampsia with a special focus on the renal facets of the disease. We describe the current animal models and give a broad overview of different biomarkers that were reported to predict preeclampsia or have a prognostic value in preeclampsia cases. We end with a summary of treatment options for preeclampsia related symptoms including the use of plasmapheresis as a rescue therapy for so far refractory preeclampsia. Most of these novel biomarkers for preeclampsia are not yet implemented in clinical use. Therefore, we recommend using proteinuria (measured by UPC ratio) as a screening parameter for preeclampsia. Delivery is the only curative treatment for preeclampsia. In early preeclampsia the primary therapy goal is to prolong pregnancy until a state were the child has an acceptable chance of survival after delivery.

Keywords: Preeclampsia, Pregnancy, Proteinuria, Biomarkers, Treatment

Core tip: This review summarises different pathophysiological theories of preeclampsia with a special focus on the renal facets of the disease. In this context current animal models are presented. The reader gets a broad overview about different biomarkers for preeclampsia. Furthermore, the article discusses treatment options for preeclampsia related symptoms including the use of plasmapheresis as a rescue therapy for so far refractory preeclampsia.