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Ferraro A, Lightstone L, 2018, Postpartum Follow-Up of Antenatally Identified Renal Problems, Renal Disease in Pregnancy, Pages: 101-106, ISBN: 9781107124073
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Lightstone L, 2018, Lupus and Vasculitis in Pregnancy, Renal Disease in Pregnancy, Pages: 157-169, ISBN: 9781107124073
Hall M, Lightstone L, 2018, Prepregnancy Counseling and Risk Assessment, Renal Disease in Pregnancy, Pages: 13-24, ISBN: 9781107124073
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Moroni G, Gatto M, Raffiotta F, et al., 2017, Can we withdraw immunosuppressants in patients with lupus nephritis in remission? An expert debate., Autoimmunity Reviews, Vol: 17, Pages: 11-18, ISSN: 1568-9972
Lupus nephritis (LN) treatment requires an initial intensive period of therapy followed by a long-term maintenance treatment in order to stabilize disease control and eventually reach renal remission. In this section, Authors discuss the feasibility of safely lowering and even suspending maintenance therapy in LN patients having entered remission, highlighting hurdles in predicting the depth and durability of disease quiescence together with the need for minimizing potentially toxic therapies. Even though no firm conclusions can still be drawn, the treating physician has to find the wise balance between disease control and treatment-related drawbacks by following patients closely and recognizing as early as possible the ones who are likely to reach a deep and durable renal remission; there is consensus that is these are the only patients in whom a potential safe complete withdrawal can be foreseen so far.
Lightstone L, Doria A, Wilson H, et al., 2017, Can we manage lupus nephritis without chronic corticosteroids administration?, Autoimmunity Reviews, Vol: 17, Pages: 4-10, ISSN: 1568-9972
The outcome of lupus nephritis (LN) has changed since the introduction of glucocorticoids (GCs), which dramatically reduced the mortality related to one of the most severe complications of systemic lupus erythematosus (SLE). Since the 1950's, other immunosuppressants, including biologic drugs (i.e. rituximab) have aided in maintaining remission, preserving kidney function, but not preventing treatment-related toxicity. GCs still remain the cornerstone in the treatment of SLE, including LN, and they are widely used in clinical practice. However, GC administration represents a double-edged sword. Indeed, from one side they allow a fast and effective control of disease activity by dampening inflammation; from the other side, they have many and severe side effects leading to organ damage. In this paper, we will discuss pros and cons of the chronic use of GCs, especially focusing on LN.
Gordon C, Amissah-Arthur M-B, Gayed M, et al., 2017, The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults., Rheumatology, Vol: 57, Pages: e1-e45, ISSN: 1462-0324
Gordon C, Amissah-Arthur M-B, Gayed M, et al., 2017, The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults: Executive Summary., Rheumatology, Vol: 57, Pages: 14-18, ISSN: 1462-0324
Wilson HR, Lightstone L, 2017, Manifestations of lupus in the kidney and how to manage them., Nephrology Dialysis Transplantation, Vol: 32, Pages: 1614-1616, ISSN: 0931-0509
Wilson HR, Gilmore A, Medjeral-Thomas NR, et al., 2017, The spectrum of complement C9 staining in lupus nephritis, 16th European Meeting on Complement in Human Disease (EMCHD), Publisher: PERGAMON-ELSEVIER SCIENCE LTD, Pages: 179-179, ISSN: 0161-5890
Turner-Stokes T, Wilson HR, Morreale M, et al., 2017, Positive antineutrophil cytoplasmic antibodyserology in patients with lupus nephritis isassociated with distinct histopathologic featureson renal biopsy, Kidney International, Vol: 92, Pages: 1223-1231, ISSN: 1523-1755
Class IV-S lupus nephritis (LN) is often associated with more necrosis and fewer subendothelial immune deposits compared to class IV-G LN, suggestive of the necrotising glomerular inflammation found in ANCA-associated vasculitis. ANCA are present in a significant proportion of patients with LN. The aim of this study was to determine whether ANCA are associated with distinct clinical and histopathological features of LN. 32 ANCA positive biopsies were compared to 222 ANCA negative biopsies from patients with LN. The majority of ANCA positive patients had anti-MPO antibodies (82%). Class IV-S LN and glomerular necrosis were more common (36% vs. 16%, p=0.0253 and 35% vs. 15%, p=0.025 respectively) and isolated Class V LN less common (10% vs. 29%, p=0.0282) in the ANCA positive group. ANCA positive patients had higher dsDNA titres (335u/ml vs. 52u/ml, p=0.00007), lower serum C4 concentration (0.125g/L vs. 0.15g/L, p=0.027) and higher serum creatinine (130µmol/L vs. 84µmol/L, p=0.047) at time of biopsy. Hence ANCA appear to influence the histological pattern of LN and are associated with worse baseline renal function and more active lupus serology. There was no significant difference in outcome between groups when matched for severity of disease and treatment using propensity scoring. Further studies are needed to examine whether ANCA in patients with LN have a pathogenic role and whether they are associated with worse renal outcomes or are simply a marker of more severe disease.
Lightstone L, Hladunewich MA, 2017, Lupus nephritis and pregnancy: concerns and management, Seminars in Nephrology, Vol: 37, Pages: 347-353, ISSN: 0270-9295
Summary: Pregnancy associated with lupus, especially lupus nephritis, is often fraught with concern for both the mother and fetus. Thus, it is paramount that care begins preconception so that proper planning in terms of optimizing the medical regimen, discontinuation of fetotoxic agents, and treatment of active disease can occur. It is well known that active nephritis at the time of conception is associated with poor outcomes. Even with quiescent disease, recent data indicate that being lupus anticoagulant–positive, nonwhite or Hispanic, and using antihypertensive medications were all predictors of worse pregnancy outcomes. Further, prior lupus nephritis also predicts higher rates of preeclampsia and HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome. Differentiating lupus nephritis from preeclampsia often presents as a conundrum, but lupus nephritis can be confirmed by the presence of decreasing complement levels and increasing double-stranded DNA (dsDNA) antibody levels in addition to new onset hypertension and proteinuria. We hope that the more mechanistic approach of measuring angiogenic markers, which are diagnostic for preeclampsia, will be the standard of care in the future. Women with lupus and prior lupus nephritis can have successful pregnancies, but outcomes are dependent on “the art of planning” as well as close communication between the obstetrician, the nephrologist, and the rheumatologist.
Stratigou V, Doyle, Carlucci F, et al., 2017, Altered expression of signalling lymphocyte activation molecule (SLAM) receptors in T cells from lupus nephritis patients - a potential biomarker of disease activity., Rheumatology, Vol: 56, Pages: 1206-1216, ISSN: 1462-0332
Objectives. The aim was to investigate whether the signalling lymphocyte activation molecule (SLAM) signalling pathways contribute to LN and whether SLAM receptors could be valuable biomarkers of disease activity.Methods. Peripheral blood mononuclear cells from 30National Research Ethics Service SLE patients with biopsy-proven LN were analysed by flow cytometry. Clinical measures of disease activity were assessed. The expression of the SLAM family receptors on T-cell subpopulations [CD4, CD8 and double negative (DN) T cells] was measured and compared between lupus patients with active renal disease and those in remission.Results. The frequency of CD8 T cells expressing SLAMF3, SLAMF5 and SLAMF7 was significantly lower in LN patients who were in remission. In contrast, these subsets were similar in patients with active renal disease and in healthy individuals. Patients with active nephritis had an increased percentage of circulating monocytes, consistent with a potential role played by these cells in glomerular inflammation. Changes in the frequency of DN T cells positive for SLAMF2, SLAMF4 and SLAMF7 were observed in lupus patients irrespective of the disease activity. We detected alterations in the cellular expression of the SLAM family receptors, but these changes were less obvious and did not reveal any specific pattern. The percentage of DN T cells expressing SLAMF6 could predict the clinical response to B-cell depletion in patients with LN.Conclusion. Our study demonstrates altered expression of the SLAM family receptors in SLE T lymphocytes. This is consistent with the importance of the SLAM-associated pathways in lupus pathogenesis.
Webster P, Lightstone L, McKay DB, et al., 2017, Pregnancy in chronic kidney disease and kidney transplantation, Kidney International, Vol: 91, Pages: 1047-1056, ISSN: 1523-1755
Chronic kidney disease (CKD) affects up to 6% of women of childbearing age in high income countries, and is estimated to affect 3% of pregnant women. Advanced renal dysfunction, proteinuria, hypertension, and poorly controlled underlying primary renal disease are all significant risks for adverse maternal, fetal, and renal outcomes. In order to achieve the best outcomes, it is therefore of paramount importance that these pregnancies are planned, where possible, to allow the opportunity to counsel women and their partners in advance and to optimize these risks. These pregnancies should be deemed high risk and they require close antenatal monitoring from an expert multidisciplinary team. We discuss the effect of pregnancy on CKD, and also current guidelines and literature with specific reference to transplantation, autoimmune disease, and medication use in pregnancy. We also discuss the benefits of prepregnancy counseling and give practical recommendations to advise pregnant women with renal disease.
Webster P, Nelson-Piercy C, Lightstone L, 2017, A complicated multisystem flare of systemic lupus erythematosus during pregnancy., BMJ Case Reports, Vol: 2017, ISSN: 1757-790X
We report a case of systemic lupus erythematosus (SLE) in a young woman who became pregnant amid a severe flare. She continued to have active disease in the face of aggressive treatments complicated by several side effects of immunosuppressive drugs including recurrent sepsis and gestational diabetes. Her fetus was at risk for congenital heart block during the second and third trimesters. Despite an extremely guarded prognosis, she delivered a healthy baby girl. This case highlights the complexities of SLE management during pregnancy. We discuss the therapeutic options available in pregnancy, and highlight the importance of cross-specialty multidisciplinary care in these women.
Beckwith H, Medjeral-Thomas N, Galliford J, et al., 2017, Mycophenolate mofetil therapy in immunoglobulin A nephropathy: histological changes after treatment, Nephrology Dialysis Transplantation, Vol: 32, Pages: i123-i128, ISSN: 0931-0509
BackgroundEndocapillary hypercellularity independently predicts renal outcome in immunoglobulin A nephropathy (IgAN). Mycophenolate mofetil (MMF) treatment is offered to patients presenting to the Imperial College Renal and Transplant Centre with IgAN and histological evidence of endocapillary hypercellularity. Clinical trials of MMF in IgAN have been inconclusive and have been limited by a lack of specific histological inclusion and exclusion criteria when recruiting patients. Evidence of histological improvement following MMF treatment would support its therapeutic use. We therefore reviewed histological changes after MMF therapy in a cohort of IgAN patients.MethodEighteen IgAN patients with native renal biopsies before and after repeated MMF treatment were identified. Patients were excluded if they had received any other immunosuppressive therapy, including corticosteroids. On the basis of the Oxford Classification of IgAN, we reviewed histological changes after MMF treatment.ResultsNine patients (50%) were male. At diagnostic renal biopsy, the median age was 35 years [interquartile range (IQR) 30–41], serum creatinine was 97 µmol/L (IQR 79–153) and urine protein creatinine ratio (UPCR) was 146 mg/mmol (IQR 98–212). The median time between biopsies was 24 months (range 9–41). Following MMF treatment, repeat biopsy demonstrated statistically significant improvement in the mean percentage of glomeruli showing endocapillary hypercellularity and cellular/fibrocellular crescents. There was no change in mesangial hypercellularity, segmental sclerosis or tubular atrophy scores. Mesangial IgA deposition was also significantly reduced. Histopathological improvement persisted after the cessation of MMF therapy, suggesting that 2 years of treatment is adequate for benefit. The median serum creatinine remained stable at 3 years follow-up at 104 µmol/L (IQR 79–147).ConclusionMMF treatment is associated with histopathological improveme
Webster P, Webster LM, Cook HT, et al., 2016, A multicenter cohort study of histologic findings and long-term outcomes of kidney disease in women who have been pregnant, Clinical Journal of the American Society of Nephrology, Vol: 12, Pages: 408-416, ISSN: 1555-905X
BACKGROUND AND OBJECTIVES: For many women pregnancy is the first contact with health services, thus providing an opportunity to identify renal disease. This study compares causes and long-term renal outcomes of biopsy-proven renal disease identified during pregnancy or within 1 year postpartum, with nonpregnant women. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Native renal biopsies (1997-2012), in women of childbearing age (16 to <50 years), from 21 hospitals were studied. The pregnancy-related diagnosis group included those women with abnormal urinalysis/raised creatinine identified during pregnancy or within 1 year postpartum. Pregnancy-related and control biopsies were matched for age and ethnicity (black versus nonblack). RESULTS: One hundred and seventy-three pregnancy-related biopsies (19 antenatal, 154 postpregnancy) were identified and matched with 1000 controls. FSGS was more common in pregnancy-related biopsies (32.4%) than controls (9.7%) (P<0.001) but there were no differences in Columbia classification. Women with a pregnancy-related diagnosis were younger (32.1 versus 34.2 years; P=0.004) and more likely to be black (26.0% versus 13.3%; P<0.001) than controls, although there were no differences in ethnicities in women with FSGS. The pregnancy-related group (excluding antenatal biopsies) was more likely to have a decline in Chronic Kidney Disease Epidemiology Collaboration eGFR in the follow-up period than the control group (odds ratio, 1.67; 95% confidence interval, 1.03 to 2.71; P=0.04), and this decline appeared to be more rapid (-1.33 versus -0.56 ml/min per 1.73 m(2) per year, respectively; P=0.045). However, there were no differences between groups in those who required RRT or who died. CONCLUSIONS: Pregnancy is an opportunity to detect kidney disease. FSGS is more common in women who have been pregnant than in controls, and disease identified in pregnancy or within 1 year postpartum is more likely to show a subsequent decline in
Miloslaysky E, Naden RP, Bijlsma JW, et al., 2016, Development of a glucocorticoid toxicity index using multi-criteria decision analysis, 2016 ACR/ARHP Annual Meeting, Publisher: Wiley, ISSN: 2326-5205
Miloslavsky EM, Naden RP, Bijlsma JW, et al., 2016, Development of a Glucocorticoid Toxicity Index (GTI) using multicriteria decision analysis, Annals of the Rheumatic Diseases, Vol: 76, Pages: 543-546, ISSN: 1468-2060
OBJECTIVES: To develop a Glucocorticoid Toxicity Index (GTI) to assess glucocorticoid (GC)-related morbidity and GC-sparing ability of other therapies. METHODS: Nineteen experts on GC use and outcome measures from 11 subspecialties participated. Ten experts were from the USA; nine from Canada, Europe or Australia. Group consensus methods and multicriteria decision analysis (MCDA) were used. A Composite GTI and Specific List comprise the overall GTI. The Composite GTI reflects toxicity likely to change during a clinical trial. The Composite GTI toxicities occur commonly, vary with GC exposure, and are weighted and scored. Relative weights for items in the Composite GTI were derived by group consensus and MCDA. The Specific List is designed to capture GC toxicity not included in the Composite GTI. The Composite GTI was evaluated by application to paper cases by the investigators and an external group of 17 subspecialists. RESULTS: Thirty-one toxicity items were included in the Composite GTI and 23 in the Specific List. Composite GTI evaluation showed high inter-rater agreement (investigators κ 0.88, external raters κ 0.90). To assess the degree to which the Composite GTI corresponds to expert clinical judgement, participants ranked 15 cases by clinical judgement in order of highest to lowest GC toxicity. Expert rankings were then compared with case ranking by the Composite GTI, yielding excellent agreement (investigators weighted κ 0.87, external raters weighted κ 0.77). CONCLUSIONS: We describe the development and initial evaluation of a comprehensive instrument for the assessment of GC toxicity.
Anders H-J, Rovin B, Jayne D, et al., 2016, ISN Nexus 2016 Symposia: Translational Immunology in Kidney Disease-The Berlin Roadmap, Kidney International Reports, Vol: 1, Pages: 327-339, ISSN: 2468-0249
To date, the treatment of immune-mediated kidney diseases has only marginally benefited from highly specific biological drugs that have demonstrated remarkable effects in many other diseases. What accounts for this disparity? In April 2016, the International Society of Nephrology held a Nexus meeting on Translational Immunology in Nephrology in Berlin, Germany, to identify and discuss hurdles that block the translational flow of target identification, and preclinical and clinical target validation in the domain of immune-mediated kidney disease. A broad panel of experts including basic scientists, translational researchers, clinical trialists, pharmaceutical industry drug developers, and representatives of the American and European regulatory authorities made recommendations on how to overcome such hurdles at all levels of the translational research process. The results of these discussions are presented here, which may serve as a roadmap for how to optimize the process of developing more innovative and effective drugs for patients with immune-mediated kidney diseases.
Miloslavsky EM, Naden RL, Stone JH, 2016, DEVELOPMENT OF A GLUCOCORTICOID TOXICITY INDEX USING MULTI-CRITERIA DECISION ANALYSIS, ANNALS OF THE RHEUMATIC DISEASES, Vol: 75, Pages: 53-54, ISSN: 0003-4967
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Bramham K, Seed PT, Lightstone L, et al., 2016, Diagnostic and predictive biomarkers for pre-eclampsia in patients with established hypertension and chronic kidney disease, Kidney International, Vol: 89, Pages: 874-885, ISSN: 1523-1755
Women with chronic kidney disease (CKD) and chronic hypertension (CHT) frequently develop superimposed pre-eclampsia, but distinction from pre-existing disease is challenging. Plasma placental growth factor (PlGF), B-type natriuretic peptide (BNP), neutrophil gelatinase-associated lipocalin (NGAL), and serum relaxin concentrations were quantified in a longitudinal prospective cohort of 121 women with CKD: 44 with chronic hypertension, and 79 healthy controls. Biomarker concentrations were compared with 32 women with pre-eclampsia without pre-existing disease. Test performance was evaluated for diagnosis of superimposed pre-eclampsia requiring delivery within 14 days of sampling. PlGF was evaluated as a promising marker in a validation cohort of women with suspected pre-eclampsia (29 with CKD; 94 with chronic hypertension; 29 with superimposed pre-eclampsia requiring delivery within 14 days) and compared with women without pre-existing disease (290 with no pre-eclampsia and 176 with pre-eclampsia requiring delivery within 14 days). From 20 and up to 42 weeks of gestation, lower maternal PlGF concentrations had high diagnostic accuracy for superimposed pre-eclampsia requiring delivery within 14 days (receiver operator characteristic 0.85) and confirmed in the validation cohort. The other plasma and serum biomarkers were not discriminatory. Thus, plasma PlGF concentrations could potentially help guide clinical decision making regarding admission and delivery for superimposed pre-eclampsia.
Lightstone L, 2015, Kidney disease and pregnancy, Medicine (United Kingdom), Vol: 43, Pages: 550-555, ISSN: 1357-3039
Women with kidney disease should be counselled about the risks pregnancy may pose to mother and fetus before they conceive. Although impaired baseline function and hypertension are associated with worse outcome, all women with renal disease should be advised that they may suffer irreversible kidney damage, may well need to change their medications in advance of pregnancy and face a higher risk of pre-eclampsia with its attendant risks to the fetus. They need to consider the implications of having a premature baby. Compared with the probability that pregnancy will exacerbate existing kidney disease, pregnancy-induced kidney disease in women with previously normal renal function is less common and kidney failure rare. The commonest causes are those associated with severe pre-eclampsia and are usually managed by early delivery. Proteinuria can persist for months after pre-eclampsia. Women with kidney disease who present in pregnancy should be assessed and a diagnosis made where possible. If their disease is relatively mild, they can be managed expectantly and monitored post partum. Arrangements for appropriate renal follow-up should be made for all women who present in pregnancy, to ensure that a diagnosis is secured and a proper management plan is in place. Women with kidney disease must generally be considered as having high-risk pregnancies; they need to be aware of this and to be managed in a centre with appropriate obstetric and kidney expertise.
Pickering MC, Ismajli M, Condon MB, et al., 2015, Eculizumab as rescue therapy in severe resistant lupus nephritis., Rheumatology, Vol: 54, Pages: 2286-2288, ISSN: 1462-0332
McAdoo SP, Tanna A, Randone O, et al., 2015, Necrotizing and crescentic glomerulonephritis presenting with preserved renal function in patients with underlying multisystem autoimmune disease: a retrospective case series, RHEUMATOLOGY, Vol: 54, Pages: 1025-1032, ISSN: 1462-0324
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Ambrose N, Khan E, Ravindran R, et al., 2015, The exaggerated inflammatory response in behçet's syndrome: Identification of dysfunctional post-transcriptional regulation of the IFN?/CXCL10 (IP-10) pathway, Clinical and Experimental Immunology, Vol: 181, Pages: 427-433, ISSN: 1365-2249
The mechanisms underlying the exaggerated inflammatory response in Behçet's syndrome (BS) remain poorly understood. We investigated the response of CD14+ blood monocytes to interferon (IFN)-γ, focusing on the chemokine CXCL10. Chemokine synthesis and release were analysed at a protein and mRNA level following stimulation with IFN-γ. Findings in BS patients were compared with 25 healthy controls (HC), 15 rheumatoid arthritis (RA) and 15 systemic lupus erythematosus (SLE) disease control patients. BS monocytes produced significantly more CXCL10 protein than HC monocytes from 2 h following IFN-γ stimulation, despite equivalent quantities of mRNA, suggesting more efficient translation. This was significantly more pronounced in BS with high disease activity and in those with ocular and neurological clinical manifestations. The imbalance between CXCL10 protein and mRNA expression was not observed in either RA or SLE patients, and was not seen with other chemokines studied (CXCL9, CXCL11 and CCL2). Furthermore, BS monocytes treated with an alternative stimulant (LPS) did not show abnormal tumour necrosis factor (TNF)-α release. Sucrose density gradients to segregate monocyte CXCL10 mRNA into free RNA or polysome-associated RNA showed equal proportions in BS and HC samples, suggesting that the difference between BS and HC may be due to reduced negative control of CXCL10 translation in BS at a post-initiation level. We conclude that BS monocytes have dysfunctional post-transcriptional regulation of CXCL10 mRNA, resulting in over-expression of CXCL10 protein upon IFN-γ stimulation. As CXCL10 is a chemokine that recruits mononuclear cells, this abnormality may contribute to the exaggerated inflammatory responses that characterizes BS.
Bramham K, Wiles K, Knight M, et al., 2015, PREGNANCY INWOMEN REQUIRING DIALYSIS: A UK NATIONAL PROSPECTIVE COHORT STUDY, 52nd Congress of the European-Renal-Association-European-Dialysis-and-Transplant-Assocation, Publisher: OXFORD UNIV PRESS, ISSN: 0931-0509
Porter A, Condon MB, Doyle AF, et al., 2015, PROSPECTIVE LONG TERM FOLLOW UP OF THE RITUXILUP STEROID SPARING REGIMEN IN LUPUS NEPHRITIS, 52nd Congress of the European-Renal-Association-European-Dialysis-and-Transplant-Assocation, Publisher: OXFORD UNIV PRESS, ISSN: 0931-0509
Wilhelmus S, Bajema IM, Bertsias GK, et al., 2015, Lupus nephritis management guidelines compared, Nephrology Dialysis Transplantation, Vol: 31, Pages: 904-913, ISSN: 1460-2385
In the past years, many (randomized) trials have been performed comparing the treatment strategies for lupus nephritis. In 2012, these data were incorporated in six different guidelines for treating lupus nephritis. These guidelines are European, American and internationally based, with one separate guideline for children. They offer information on different aspects of the management of lupus nephritis including induction and maintenance treatment of the different histological classes, adjunctive treatment, monitoring of the patient, definitions of response and relapse, indications for (repeat) renal biopsy, and additional challenges such as the presence of vascular complications, the pregnant SLE patient, treatment in children and adolescents and considerations about end-stage renal disease and transplantation. In this review, we summarize the guidelines, determine the common ground between them, highlight the differences and discuss recent literature.
Bramham K, Seed P, Nelson-Piercy C, et al., 2015, [42-OR]: Diagnostic accuracy of placental growth factor in women with chronic kidney disease or hypertension and suspected preeclampsia: A prospective cohort study., Pregnancy Hypertens, Vol: 5
OBJECTIVES: Women with chronic kidney disease (CKD) and chronic hypertension (CHT) are at increased risk of superimposed pre-eclampsia (SPE) and associated adverse pregnancy outcomes. Diagnosis of SPE is challenging in women with CKD or CHT as hypertension and proteinuria exist in women without the condition. Placental growth factor (PlGF) is a secondary marker of associated placental dysfunction in pre-eclampsia (PE), with known low plasma concentrations in the disease. The aim of this study was to explore the role in the diagnosis of SPE in women with CKD or CHT. METHODS: Women with CKD or CHT, SPE, PE and low risk controls, were recruited after 20weeks gestation. Plasma concentrations of PlGF were measured with Alere Triage® assay. Proportions of women with low PlGF (<5th Centile) were compared. RESULTS: Samples from 129 women with CKD or CHT, 24 women with PE and 71 healthy controls were analyzed. Area under ROC for low PlGF for the diagnosis of pre-eclampsia and superimposed pre-eclampsia was high. ROC for women with CHT only was 0.89 (SE 0.07) and CKD (with and without CHT) was 0.98 (SE 0.02). There was no correlation between serum creatinine and PlGF (R=0.03, P=0.74). For women with CHT/CKD, PlGF<5th Centile for the diagnosis of SPE had high specificity (85.3%) and negative predictive values (96.7%) but lower sensitivity (75%) and positive predictive value (37.5%). CONCLUSIONS: Low PlGF is the first test to have such high specificity, positive and negative predictive values for SPE in women with CKD and/or CHT, despite the potential contribution of pre-existing endothelial dysfunction. Further exploration of the predictive value of PlGF for adverse pregnancy events in women with CKD and/or CHT and its role in cases of diagnostic uncertainty is required. DISCLOSURES: K. Bramham: None. P. Seed: None. C. Nelson-Piercy: None. L. Lightstone: None. L. Ashford: None. J. Butler: None. L. Poston: None. L. Chappell: None.
Webster P, Wardle A, Bramham K, et al., 2014, Tacrolimus is an effective treatment for lupus nephritis in pregnancy, LUPUS, Vol: 23, Pages: 1192-1196, ISSN: 0961-2033
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