Original Investigation
Pathogenesis and Treatment of Kidney Disease
Kidney Disease After Preeclampsia: A Systematic Review and Meta-analysis

https://doi.org/10.1053/j.ajkd.2009.12.036Get rights and content

Background

Preeclampsia (the development of proteinuria and hypertension after 20 weeks of gestation) is common; however, there is uncertainty about the natural history of subsequent kidney disease. Our objective is to undertake a systematic review and meta-analysis to determine whether women with a history of preeclampsia are at increased risk of subsequent kidney disease.

Study Design

Systematic review and meta-analyses of observational studies.

Setting & Population

Studies examining kidney outcomes in women with a history of preeclampsia compared with women with unaffected pregnancies.

Selection Criteria

From MEDLINE and EMBASE searches, we included case-control and cohort studies of kidney outcomes at least 6 weeks postpartum in women with and without a history of preeclampsia. 2 independent reviewers determined study eligibility, extracted data, and assessed quality.

Study Factor

Preeclampsia.

Outcomes

Microalbuminuria, proteinuria, serum creatinine level, and estimated glomerular filtration rate.

Results

7 cohort studies were included, involving 273 patients with preeclampsia and 333 patients with uncomplicated pregnancies. At a weighted mean of 7.1 years postpartum, 31% of women with a history of preeclampsia had microalbuminuria compared with 7% of women with uncomplicated pregnancies, a 4-fold increased risk, whereas women with severe preeclampsia had an 8-fold increase. Serum creatinine level and estimated glomerular filtration rate were not significantly different at follow-up in women with and without preeclampsia, making it unlikely that they would have been different at baseline.

Limitations

Limitations of this systematic review include potential confounders that were not explored in most or any of the original studies, the small size of many studies, and possible publication bias (lack of negative studies).

Conclusion

Women with a history of preeclampsia have an increased risk of microalbuminuria with a prevalence similar to the published prevalence in patients with type 1 diabetes mellitus. Further research is needed to determine whether the increased risk of microalbuminuria persists after adjustment for a thorough set of confounding factors in larger populations and the mechanisms underlying this association.

Section snippets

Methods

We followed the MOOSE (Meta-analysis of Observational Studies in Epidemiology) consensus statement for reporting of meta-analysis of observational studies.21

Results

As shown in Fig 1, a total of 1,243 nonduplicate titles and abstracts were identified in our searches. Based on our screening process, 116 citations were selected to undergo full-text article review. The most common reasons for exclusion were study design and failure to report kidney outcomes.

Seven studies26, 27, 28, 29, 30, 31, 32 (all cohort) were included, involving 273 patients with preeclampsia and 333 patients with uncomplicated pregnancies at a weighted mean follow-up of 7.1 years

Discussion

In this systematic review and meta-analysis, we determined that after a pregnancy complicated by preeclampsia, approximately 31% of women had microalbuminuria compared with 7% of women with uncomplicated pregnancies. This prevalence of microalbuminuria 7 years after preeclampsia is similar to that found in patients with type 1 diabetes mellitus (28% at 14 years after diagnosis),33 whereas the prevalence after uncomplicated gestations was similar to that reported in the general population in the

Acknowledgements

We gratefully acknowledge the assistance in developing the search strategy by Ms Elizabeth Uleryk, Chief Librarian, Hospital for Sick Children, Toronto, Canada; and our translators, including Angelina Krol, Christian Schlosser, Issei Nakamura, Iman Aouf, Alex Lagunov, and Emilija Makaji.

Support: Drs McDonald and Devereaux are each supported by a Canadian Institutes of Health Research New Investigator Award. Dr Han is supported by a State Scholarship Fund by the China Scholarship Council. Dr

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    Originally published online as doi:10.1053/j.ajkd.2009.12.036 on March 26, 2010.

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