Pre-eclampsia y riesgo de enfermedad renal tardía

Pre-eclampsia and risk of later kidney disease: nationwide cohort study | The BMJ

Este es un estudio para leer y recordar


https://www.bmj.com/content/365/bmj.l1516

ABSTRACT

Objective To investigate associations between pre-eclampsia and later risk of kidney disease.

Design Nationwide register based cohort study.

Setting Denmark.

Population All women with at least one pregnancy lasting at least 20 weeks between 1978 and 2015.

Main outcome measure Hazard ratios comparing rates of kidney disease between women with and without a history of pre-eclampsia, stratified by gestational age at delivery and estimated using Cox regression.

Results The cohort consisted of 1 072 330 women followed for 19 994 470 person years (average 18.6 years/woman). Compared with women with no previous pre-eclampsia, those with a history of pre-eclampsia were more likely to develop chronic renal conditions: hazard ratio 3.93 (95% confidence interval 2.90 to 5.33, for early preterm pre-eclampsia (delivery <34 weeks); 2.81 (2.13 to 3.71) for late preterm pre-eclampsia (delivery 34-36 weeks); 2.27 (2.02 to 2.55) for term pre-eclampsia (delivery ≥37 weeks). In particular, strong associations were observed for chronic kidney disease, hypertensive kidney disease, and glomerular/proteinuric disease. Adjustment for cardiovascular disease and hypertension only partially attenuated the observed associations. Stratifying the analyses on time since pregnancy showed that associations between pre-eclampsia and chronic kidney disease and glomerular/proteinuric disease were much stronger within five years of the latest pregnancy (hazard ratio 6.11 (3.84 to 9.72) and 4.77 (3.88 to 5.86), respectively) than five years or longer after the latest pregnancy (2.06 (1.69 to 2.50) and 1.50 (1.19 to 1.88). By contrast, associations between pre-eclampsia and acute renal conditions were modest.

Conclusion s Pre-eclampsia, particularly early preterm pre-eclampsia, was strongly associated with several chronic renal disorders later in life. More research is needed to determine which women are most likely to develop kidney disease after pre-eclampsia, what mechanisms underlie the association, and what clinical follow-up and interventions (and in what timeframe post-pregnancy) would be most appropriate and effective.

Factores de riesgo cardiovascular aterosclerótico no tradicionales

En general cuando hablamos de los FRCVA (riesgo cardiovascular ateriosclerótico) en el adulto mayor ponemos atención especialmente a cuatro FRCV mayores para ECV, los cuales son hipertension arterial, dislipidemia y tabaquismo, sin embargo es muy importante en la actualidad tomar en cuenta otros FRCVA no tradicionales los cuales son:

–      Edad

–      Enfermedad renal crónica

–      Gripe/ Neumonía/ Otras infecciones

–      Enfermedad periodontal

–      Los pacientes que sobreviven al cáncer después de un tratamiento con quimioterapia o radioterapia

–      Artitis reumatoidea, espondilitis anquilosante y psoriasis precoz grave

–      Síndrome de apnea obstructiva del sueño

–      Disfunción eréctil

–      Complicaciones obstétricas

–      Grupo étnico

–      Contaminación ambiental

Estos usualmente no son tomados en cuenta y son muy importantes al hacer una evaluación integral del paciente y por ello quiero hacer énfasis en los mismos. Ponerles atención y sobre todo orientarse a su prevención, detección y tratamiento.