Angiogenic and antiangiogenic factors in pregnant women with chronic kidney disease: the role of sflt-1/plgf ratio in the prediction and diagnosis of preeclampsia

Aim: to compare the levels of angiogenic and antiangiogenic factors in different periods of pregnancy complicated or not complicated by PE, in patients with CKD and assess the significance of sFlt-1/PlGF ratio in the prediction and diagnosis of PE in women with kidney disease. Methods: in 130 pregnant women with CKD at different stages, the gestation serum levels of sFlt-1 and PlGF have been determined, and the sFlt-1/PlGF ratio was calculated and compared in patients with and without PE. To determine the prognostic value of the sFlt-1/PlGF ratio, the ROC-curves were plotted and the quality of prognosis was assessed. Results: in CKD patients who develop PE compared with women without PE, the median PlGF in the second trimester of pregnancy were significantly lower - 134 (7-2113) pg/ml vs 317 (59-2203) pg/ml, p=0.001, and the median sFlt-1/PlGF ratio was significantly higher: 9.87 (1.86-701) vs 4,57 (0.69-19.2), p=0.001. sFlt-1/PlGF ratio was substantial increased in the second trimester in women with early (before 34 weeks gestation) PE compared to patients without PE: 30.1 (2.37-701) vs 4.66 (0.79-17.1), p=0.00009. In patients with PE an upward trend in sFlt-1/PlGF ratio was observed 5 weeks before delivery, while 3 weeks before delivery it was significantly higher than the that for uncomplicated pregnancy. An increased risk of PE was observed in the individual values of the sFlt-1/PlGF ratio above 6.3 in the second trimester of pregnancy, and PE developed in all pregnant women with the ratio above 20.7. Conclusions: an assess of the sFlt-1/PlGF ratio is a powerful method of prediction and early diagnosis of PE in pregnant patients with CKD.

беременность, хроническая болезнь почек, преэклампсия, ангиогенные факторы, растворимая fms-подобная тирозинкиназа 1, плацентарный фактор роста, chronic kidney disease, preeclampsia, angiogenic markers, sFlt-1, PlGF

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