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Difficulty of predicting early-onset super-imposed preeclampsia in pregnant women with hemodialysis due to diabetic nephropathy by serum levels of sFlt-1, PlGF, and sEng

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Abstract

There are few case reports in which circulating levels of soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF), and soluble endoglin (sEng) were measured before the onset of super-imposed preeclampsia in women with hemodialysis. A 40-year-old Japanese nulliparous women with hemodialysis due to diabetic nephropathy became pregnant by frozen embryo transfer. Intensive hemodialysis was started at 5 weeks of gestation. Her blood pressure (BP) in the first trimester was around 130/80 mmHg. At 20+3 weeks, she was admitted for close monitoring; her BP was 137/75 mmHg. Her BP increased to 157/88 mmHg at 31+2 weeks, and nifedipine at 20 mg/day was started at 31+6 weeks. However, the serial longitudinal measurements of sFlt-1, PlGF, and sEng did not predict the onset of super-imposed preeclampsia. Cesarean section was performed at 33+6 weeks due to uncontrollable hypertension. A healthy female infant weighing 2138 g was delivered. As for the changes of biomarkers between just before and just after hemodialysis, sFlt-1 was significantly higher just after compared with just before hemodialysis (5774 ± 1875 pg/mL vs. 2960 ± 905 pg/mL, respectively, p < 0.001). PlGF was also significantly higher just after compared with just before hemodialysis (2227 ± 1038 pg/mL vs. 1377 ± 614 pg/mL, respectively, p < 0.001). However, the sFlt-1/PlGF ratio and sEng levels were not significantly different between just before and just after hemodialysis (p = 0.115, p = 0.672, respectively). In conclusion, prediction of early-onset super-imposed preeclampsia using angiogenic and anti-angiogenic markers in pregnant women with hemodialysis might be difficult.

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Acknowledgements

This work was supported by Grants-in-Aid (24592482 and 17K11247 to A.O.) from the Ministry of Education, Culture, Sports, Science and Technology, Japan.

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  1. Hiroyuki Morisawa and Chikako Hirashima contributed equally to this work.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan

    Hiroyuki Morisawa, Chikako Hirashima, Miho Sano, Shiho Nagayama, Hironori Takahashi & Akihide Ohkuchi

  2. Department of Animal Science, Tokyo University of Agriculture, 1737 Funako, Atsugi-shi, Kanagawa, 243-0034, Japan

    Koumei Shirasuna

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  1. Hiroyuki Morisawa
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  2. Chikako Hirashima
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Correspondence to Akihide Ohkuchi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This is a research involving a human being. All procedures performed in this study were in accordance with the ethical standards of the institutional research committee at which the studies were conducted (IRB approval number: Dai-I-17-Hen-29-Gou) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Morisawa, H., Hirashima, C., Sano, M. et al. Difficulty of predicting early-onset super-imposed preeclampsia in pregnant women with hemodialysis due to diabetic nephropathy by serum levels of sFlt-1, PlGF, and sEng. CEN Case Rep 9, 101–105 (2020). https://doi.org/10.1007/s13730-019-00435-y

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