|Year : 2018 | Volume
| Issue : 2 | Page : 88-90
Liver and kidney function tests in elderly gravidae presenting with preeclampsia
Roopam Panda, Himel Mondal
Department of Physiology, MKCG Medical College, Ganjam, Odisha, India
|Date of Web Publication||8-May-2018|
Department of Physiology, MKCG Medical College, Ganjam, Odisha
Source of Support: None, Conflict of Interest: None
Background: Preeclampsia, a pregnancy-specific syndrome, causes derangement in liver and kidney functions. Increase in maternal age increases the pregnancy-associated complications. Aim: The aim of this study was to compare liver and kidney functions among two groups of pregnant women presenting with preeclampsia: age <35 years and age ≥35 years (i.e., elderly gravidae). Materials and Methods: Pregnant women presenting with preeclampsia in age <35 years comprised the control group and pregnant women in age ≥35 years comprised the study group. Both the groups were tested for serum bilirubin, alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase for assessing liver function and serum urea, creatinine and uric acids for assessing kidney function. The mean value of measured parameters was compared by unpaired t-test with α = 0.05. Results: The mean age in control group (n = 50) was 22.44 ± 3.60 years and in study group (n = 50) was 36.22 ± 2.39 years. Liver function test parameters did not show any statistically significant difference in control and study groups. Urea and uric acid in study group (38.18 ± 7.28 mg/dL and 7.31 ± 0.84 mg/dL, respectively) were significantly higher than control group (32.92 ± 8.91 mg/dL and 6.19 ± 0.96 mg/dL, respectively). Conclusion: Elderly gravidae with preeclampsia showed a higher level of urea and uric acid when compared with women <35 years of age presenting with preeclampsia. Hence, an increase in maternal age in preeclampsia may increase the risk of kidney function deterioration.
Keywords: Creatinine, hypertensive disorder, liver function tests, preeclampsia, pregnancy
|How to cite this article:|
Panda R, Mondal H. Liver and kidney function tests in elderly gravidae presenting with preeclampsia. Adv Hum Biol 2018;8:88-90
| Introduction|| |
Hypertensive disorder in pregnancy increases complication in about 5%–10% of all pregnancies. Preeclampsia is a pregnancy-specific syndrome which can affect multiple organ system of the body. According to the working group classification, it is diagnosed when a pregnant woman presents with high blood pressure (BP) (i.e., BP ≥140/90 mmHg) along with proteinuria (i.e., urinary protein ≥300 mg/24 h or ≥1+ dipstick).,,
Preeclampsia may further be complicated by involvement of liver and kidney to different extents. Although the plasma albumin level remains decreased throughout the normal pregnancy, serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels remain within the normal limits. Hence, measurement of these enzymes can be used to diagnose liver disease during pregnancy. There is an appreciable increase in renal blood flow and glomerular filtration rate in normal pregnancy. However, in preeclampsia, there is a reduction in renal perfusion and glomerular filtration rate. These factors may be responsible for an kidney function derangement.,
Maternal age is increasing in developed and developing countries., It is well established that the elderly gravidae are at increased risk of pregnancy-related health issues.
With this context, the aim of this study was to test the liver and kidney function in elderly gravidae (i.e., age ≥35 years) presenting with preeclampsia and to compare that with liver and kidney functions in pregnant women of age <35 years presenting with preeclampsia.
| Materials and Methods|| |
After obtaining permission from the institutional ethics committee, this cross-sectional study was conducted during the period of 2015–2017 in the Department of Physiology, Department of Biochemistry, and Department of Obstetrics and Gynecology.
Sample and recruitment procedure
For this study, we recruited two groups of pregnant women. Pregnant women presenting with preeclampsia <35 years of age comprised control group and pregnant women presenting with preeclampsia ≥35 years of age comprised study group. We used convenience sampling technique. Recruitment of pregnant women with preeclampsia was done from the Outpatient and Inpatient Department of Obstetrics and Gynecology with predefined inclusion and exclusion criteria. For both control and study groups, the inclusion criteria included age above 18 years, systolic BP ≥140 mmHg and diastolic BP ≥90 mmHg with proteinuria ≥300 mg/24 h or >1+ dipstick,, provided written consent for participation. Exclusion criteria included previous history of hypertension or diabetes mellitus, history of recurrent miscarriage, multiple foetuses, idiopathic thrombocytopenic purpura or other bleeding diathesis, patients on immunosuppressive therapy and any addiction (e.g., alcohol, smoking and drugs).
Age of the participants was recorded in completed years. Gestational age was recorded in weeks. Height was measured by a stadiometer to nearest 0.1 cm. Weight was measured by a weighing scale with 0.1 kg sensitivity. BP was measured with an aneroid sphygmomanometer.
Venous blood was collected from antecubital vein with aseptic precautions. Liver function test parameters (serum bilirubin, AST, ALT and alkaline phosphatase [ALP]) and kidney function test parameters (serum urea, creatinine and uric acid) were tested by a fully auto-clinical chemistry analyser – TBA 120 FR (TOSHIBA Medical systems corporation, Japan). Collected data were preserved for analysis.
Liver function test parameters and kidney function test parameters were entered in Microsoft excel spreadsheet for both control and study groups and expressed in mean and standard deviation. Then, the mean and standard deviation of two groups were compared by unpaired t-test with two tail α = 0.05. Hence, P < 0.05 denotes statistical significance. Statistical analyses were carried out in GraphPad Prism 6.01 for windows (GraphPad Software, Inc., CA, USA).
| Results|| |
Fifty pregnant women <35 years of age with preeclampsia comprised the control group and 50 pregnant women with ≥35 years of age presenting with preeclampsia constituted the study group. Age, gestational age, height, weight, BMI and systolic and diastolic BP of control and study groups are shown in [Table 1]. Liver function test parameters in control and study groups are shown in [Table 2], and kidney function test parameters are shown in [Table 3].
|Table 1: Age, gestational age, height, weight, body mass index and systolic and diastolic blood pressure of control and study groups expressed in mean and standard deviation|
Click here to view
|Table 2: Liver function tests parameters in pregnant women presenting with preeclampsia in control and study groups|
Click here to view
|Table 3: Kidney function test parameters in pregnant women presenting with preeclampsia in control and study groups|
Click here to view
| Discussion|| |
The aim of this study was to compare the liver and kidney function test parameters in pregnant women presenting with preeclampsia in age <35 years and age ≥35 years.
The mean serum bilirubin and ALT in both control and study groups were within normal range [Table 2]. The mean AST and mean ALP level showed increased values in both the groups. Makuyana et al. compared liver function in normal and preeclamptic gestation and found no difference in serum bilirubin and ALT level. They also reported an increased AST and ALP level in preeclamptic gestation. A study by Mishra et al. also showed that preeclampsia is one of the leading causes of abnormal liver function during pregnancy  and that abnormality has an adverse effect on both mother and foetus. In this study, when we compared the liver function test parameters, there was no significant difference in control and study groups. This suggests that increase in maternal age in preeclampsia may not be an additional risk for increased derangement of liver function.
Kidney function test parameters showed normal mean creatinine level in both study and control groups without any difference in mean values between the groups [Table 3]. Serum urea and uric acid level were increased in both the groups and study groups showed significantly increased level. In normal pregnancy, the glomerular filtration rate increases than the normal level and it eventually decreases the level of serum creatinine, urea and uric acid. However, in pregnancy presenting with preeclampsia, there is generalised endothelial dysfunction which causes renal impairment. An increase in serum uric acid in preeclampsia is a well-established fact. Due to decreased glomerular filtration,, the level of serum urea increases in preeclampsia and it has been reported in previous studies., In this study, it was found that urea and uric acid level further increases with advancement of maternal age.
Hence, along with adverse maternal and foetal outcome associated with advanced maternal age, there may be higher abnormality in kidney function in elderly gravidae presenting with preeclampsia.
This study has several limitations. The study period was limited; hence, a small number of elderly gravidae with preeclampsia could be included in the study. Furthermore, the data were collected from a single tertiary care hospital. The samples may not represent the population. Due to logistics limitations, all elderly gravidae presenting with preeclampsia in the outpatient department could not be included in the study. Hence, the results of this study should be interpreted with caution.
| Conclusion|| |
Elderly gravidae, presenting with preeclampsia, showed higher level of urea and uric acid when compared with pregnant women of <35 years of age presenting with preeclampsia. Hence, an increase in maternal age may increase the risk of kidney function deterioration in preeclampsia. Further studies from different institutions with larger sample are required to explore the precise association of maternal age with liver and kidney functions in preeclampsia.
We would like to thank the patients and their family members for their cooperation during data collection. We acknowledge the help of Dr. Tufan Khalua, Department of Obstetrics and Gynecology, Burdwan Medical College and Hospital, West Bengal, for his help during preparation of the manuscript.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Pregnancy hypertension. In: Williams Obstetrics. 23rd
ed. USA: The McGraw-Hill Companies, Inc.; 2010. p. 706-56.
Jeyabalan A. Epidemiology of preeclampsia: Impact of obesity. Nutr Rev 2013;71 Suppl 1:S18-25.
Moser M. Working group report on high blood pressure in pregnancy. J Clin Hypertens 2001;3:75-88.
Mammaro A, Carrara S, Cavaliere A, Ermito S, Dinatale A, Maria E, et al
. Hypertensive disorders of pregnancy. J Prenat Med 2009;3:1-5.
Townsend R, O'Brien P, Khalil A. Current best practice in the management of hypertensive disorders in pregnancy. Integr Blood Press Control 2016;9:79-94.
Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr 2016;27:89-94.
Jeyabalan A, Conrad KP. Renal function during normal pregnancy and preeclampsia. Front Biosci 2007;12:2425-37.
Hussein W, Lafayette RA. Renal function in normal and disordered pregnancy. Curr Opin Nephrol Hypertens 2014;23:46-53.
Kenny LC, Lavender T, McNamee R, O'Neill SM, Mills T, Khashan AS, et al.
Advanced maternal age and adverse pregnancy outcome: Evidence from a large contemporary cohort. PLoS One 2013;8:e56583.
Pawde AA, Kulkarni MP, Unni J. Pregnancy in women aged 35 years and above: A prospective observational study. J Obstet Gynaecol India 2015;65:93-6.
Benli AR, Cetin Benli N, Usta AT, Atakul T, Koroglu M. Effect of maternal age on pregnancy outcome and cesarean delivery rate. J Clin Med Res 2015;7:97-102.
Makuyana D, Mahomed K, Shukusho FD, Majoko F. Liver and kidney function tests in normal and pre-eclamptic gestation – A comparison with non-gestational reference values. Cent Afr J Med 2002;48:55-9.
Mishra N, Mishra VN, Thakur P. Study of abnormal liver function test during pregnancy in a tertiary care hospital in chhattisgarh. J Obstet Gynaecol India 2016;66:129-35.
Dang A, Agarwal N, Bathla S, Sharma N, Balani S. Prevalence of liver disease in pregnancy and its outcome with emphasis on obstetric cholestasis: An Indian scenario. J Obstet Gynaecol India 2010;60:413-8.
Cheung KL, Lafayette RA. Renal physiology of pregnancy. Adv Chronic Kidney Dis 2013;20:209-14.
Conrad KP, Davison JM. The renal circulation in normal pregnancy and preeclampsia: Is there a place for relaxin? Am J Physiol Renal Physiol 2014;306:F1121-35.
Bainbridge SA, Roberts JM. Uric acid as a pathogenic factor in preeclampsia. Placenta 2008;29 Suppl A: S67-72.
Moran P, Lindheimer MD, Davison JM. The renal response to preeclampsia. Semin Nephrol 2004;24:588-95.
Müller-Deile J, Schiffer M. Preeclampsia from a renal point of view: Insides into disease models, biomarkers and therapy. World J Nephrol 2014;3:169-81.
Hassan TJ, Sadaruddin A, Jafarey SN. Serum calcium, urea and uric acid levels in pre-eclampsia. J Pak Med Assoc 1991;41:183-5.
Cleary-Goldman J, Malone FD, Vidaver J, Ball RH, Nyberg DA, Comstock CH, et al.
Impact of maternal age on obstetric outcome. Obstet Gynecol 2005;105:983-90.
[Table 1], [Table 2], [Table 3]