Preeclamptic nephropathy

With the recent discovery of potential serum 'toxins' in human preeclampsia, it is timely to consider how these might relate to preeclamptic nephropathy. This review will discuss the clinical presentation of preeclampsia with an emphasis on renal involvement. It will explore the nature of the renal histological changes including endothelial and the more recently discovered podocyte changes, the implications of elevated anti-angiogenic molecules, anti-angiotensin-1 receptor agonistic antibodies and other proposed mechanisms in causing or exacerbating renal lesions. It will also explore the role of pre-existing renal disease in causing preeclampsia and the potential for new biomarkers, both serum and urinary, to inform clinical practice with regard to differentiating preeclampsia from pre-existing renal disease. Recommendations about the future of women who have had preeclampsia are unclear but the general consensus is that there are future cardiovascular risks, and to a lesser extent, future renal risks in these women. Regular review of proteinuria and glomerular filtration rate as well as overall cardiovascular risk status seems a logical step.