Hiperemezis gravidarumun maternal böbrek sağlığı üzerine etkisi: Maternal serumda nötrofil jelatinaz ile ilişkili lipokalin düzeylerinin araştırılması

Year 2019, , 848 - 851, 03.12.2019

İlknur Çöl Madendağ , Mefkure Eraslan Şahin , Yusuf Madendağ , Erdem Şahin , Çiğdem Karakükçü

https://doi.org/10.28982/josam.659787

Abstract

Amaç: Hiperemezis gravidarum (HG), hamile kadınların % 0,8-2,0'ında meydana gelen ve böbrek hasarına yol açabilen ciddi bir durumdur. İskemik perfüzyon hasarı birkaç dakika içinde, renal distal tübüler hücreler, nötrofil jelatinaz ile ilişkili lipokalini (NGAL) serbest bırakır. Bu çalışmanın amacı HG başlangıcından sonra maternal serumdaki NGAL seviyelerini ve HG şiddeti ile böbrek iskemisi ve böbrek hasarı arasındaki ilişkiyi değerlendirmektir.

Yöntem: Kontrol grubu benzer demografik özelliklere sahip sağlıklı gönüllülerden oluşturuldu. HG hastaları Pregnancy-Unique Quantification of Emesis Ölçeğine göre hastalık şiddetine göre üç gruba ayrıldı: hafif (≤6); orta (7-12); ve şiddetli (≥13). Demografik parametreler, biyokimyasal parametreler ve serum NGAL düzeyleri gruplar arasında karşılaştırıldı.

Bulgular: Serum glukoz, serum kan üre azotu, serum kreatinin, serum fosfor, aspartat aminotransferaz ve alanin aminotransferaz düzeyleri gruplar arasında benzerdi. Serum sodyum seviyeleri şiddetli HG grubunda diğer tüm HG gruplarına göre anlamlı derecede yüksekti. İdrar ozmolaritesi orta ve şiddetli HG gruplarında kontrol ve hafif HG gruplarına göre anlamlı derecede yüksekti. Gruplar arasında serum NGAL düzeylerinde anlamlı fark yoktu.

Sonuç: Bulgularımız HG ile komplike olan hastalarda serum NGAL seviyelerinin değişmediğini göstermiştir.

Keywords

Neutrophil gelatinase-associated lipocalin, Hyperemesis gravidarum, Dehidrasyon

Effect of hyperemesis gravidarum on maternal renal health: An investigation of the levels of neutrophil gelatinase-associated lipocalin in maternal serum

Abstract

Aim: Hyperemesis gravidarum (HG) is a severe condition that occurs in 0.8–2.0% of pregnant women and can lead to kidney damage. Within minutes of ischemic perfusion injury, renal distal tubular cells release neutrophil gelatinase-associated lipocalin (NGAL). The aim of this study was to assess the levels of NGAL in maternal serum after HG onset and the association between HG severity, renal ischemia, and subsequent kidney damage.

Methods: In this case-control study, the control group comprised healthy volunteers with similar demographic characteristics. The HG patients were divided into three groups according to disease severity based on the Pregnancy-Unique Quantification of Emesis scale as follows: Mild (≤6); moderate (7–12); and severe (≥13). Demographic parameters, biochemical parameters, and serum NGAL levels were compared among the groups.

Results: Serum glucose, serum blood urea nitrogen, serum creatinine, serum phosphorus, aspartate aminotransferase, and alanine aminotransferase levels were similar among the groups. Serum sodium levels were significantly higher in the severe HG group than in all other HG groups. Urine osmolarity was significantly higher in the moderate and severe HG groups than in the control and mild HG groups. There were no differences in serum NGAL levels among the groups.

Conclusion: Our results suggested that serum NGAL levels were not altered in patients complicated by HG.

Keywords

Neutrophil gelatinase-associated lipocalin, Hyperemesis gravidarum, Dehydration

References

• 1. Grooten IJ, Mol BW, van der Post JAM, Ris-Stalpers C, Kok M, Bais JMJ, et al. Early nasogastric tube feeding in optimising treatment for hyperemesis gravidarum: the MOTHER randomised controlled trial (maternal and offspring outcomes after treatment of HyperEmesis by refeeding). BMC Pregnancy Childbirth. 2016;16(1):22.
• 2. Madendag Y, Sahin E, Madendag Col I, Eraslan SM, Tayyar AT, Ozdemir F, et al. The effect of hyperemesis gravidarum on the 75 g oral glucose tolerance test screening and gestational diabetes mellitus. J Matern Fetal Neonatal Med. 2018;31(15):1989–92.
• 3. Practice Bulletin No. 153: Nausea and Vomiting of Pregnancy. Obstet Gynecol. 2015;126(3):e12–e24. https://doi.org/10.1097/AOG.
• 4. Koudijs HM, Savitri AI, Browne JL, Amelia D, Baharuddin M, Grobbee DE, et al. Hyperemesis gravidarum and placental dysfunction disorders. BMC Pregnancy Childbirth. 2016;16(1):374.
• 5. Mullin PM, Ching C, Schoenberg F, MacGibbon K, Romero R, Goodwin TM, et al. Risk factors, treatments, and outcomes associated with prolonged hyperemesis gravidarum. J Matern Fetal Neonatal Med. 2012;25(6):632–6.
• 6. Sahin E, Madendag Y, Eraslan Sahin M, Col Madendag I, Karakukcu C, Acmaz G, et al. Effect of severe hyperemesis gravidarum on maternal vascular endothelial health: evaluation of soluble adhesion molecules. J Matern Fetal Neonatal Med. 2018:1–5.
• 7. Sahin E, Madendag Y, Sahin ME, Tayyar AT, Madendag IC, et al. Maternal type 1collagen N-terminal telopeptide levels in severe hyperemesis gravidarum. BMC Pregnancy and Childbirth. 2018;18(1):502.
• 8. Kjeldsen L, Bainton DF, Sengelov H, Borregaard N. Identification of neutrophil gelatinase-associated lipocalin as a novel matrix protein of specific granules in human neutrophils. Blood 1994;83:799-807.
• 9. Kuwabara T, Mori K, Mukoyama M, Kasahara M, Yokoi H, Saito Y, et al. Urinary neutrophil gelatinase-associated lipocalin levels reflect damage to glomeruli, proximal tubules, and distal nephrons. Kidney Int. 2009;75:285–94.
• 10. Mishra J, Ma Q, Prada A, Mitsnefes M, Zahedi K, Yang J, et al. Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol. 2003;14:2534–43.
• 11. Mishra J, Dent C, Tarabishi R, Mitsnefes MM, Ma Q, Kelly C, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet. 2005;365:1231–8.
• 12. Birkeland E, Stokke G, Tangvik RJ, Torkildsen EA, Boateng J, Wollen AL, et al. Norwegian PUQE (pregnancy-unique quantification of Emesis and nausea) identifies patients with hyperemesis gravidarum and poor nutritional intake: a prospective cohort validation study. PLoS One. 2015;10(4):e0119962.
• 13. Jo SK, Rosner MH, Okusa MD: Pharmacologic treatment of acute kidney injury: why drugs haven’t worked and what is on the horizon. Clin J Am Soc Nephrol. 2007;2:356–65.
• 14. Antonopoulos CN, Kalkanis A, Georgakopoulos G, Sergentanis TN Rigopoulos DN: Neutrophil gelatinase-associated lipocalin in dehydrated patients: a preliminary report. BMC Research Notes. 2011;4:435.
• 15. Çelik T, Altekin E, İşgüder R, Kenesari, Y, Duman M, Arslan N. Evaluation of neutrophil gelatinase-associated lipocalin in pediatric patients with acute rotavirus gastroenteritis and dehydration. Italian J Ped. 2013;39(1):52.
• 16. Bayoglu Tekin Y, Guvendag Guven ES, Mete Ural U, Yazici ZA, Kirbas A, Kir Sahin F. Evaluation of the effects of fasting associated dehydration on maternal NGAL levels and fetal renal artery Doppler parameters. J Matern Fet Neonatal Med. 2016;29(4):629-32.