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Preeclampsia: a gestational cardiorenal syndrome.

Gyselaers, W; Thilaganathan, B (2019) Preeclampsia: a gestational cardiorenal syndrome. J Physiol, 597 (18). pp. 4695-4714. ISSN 1469-7793 https://doi.org/10.1113/JP274893
SGUL Authors: Thilaganathan, Baskaran

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Abstract

It is generally accepted today that there are two different types of preeclampsia: an early-onset or placental type and a late-onset or maternal type. In the latent phase, the first one presents with a low output/high resistance circulation eventually leading in the late second or early third trimester to an intense and acutely aggravating systemic disorder with an important impact on maternal and neonatal mortality and morbidity; the other type presents initially as a high volume/low resistance circulation, gradually evolving to a state of circulatory decompensation usually in the later stages of pregnancy, with a less severe impact on maternal and neonatal outcome. For both processes, numerous dysfunctions of the heart, kidneys, arteries, veins and interconnecting systems are reported, most of them presenting earlier and more severely in early- than in late-onset preeclampsia; however, some very specific dysfunctions exist for either type. Experimental, clinical and epidemiological observations before, during and after pregnancy are consistent with gestation-induced worsening of subclinical pre-existing chronic cardiovascular dysfunction in early-onset preeclampsia, and thus sharing the pathophysiology of cardiorenal syndrome type II, and with acute volume overload decompensation of the maternal circulation in late-onset preeclampsia, thus sharing the pathophysiology of cardiorenal syndrome type 1. Cardiorenal syndrome type V is consistent with the process of preeclampsia superimposed upon clinical cardiovascular and/or renal disease, alone or as part of a systemic disorder. This review focuses on the specific differences in haemodynamic dysfunctions between the two types of preeclampsia, with special emphasis on the interorgan interactions between heart and kidneys, introducing the theoretical concept that the pathophysiological processes of preeclampsia can be regarded as the gestational manifestations of cardiorenal syndromes.

Item Type: Article
Additional Information: This is the peer reviewed version of the following article: Gyselaers, W. and Thilaganathan, B. (2019), Preeclampsia: a gestational cardiorenal syndrome. J Physiol, 597: 4695-4714, which has been published in final form at https://doi.org/10.1113/JP274893. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
Keywords: cardiorenal syndrome, early onset preeclampsia, late onset preeclampsia, maternal hemodynamics, preeclampsia, Cardio-Renal Syndrome, Female, Gestational Age, Hemodynamics, Humans, Placenta, Pre-Eclampsia, Pregnancy, Pregnancy Trimester, Third, Placenta, Humans, Pre-Eclampsia, Gestational Age, Pregnancy, Pregnancy Trimester, Third, Female, Hemodynamics, Cardio-Renal Syndrome, Preeclampsia, Cardiorenal syndrome, Early onset preeclampsia, Late onset preeclampsia, Maternal hemodynamics, 06 Biological Sciences, 11 Medical and Health Sciences, Physiology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: J Physiol
ISSN: 1469-7793
Language: eng
Dates:
DateEvent
12 September 2019Published
14 August 2019Published Online
13 June 2019Accepted
Publisher License: Publisher's own licence
PubMed ID: 31343740
Web of Science ID: WOS:000481096000001
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/113623
Publisher's version: https://doi.org/10.1113/JP274893

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