66 Renal long-term follow up after pregnancy and risk of chronic kidney disease

Introduction Glomerular filtration rate (GFR) increases during pregnancy and some incipient nephropathies may appear after this period, especially when gestational hypertension (GH) is present. Objectives Renal evaluation in women over 10 years after pregnancy. Methods Total of 30 volunteer patients whose last childbirth was 10–20 years ago. Renal parameters assessed were: urinary excretion of retinol-binding protein (RBP), urine protein/creatinine ratio (PCR), Urine albumin/creatinine ratio (ACR), serum creatinine, serum C cystatin, vitamin D (25OHD), serum uric acid, vascular endothelial growth factor (VEGF), estimated GFR (eGFR) based on Modification of Diet in Renal Disease (MDRD) Study and the Chronic Kidney Disease Epidemiology Collaboration equation – CKD-EPI Creatinine, 2009 (CKD-EPI crea), CKD-EPI Cystatin C, 2012 (CKD-EPI cys) and CKD-EPI Creatinine-Cystatin C, 2012 (CKD-EPI crea-cys) equations. Results The average age was 45.5 years old, 56.6% were afro descendant, and mean time after last labor was 13.7 years. Approximately 6.6% had type 2 diabetes and 30.3% had chronic hypertension (CH) after pregnancy (among them 90% had GH). Mean body mass index (BMI) was 29.1 kg/m 2 (overweight), although all patients with CAH were obese. Mean value of cystatin C was 1.45 mg/L (elevated in 20%), RBP 0.30 mg/L (high level in only one case), PCR 0.02 g/g, ACR 6.91 mg/g creatinine (high level in only one case), 25OHD 24.34 ng/mL (deficiency in 33.3%), serum uric acid 4.50 mg/dL (high level in only one case), serum creatinine 0.73 mg/dL (normal level in all cases), VEGF 312.04 pg/mL (high level in two cases). Mean clearance of creatinine using MDRD was 93.5 mL/min/1.73 m 2 , CKD-EPI crea 101.7 mL/min/1.73 m 2 , CKD-EPI cys 49.0 mL/min/1.73 m 2 and CKD-EPI crea-cys 68.3 mL/min/1.73 m 2 (about 30% less when compared with the equations without cystatin C, then 26.6% had eGFR  2 ). None of the patients had ever been assisted by a nephrologist. Conclusions Obesity, CH, 25OHD deficiency, high levels of serum cystatin C and low eGFR may appear years after pregnancy, especially if GH was present. Women who had GH should have long-term follow up with nephrologist to have a more complete and regular renal evaluation. The eGFR by combined creatinine-cystatin C equation seems to be better than other formulas and it could be useful to detect early chronic kidney disease. Fapesp n° 2014/00213-7