Some aspects of renal function in toxaemia of pregnancy. As seen in Kenyatta National Hospital and Pumwani maternity Hospital, Nairobi
Abstract
Over a period of seven months, 77 patients wi th preeclampsia
(toxaemia of pregnancy) and 47 women having
normal pregnancy were studied and compared. It was found
that pre-eclampsia was a condition of the young
primigravida (mean age 24.6 ± 0.45 years) and occurred
generally during the last few weeks of gestation (median
gestational age 36 weeks)
The mean systolic blood pressure was significantly higher
among pre-eclamptics (153.81 ± 1.22 mmHg) compared to
that of the controls (111:67 ± 1.24 rnrnHg)P s 001.
Significantly higher diastolic blood pressures were also
noted in pre-eclamptics (mean 101.07 ± 0.79 mmHg)
compared to controls (mean 70.83 ± 0.98 mmHg), P ~001.
Most of the cases had oedema of varying severity. Only
three controls had mild oedema probably due to partial
obstruction of the venous return by the gravid uterus.
All the cases had mi ld to severe proteinuria but no
proteinuria was noted in the controls.
Serum sodium levels tended to be lower (mean 132.5 ±0.3
mmol/l) in the pre-eclamptic as compared to that of the
controls (mean 135.7 ± 0.65 mmHg), P -<001.
Serum potassium levels were within normal limits though
generally higher in the pre-eclamptic patients (mean 4.48
± 0.108 mmol/l) compared to control level (mean of 3.96
± 0.059 mmol/l).
Blood urea nitrogen in pre-eclampsia ranged between 1.2
and 21.9 mrnol /litre with a median of 5.05 mrnol/l while
that for the controls ranged between 1.0 and 2.9 mmol/l
with median value of 1.7 mmol/l. The corresponding
clearances had a mean of 47.21 mls/min with SEM of 2.231
and 74.287 ml s/min with a SEM of 4.446 for the preeclampsia
and controls respectively, (P <-001).
Serum creatinine in the pre-eclamptic patients ranged
from 60 to 206 micromolll with median value of 88
micromol/l and that of controls ranged between 50 and
127 micromol/l with a median value of 78 micromoi/i. p
<- 001. Creatinine clearance for pre-eclamptics ranged
between 40.5 and 133.8 mls/min and that of the controls
between 67.0 and 164.6 mIs/min.
The mean creatinine clearances for pre-eclamptic patients
and controls were 82.521 mls/min with SEN of 2.461 and
104.03 mllmin with SEM of 3.69 respectively, P < 001.
Serum uric acid for pre-eclamptics ranged from 70. to
1500 micromol/L with mean of 768.67 micromol/L while that
of the controls ranged from 51 to 598 with a mean of
243.43 micromol/L. The corresponding median uric acid
clearances for pre-eclamptics was 4.081 ml/min and that
of the controls was 9.313 ml/min, (P <- 001).
Urine osmolality for the pre-eclamptic patients ranged
from 100. to 840 mosmol/kg with a median of 330 mosmol/kg
while that of controls ranged between 120 to 840 rnosrnl/kg
with a median of 385 mosml/kg. There was no significant
difference noted between the two groups.
Associations between blood pressure, parity, age and
renal functions were investigated but there was no
significant correlation in both cases and controls except
for that of age and urea clearance which tended to show
that the older the subject the better the urea clearance.'
The study seemed to suggest that pre-eclampsia does
impair the glomerular function of the kidney to an
extent, however, no significant impairment as far as the
concentration aspect of the kidney was concerned.
Citation
Degree of Master of Medicine in Internal MedicinePublisher
University of Nairobi Department of Medicine, College of Health Sciences
Description
A thesis submitted in partial fuIfillment for the degree of
Master of Medicine in Internal Medicine of the University of
Nairobi 1989.