Abstract
Background. Although the pre-eclamptic pathogenesis begins at least around the 18th week of pregnancy, clinically evident disease often does not appear until the third trimester. This long pre-symptomatic latency period has led to intensive research for early markers of evolving disease. We evaluated urine excretion and plasma levels of orosomucoid and albumin longitudinally in healthy and pre-eclamptic pregnancies. Orosomucoid is an acute phase protein involved in inflammation and protection of the endothelium. Methods. From a prospective, longitudinal cohort study consisting of 1,631 women, 32 women developed pre-eclampsia, and 5 controls for every case of pre-eclampsia were found. Blood samples were collected 4 times and urine samples 6 times from the 18/19th week and throughout pregnancy. Orosomucoid and albumin in plasma were analysed by standard methods, and in urine by sandwich ELISA. Results. Orosomucoid/creatinin excretion ratio was significantly higher early in pre-eclamptic pregnancies (from the 20th week of pregnancy, p=0.0053) compared with healthy pregnancies, the difference increased throughout pregnancy. Albumin/creatinin ratio increased subsequent to the increase in orosomucoid. In the plasma samples, orosomucoid was significantly higher late in pre-eclamptic pregnancies (≥36th week, p=0.0275). Conclusions. Pre-eclampsia is associated with a pre-symptomatic increase in the urine excretion of orosomucoid, and orosomucoid excretion precedes that of albumin. Orosomucoid excretion can probably be used as a prognostic tool in combination with other screening methods, and seems to be a more sensitive marker for evolving pre-eclampsia than albumin. Plasma orosomucoid is significantly increased late in pre-eclampsia. Thus, the increased excretion of orosomucoid must primarily originate from altered renal processing of orosomucoid.
| Abbreviations | ||
| BCG | = | bromcresolgreen |
| CRP | = | C reactive protein |
| CV | = | coefficient of variation |
| ELISA | = | enzyme linked immunosorbent assay |
| Eu | = | europium |
| GA | = | gestational age |
| GFR | = | glomerular filtration rate |
| IL | = | interleukin |
| mRNA | = | messenger ribonucleic acid |
| NF-κB | = | nuclear factor kappa B |
| P | = | plasma |
| ROC | = | receiver operating characteristics |
| RPF | = | renal plasma flow |
| S | = | serum |
| U | = | urine |
| Abbreviations | ||
| BCG | = | bromcresolgreen |
| CRP | = | C reactive protein |
| CV | = | coefficient of variation |
| ELISA | = | enzyme linked immunosorbent assay |
| Eu | = | europium |
| GA | = | gestational age |
| GFR | = | glomerular filtration rate |
| IL | = | interleukin |
| mRNA | = | messenger ribonucleic acid |
| NF-κB | = | nuclear factor kappa B |
| P | = | plasma |
| ROC | = | receiver operating characteristics |
| RPF | = | renal plasma flow |
| S | = | serum |
| U | = | urine |