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Nephropathy following pre-eclampsia — Clinical Guidelines

Overview

Nephropathy following pre-eclampsia refers to kidney damage that can occur as a consequence of this pregnancy complication. Preeclampsia is characterized by new-onset hypertension and proteinuria or end-organ dysfunction after 20 weeks of gestation.

Diagnosis

Elevated circulating neutrophil gelatinase-associated lipocalin (NGAL) is associated with preeclampsia 2.

Elevated circulating pentraxin-3 (PTX-3) is observed in women with preeclampsia compared to normal pregnancies and may be present before clinical onset 4.

The sFlt-1/PlGF ratio demonstrates good predictive performance for preeclampsia 1.

Management

Oral antioxidant therapies have shown beneficial effects in preeclampsia prevention 3.

Antioxidant therapy may have a positive impact on intrauterine growth restriction during preeclampsia treatment 3.

Special Populations

Pregnancy: Preeclampsia is a condition specific to pregnancy 1 2 3 4. Biomarkers like sFlt-1, PlGF, NGAL, and PTX-3 are studied in pregnant women for prediction and association with preeclampsia 1 2 4. Antioxidant therapies are evaluated for prevention and treatment in pregnancy 3.

Key Recommendations

The sFlt-1/PlGF ratio shows good predictive performance for preeclampsia 1. (Evidence: Strong)

Oral antioxidant therapies have demonstrated beneficial effects in the prevention of preeclampsia 3. (Evidence: Strong)

Circulating NGAL levels are significantly higher in women with preeclampsia compared to controls 2. (Evidence: Moderate)

Circulating PTX-3 levels are significantly higher in women with preeclampsia compared to normal pregnancies 4. (Evidence: Moderate)

References

1 Zhang L, Li W, Chi X, Sun Q, Li Y, Xing W et al.. Predictive performance of sFlt-1, PlGF and the sFlt-1/PlGF ratio for preeclampsia: A systematic review and meta-analysis. Journal of gynecology obstetrics and human reproduction 2025. link 2 Wei Y, Li L, Wang F, Fu L, Li Z, Hu Y. Circulating neutrophil gelatinase-associated lipocalin and preeclampsia: a meta-analysis. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2023. link 3 Alves PRMM, Fragoso MBT, Tenório MCS, Bueno NB, Goulart MOF, Oliveira ACM. The role played by oral antioxidant therapies in preventing and treating preeclampsia: An updated meta-analysis. Nutrition, metabolism, and cardiovascular diseases : NMCD 2023. link 4 Liu Y, Li P. Circulating pentraxin-3 and preeclampsia: a meta-analysis of 17 case-control studies. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2021. link

Nephropathy following pre-eclampsia