Urinary IgM excretion: a reliable marker for adverse pregnancy outcomes in women with chronic kidney disease

• Published in: Journal of nephrology 2019-04, Vol.32 (2), p.241-251
• Main Authors: Leaños-Miranda, Alfredo, Campos-Galicia, Inova, Ramírez-Valenzuela, Karla Leticia, Berumen-Lechuga, María Guadalupe, Isordia-Salas, Irma, Molina-Pérez, Carlos José
• Format: Article
• Language: English
• Subjects: Adult; Biomarkers - urine; Birth Weight; Case-Control Studies; Female; Gestational Age; Humans; Immunoenzyme Techniques; Immunoglobulin M - urine; Infant, Newborn; Infant, Premature; Infant, Small for Gestational Age; Medicine; Medicine & Public Health; Nephrology; Obstetric Nephrology; Original; Original Article; Pre-Eclampsia - etiology; Predictive Value of Tests; Pregnancy; Pregnancy Complications - etiology; Pregnancy Outcome; Premature Birth - etiology; Proteinuria - diagnosis; Proteinuria - etiology; Proteinuria - urine; Renal Elimination; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - urine; Risk Assessment; Risk Factors; Urinalysis; Urology; Young Adult
• ISSN: 1121-8428; 1724-6059
• DOI: 10.1007/s40620-018-0536-9

Objective Chronic kidney disease (CKD) pregnancies are at high risk of developing adverse outcomes. In non-pregnant subjects with CKD, higher urinary IgM levels are associated with poor renal survival and higher rates of cardiovascular deaths. In this study, we assessed whether urinary IgM levels are associated with an increased risk of adverse pregnancy outcomes (APO) in CKD pregnancies. Methods We performed a nested case–control study within a cohort of CKD patients with singleton pregnancies attended at a tertiary care hospital. The study included 90 CKD patients who eventually developed one or more APO and 77 CKD patients who did not. Urinary IgM excretion was determined from the 24-h urine samples at enrollment by an ultrasensitive enzyme immunoassay. Results The risk for combined APO and for preeclampsia (PE) was higher among women with urinary IgM and proteinuria levels values in the highest quartile or with CKD stages 4–5 (odds ratios, OR ≥ 2.9), compared with the lowest quartile or with CKD stage 1. Urinary IgM levels were more closely associated with the risk of either combined or specific APO (PE, preterm birth, and for having a small-for-gestational-age infant; OR ≥ 5.9) than either the degree of total proteinuria or CKD stages. Among patients with CKD stage 1, the risk of combined APO, PE, and preterm birth was higher in women with urinary IgM levels values in the highest quartile (OR ≥ 4.8), compared with the three lower quartiles, independently of proteinuria. Conclusion In CKD pregnancies, at the time of initial evaluation, proteinuria and CKD stage are associated with increased risk of combined APO. However, urinary IgM concentrations appear to be better predictors of an adverse outcome and may be useful for risk stratification in CKD pregnancies.