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The Role of Renal Compartment Syndrome in Renal Injury During Preeclampsia
Preeclampsia and other hypertensive disorders of pregnancy impact 2-8% of pregnancies with often devastating results. Current treatment methods resort to birth, which forces the fetus into the world before they are fully developed but can save the mother’s life. Preeclampsia is broadly considered to be of placental origin and current etiologic understanding focuses on systemic endothelial dysfunction triggered by an imbalance of vasoregulatory factors released by this maternal/fetal organ. This imbalance explains many early-term cases but fails to adequately address later cases where this imbalance is not always seen. Conversely, ischemia-reperfusion of the kidney is known to correlate with endothelial dysfunction, and preeclamptic women are known to have a stenosis in their left renal vein (LRV) in the supine position (on their back). Herein, we suggest that extrinsic compression of the LRV by the gravid uterus, without collaterals, produces a renal injury which can induce systemic endothelial cell dysfunction. We theorize this compression is position dependent and produces renal ischemia through an unchecked cycle of increased intrarenal pressure, subsequent afferent arteriole constriction and decreased glomerular perfusion, and activation of the renin-angiotensin-aldosterone system. We aim to elucidate this through murine studies of a surgically induced LRV stenosis and a retrospective clinical study where the maternal renal veins are measured from magnetic resonance images. Findings from this work suggest partial renal venous outflow obstruction leads to renal injury but could be moderated through alternative maternal resting positions. This potential alternative pathologic mechanism has significant clinical implications for future therapies targeting this condition.
- Doctor of Philosophy
- Biomedical Engineering
- West Lafayette